Combination of anterior tibial and femoral tunnels makes the signal intensity of antero-medial graft higher in double-bundle anterior cruciate ligament reconstruction

Chiba, Daisuke; Yamamoto, Yuji; Kimura, Yuka; Sasaki, Shizuka; Tsuda, Eiichi; Ishibashi, Yasuyuki

doi:10.1007/s00167-020-06014-4

Cited by 9 publications

(7 citation statements)

References 47 publications

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“… 14 , 30 The signal intensity ratio (SIR) was calculated as ( AMB intensity or PLB intensity )/ PCL intensity . The intrarater reliability to determine and calculate the SIR ranged from 0.742 to 0.870, 9 indicating relatively strong agreement.…”

Section: Methodsmentioning

confidence: 96%

Association Between Early Postoperative Graft Signal Intensity and Residual Knee Laxity After Anterior Cruciate Ligament Reconstruction

Chiba

Yamamoto

Kimura

et al. 2022

Orthopaedic Journal of Sports Medicine

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Background: Magnetic resonance imaging (MRI) graft signal intensity is associated with graft damage after anterior cruciate ligament reconstruction (ACLR). However, little is known about the relationship between graft signal intensity and residual laxity of the reconstructed knee based on patient age. Purpose/Hypothesis: To evaluate the relationship between graft signal intensity and residual laxity in younger and older patients who underwent ACLR. We hypothesized that higher graft signal intensity would be associated with reduced postoperative knee stability. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 192 patients who underwent double-bundle ACLR were recruited. Proton density–weighted and T2-weighted MRI was performed at 3, 6, and 12 months after surgery, and the signal intensity ratio (SIR) of the anteromedial and posterolateral bundles was measured as the graft signal intensity reference values. At 12 months after surgery, if the KT-1000 arthrometer measurement exhibited a side-to-side difference of ≥2 mm, the patient was determined as having anterior knee laxity. Rotatory knee laxity was defined as a positive pivot shift with International Knee Documentation Committee grade ≥1. The Mann-Whitney U test was used to compare the SIR in patients with and without residual laxity. The Spearman correlation coefficient was used to evaluate the relationship between demographic parameters and the SIR. Based on receiver operating characteristic curves, the optimal SIR cutoff values to predict residual laxity were calculated, and logistic regression analysis was conducted. Results: Of 192 patients, 26 (13.5%) had anterior knee laxity, and 20 (10.4%) had rotatory knee laxity. The SIR was negatively correlated with age. In younger patients (<30 years; n = 135), those with residual laxity had a significantly higher SIR than those without laxity; this relationship was not significant in older patients (≥30 years; n = 57). Based on receiver operating characteristic curves and logistic regression analysis, the cutoff values that were determined for the SIR were significantly associated with a higher odds ratio of residual laxity. Conclusion: Graft signal intensity decreased with patient age. Patients with higher graft signal intensity in the early postoperative phase after ACLR exhibited a higher prevalence of residual laxity, particularly in younger patients.

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Section: Methodsmentioning

confidence: 96%

Association Between Early Postoperative Graft Signal Intensity and Residual Knee Laxity After Anterior Cruciate Ligament Reconstruction

Chiba

Yamamoto

Kimura

et al. 2022

Orthopaedic Journal of Sports Medicine

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“…This study recruited patients who had received double‐bundle ACLR (DB‐ACLR) from January 2010 to December 2015 in a single center. The current analysis was conducted by the data set which has been published previously [13] to comprehensively evaluate the relationship among the graft tunnel positions, the graft integrity of MRI, and postoperative knee laxity. First, total of 309 patients who underwent DB‐ACLR were recruited.…”

Section: Methodsmentioning

confidence: 99%

Laterally shifted tibial tunnel can be the risk of residual knee laxity for double-bundle anterior cruciate ligament reconstruction

Chiba

Yamamoto

Kimura

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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Purpose To elucidate the relationship between graft tunnel position and knee laxity in the cases of double-bundle ACL reconstruction. Methods Total of 132 cases were included. Femoral and tibial tunnels were evaluated by quadrant method on 3D-CT. As additional reference of tibia, the distances from medial tibial spine to the tunnel center (D MS ) and from Parsons' knob to the tunnel center (D PK ) were evaluated; %D MS /ML and %D PK /AP were calculated (ML and AP: mediolateral and anteroposterior width of tibial plateau). Preoperative and postoperative (1 year from surgery) stabilities were evaluated by Lachman and pivot-shift procedures. If there was ≥ 2 mm side-to-side diference, the subject was deined as having anterior knee laxity (AKL); if the pivot-shift phenomenon was observed with IKDC grade ≥ 1, there was rotatory knee laxity (RKL). Multiple logistic regression analysis was conducted with the prevalence of AKL or RKL as the dependent variable and with tunnel positions as the independent variables. Results Overall, 21 subjects (15.9%) showed AKL, and 15 subjects (11.4%) showed RKL. Those with postoperative laxity showed higher %D MS /ML and higher femoral position than those without laxity. Regarding posterolateral bundle, logistic regression model estimated that %D MS /ML was associated with the prevalence of AKL (B = 0.608; p < 0.001) and RKL (B = 0.789; p < 0.001); %high-low femoral tunnel position (B = − 0.127; p = 0.023) was associated with that of RKL. Conclusion There was the risk of residual knee laxity in ACL-reconstructed knee when tibial tunnel shifted more laterally or higher femoral tunnel was created with regard to posterolateral bundle. Level of evidence III.

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“…10,49,52 The femoral and tibial tunnel positions were evaluated in terms of the quadrant method on the 3D-CT reconstruction image described in previous studies. 6,9,22,46 Measurements of width were obtained at the widest point of each tunnel by drawing a line perpendicular to its longitudinal axis.…”

Section: Three-dimensional Computed Tomography Evaluationmentioning

confidence: 99%

Comparison of the Clinical Outcomes of Revision and Primary ACL Reconstruction: A Matched-Pair Analysis With 3-5 Years of Follow-up

Lin

Wang

et al. 2023

Am J Sports Med

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Background: There are limited studies designed by matching related factors to compare clinical outcomes and return to sport (RTS) between patients undergoing revision anterior cruciate ligament reconstruction (R-ACLR) and primary ACLR (P-ACLR). Purpose: (1) To compare the outcomes between R-ACLR and P-ACLR in a matched-pair analysis with 3- to 5-year follow-up and (2) to evaluate patient-reported factors for not returning to preinjury-level sport. Study Design: Cohort study; Level of evidence, 4. Methods: Patients who underwent R-ACLR between September 2016 and November 2018 were propensity matched by age, sex, body mass index, passive anterior tibial subluxation, and generalized hypermobility in a 1:1 ratio to patients who underwent P-ACLR during the same period. By combining in person follow-up at 2 years postoperatively and telemedicine interview at the final follow-up (January 2022), knee stability and clinical scores were compared, including International Knee Documentation Committee (IKDC), Lysholm, and Tegner. Status of RTS was requested, specifically whether the patient returned to preinjury level of sport. Patient-reported reasons for not returning were analyzed. Results: There were 63 matched pairs in the present study. Knee stability was similar in terms of KT-2000 arthrometer, Lachman test, and pivot-shift test results between the groups at 2 years of follow-up. At the final follow-up, no significant difference was found between groups for postoperative clinical scores (IKDC, Tegner, and Lysholm) ( P > .05). There was a significant difference in total RTS: 53 (84.1%) in the P-ACLR cohort and 41 (65.1%) in the R-ACLR cohort ( P = .014). No significant difference was shown in terms of RTS at the same level: 35 (55.6%) in P-ACLR and 31 (49.2%) in R-ACLR ( P = .476). Significantly more patients showed fear of reinjury: 26 of 32 (81.3%) in the R-ACLR group as compared with 15 of 28 (53.5%) in the P-ACLR group ( P < .021). Conclusion: R-ACLR resulted in similar clinical scores (IKDC, Tegner, and Lysholm) but significantly lower RTS versus P-ACLR at 3 to 5 years of follow-up. Fear of reinjury was the most common factor that caused sport changes in patients with R-ACLR.

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Combination of anterior tibial and femoral tunnels makes the signal intensity of antero-medial graft higher in double-bundle anterior cruciate ligament reconstruction

Cited by 9 publications

References 47 publications

Association Between Early Postoperative Graft Signal Intensity and Residual Knee Laxity After Anterior Cruciate Ligament Reconstruction

Association Between Early Postoperative Graft Signal Intensity and Residual Knee Laxity After Anterior Cruciate Ligament Reconstruction

Laterally shifted tibial tunnel can be the risk of residual knee laxity for double-bundle anterior cruciate ligament reconstruction

Comparison of the Clinical Outcomes of Revision and Primary ACL Reconstruction: A Matched-Pair Analysis With 3-5 Years of Follow-up

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