Comparison of Three Techniques of Anterior Cruciate Ligament Reconstruction with Bone-Patellar Tendon-Bone Graft: Differences in Anterior Tibial Translation and Tunnel Enlargement with Each Technique

Otsuka, Hironori; Ishibashi, Yasuyuki; Tsuda, Eiichi; Sasaki, Kazuhiro; Toh, Satoshi

doi:10.1177/03635465030310022101

Cited by 48 publications

(50 citation statements)

References 24 publications

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“…4 MRI image, 2 years after surgery. A cavity-like expansion of the former femoral drill tunnel and screw site is displayed (arrows) postoperative tunnel enlargement was less using anatomic graft fixation close to the joint line than nonanatomic graft fixation [1,4,20,33]. As reasons for bone tunnel enlargement, mechanical and biological and multifactorial reasons have been discussed [11,16,27,34].…”

Section: Discussionmentioning

confidence: 99%

Soft tissue graft interference fit fixation: observations on graft insertion site healing and tunnel remodeling 2 years after ACL reconstruction in sheep

Hunt

Rehm

Weiler

2006

Knee Surg Sports Traumatol Arthrosc

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Using soft tissue grafts for anterior cruciate ligament (ACL) reconstruction, insertion site healing plays a crucial role in the long-term fate of the graft. It has been shown in an experimental animal study that using a soft tissue graft and anatomic graft fixation, a direct ligamentous insertion alike the native ACL developed 24 weeks postoperatively. Yet there are no reports on the long-term insertion site healing of anatomically fixed soft tissue grafts. The objective of this study was to evaluate graft insertion site healing, the intra-tunnel fate of the graft and its osseous replacement 2 years after ACL reconstruction in sheep. The left ACLs of six sheep were replaced by an autologous flexor tendon split graft and anatomically fixed with biodegradable poly-(D, L-lactide) interference screws. Animals received polychromic sequential labeling at different points in time to determine bone apposition per period. For evaluation of the insertion site healing and intra-tunnel changes, MRI scans were taken in vivo. Following sacrifice, radiographic imaging, conventional histology and fluorescence microscopy was undertaken. Most of the specimens showed a wide direct ligamentous insertion. It showed patterns alike the direct ligament insertion seen in intact ACLs. The intra-tunnel part of the graft had completely lost its tendon-like structure and in two cases, it was separated from the graft insertion by a thick bony layer. The biodegradable interference screw was fully degraded in all specimens. Ossification of the former drill tunnels was intense, showing only partial-length tunnel remnants in one femoral and three tibial specimens. As the graft heals to the joint surface and the aperture site is closed with soft tissue, mechanical stress of the intra-tunnel part of the graft is eliminated and the bone tunnel is protected from synovial fluid, resulting in osseous bridging of the tunnel aperture site, accelerated intra-tunnel graft resorption and its osseous replacement.

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Section: Discussionmentioning

confidence: 99%

Soft tissue graft interference fit fixation: observations on graft insertion site healing and tunnel remodeling 2 years after ACL reconstruction in sheep

Hunt

Rehm

Weiler

2006

Knee Surg Sports Traumatol Arthrosc

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“…The tibial tunnel was completed using a coring reamer instead of a drill bit to collect the cored cancellous bone. The part of cored cancellous bone was sutured to the graft substance beside the tibial bone plug to infill the empty space in the tibial tunnel and secure the graft closer to the original ACL attachment [32]. The remaining part of the core bone was grafted into the patellar and tibial defects of the graft donor site [48].…”

Section: Methodsmentioning

confidence: 99%

Comparable Results Between Lateralized Single- and Double-bundle ACL Reconstructions

Tsuda

Ishibashi

Fukuda

et al. 2008

Clin Orthop Relat Res

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“…Webster et al confirmed that bone tunnel widening measurement made only manually with radiographs is acceptable [15]. Otsuka et al suggested one year as the ideal follow-up period to evaluate tunnel widening in ACL reconstruction [16]. Hantes et al [17], Vadala et al [18], Yu et al [19], and Howell et al [20] commented that differences in the aggressiveness and duration of a rehabilitation program can affect these results.…”

Section: Introductionmentioning

confidence: 99%

A new technique in double-bundle anterior cruciate ligament reconstruction using implant-free femoral fixation

Prado

Ntagiopoulos²,

Fucs

et al. 2012

International Orthopaedics (SICOT)

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Purpose The study is a prospective case-series analysis to demonstrate a new double bundle technique for anterior cruciate ligament (ACL) reconstruction with the use of hamstring tendons through a single tibial tunnel, a double femoral socket with implant-free femoral fixation and interference screw for tibial fixation. Materials and methods Twenty-one patients were treated with the same technique. Hamstring tendons were not removed from the tibial side, and using a single tibial and a double femoral tunnel of 8 and 6 mm, respectively, anatomic ACL reconstruction was performed. Graft passage was performed from the tibial side to the posterolateral femoral tunnel and was looped back to the anteromedial femoral tunnel to be fixed on the tibial tunnel with an interference screw and additional extracortical fixation. Follow-up of the study group was performed for a two-year period, documenting standard clinical and radiographic parameters. Results Post-operative follow-up (mean 24 months) revealed radiological widening of tibial tunnel (mean 133.6%) in all patients and minor femoral tunnels widening (119.4% and 117.5%). Clinical evaluation showed no signs of instability, and knee evaluation using the IKDC score was performed. Conclusion The manuscript describes a novel technique in ACL reconstruction, and reports the radiographic results of tunnel widening and clinical scores. Implant-free femoral fixation led to minor tunnel widening similar to previously published data. Further studies need to be performed to compare the long-term results with different published techniques of cost-effective implant-free ACL reconstruction.

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Comparison of Three Techniques of Anterior Cruciate Ligament Reconstruction with Bone-Patellar Tendon-Bone Graft: Differences in Anterior Tibial Translation and Tunnel Enlargement with Each Technique

Abstract: Anatomic fixation of the graft decreased the tunnel enlargement but had no effect on knee stability at 2-year follow-up.

Cited by 48 publications

References 24 publications

Soft tissue graft interference fit fixation: observations on graft insertion site healing and tunnel remodeling 2 years after ACL reconstruction in sheep

Soft tissue graft interference fit fixation: observations on graft insertion site healing and tunnel remodeling 2 years after ACL reconstruction in sheep

Comparable Results Between Lateralized Single- and Double-bundle ACL Reconstructions

A new technique in double-bundle anterior cruciate ligament reconstruction using implant-free femoral fixation

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