Comparisons of femoral tunnel enlargement in 169 patients between single-bundle and anatomic double-bundle anterior cruciate ligament reconstructions with hamstring tendon grafts

Kawaguchi, Yasuyuki; Kondo, Eiji; Kitamura, Nobuto; Kai, Shuken; Inoue, M.; Yasuda, Kazunori

doi:10.1007/s00167-011-1455-7

Cited by 68 publications

(89 citation statements)

References 43 publications

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“…As two different tunnels are used in tibial and femoral sides, they can't be compared with conventional single bundle technique. Kawaguchi found lesser incidence of femoral tunnel enlargement in cases of double bundle ACL reconstruction than single bundle ACL reconstruction [16] . Yoon et al found that on tibial side, between AM and PM bundles, there was significant enlargement of anteromedial bundle which was statistically significant [17] .…”

Section: Discussionmentioning

confidence: 90%

Radiological and clinical evaluation amongst types of tibial tunnel widening and choice of graft fixation implants in ACL reconstruction

Deore¹,

Patil²,

Samant³

et al. 2017

Int. J. Orthop. Sci.

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Objective: To study incidence of tibial tunnel widening and its functional correlation in patients operated with ACL reconstruction with four fold hamstring tendon autograft. To evaluate radiologically and clinically tunnel widening when tibial side of graft is fixed with suture disc or interference screw and to study type of tunnel widening (cavity type, cone type and line type) and its functional correlation. Introduction: Arthroscopic ACL reconstruction is most commonly done ligament reconstruction surgery in orthopaedic with gratifying results. However, it is also associated with complications. Tunnel widening (TW) as one of the complications has been topic of discussion in orthopaedic literature recently. Type of graft fixation in tibia has been considered as cause of tunnel widening. We compared TW in grafts fixed with suture disc and interference screw, evaluated type of tunnel widening in tibia and its correlation in terms of radiology and function. Methodology: A cohort of 30 patients operated with arthroscopic ACL reconstruction were evaluated over a period of three years. Patients were divided between suture disc group and interference screw group for tibial fixation and femoral fixation was kept same in both the groups i.e. suspensory. We assessed amount of tunnel widening in tibia with radiographs and CT scan at 3 months 6 months and 12 months, divided TW into cavity type, cone type and line type. We tried to correlate amount of TW with type of tibial fixation and its functional score. We also tried to correlate type of TW and functional score. Results: Amount of TTW was more with interference screw group than suture disc group at 12 months. Lysholm score was almost equal in both the groups. Type of tunnel widening: cavity type is more common 53 %, followed by cone type 26% and then line type 21 %. TTW was highest i.e. 12.11mm in cavity type, followed by 12.04 in cone type and 11.72 in line type. Functional score was almost similar in all types. Conclusion: Both the groups i.e. suture disc and interference group had considerable tunnel widening but the difference between them is negligible to conclude superiority of on over the other. Functional score is similar in both the groups. Regarding type of tibial tunnel widening, cavity type TTW is most common (53%), followed by cone type (26%) and least common is line type widening (21 %). Maximum tunnel widening is in cavity type and if it's less than 12 mm then functional score is good in those patients. There is no significant correlation between the type of TTW and clinical stability and functional scores. But it has surgical implications as more tunnel widening leaves lesser bone bed for revision ACL reconstruction.

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Section: Discussionmentioning

confidence: 90%

Radiological and clinical evaluation amongst types of tibial tunnel widening and choice of graft fixation implants in ACL reconstruction

Deore¹,

Patil²,

Samant³

et al. 2017

Int. J. Orthop. Sci.

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“…Tunnel enlargement was defined as more than 2.5 mm of the drill bit size, clear enlargement as 2.5-4.5 mm and massive enlargement as more than 4.5 mm, whereas borderline enlargement was defined as 0.5-2 mm 29 . Kawaguchi et al compared femoral tunnel widening between single-bundle and anatomic double-bundle ACL reconstructions with hamstring tendon grafts 19 . The tunnel measurement was taken at the intra-articular outlet of the femoral tunnels in each plane, perpendicular to the direction of the long axis of the tunnels 19 .…”

Section: Radiographsmentioning

confidence: 99%

“…Kawaguchi et al compared femoral tunnel widening between single-bundle and anatomic double-bundle ACL reconstructions with hamstring tendon grafts 19 . The tunnel measurement was taken at the intra-articular outlet of the femoral tunnels in each plane, perpendicular to the direction of the long axis of the tunnels 19 . Surer et al divided the longitudinal axis of the bone tunnel into three equal portions.…”

Section: Radiographsmentioning

confidence: 99%

How to evaluate bone tunnel widening after ACL reconstruction - a critical review

Michael

2017

MLTJ

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SummaryBackground: Comparing different imaging modalities and methods for assessment tunnel widening after ACL reconstruction and providing a detailed evidence-based literature overview. Methods: PubMed was searched from 1970 to 2016 using the terms "ACL reconstruction" and "tunnel" and "imaging" or "CT" or "computerized tomography" or "MRI" or "magnetic resonance imaging" or "radiographs". 647 studies were found. 575 articles were excluded due to absence of specific radiological measurement methods of tunnel widening and 40 due to repetition of a previously published radiological measurement method. 32 articles were included reporting interand intraobserver reliabilities of tunnel measurement methods after ACL reconstruction. Results: A variety of different algorithms and measurement methods using radiographs, magnetic resonance imaging, computed tomography or SPECT/CT evaluating tunnel position and bone tunnel enlargement have been described. Tunnel delination restricts an exact analysis using X-ray. Measurements using CT or MR were mostly obtained perpendicular to the tunnel axis or using specialized software for tunnel volume calculation in 3D. Based on the review the width of the femoral and tibial tunnels should be assessed perpendicular to the tunnel axis at different levels in relation to the joint. At least one measurement should be performed at the tunnel entrance, exit and midpoint of the tunnel. Conclusion: CT should be considered the gold standard assessing tunnel widening in patients after ACL reconstruction. If specialized software is available calculating the tunnel volume, measurements should be preferably performed in 3D CT. Level of evidence: II.

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“…Although the incidence is unknown and variable occurrence has been documented in the literature, bone tunnel widening after anterior cruciate ligament (ACL) reconstruction is well established [1,2,3,4,5,6] . It occurs predominantly during the first six months after surgery and has been documented up to two years postoperatively [1,3,7,8,9,10] .…”

Section: Introductionmentioning

confidence: 99%

“…Some authors report a decrease in tunnel diameter three years after surgery [3] . Although many studies showed no effects of bone tunnel widening on clinical outcomes or objective laxity [3,5,8,9,11,12,13,14] , a few investigations demonstrated that it might be associated with anterior knee laxity and an early sign of graft failure [15,16] . Thus, the clinical significance of bone tunnel widening has not yet been fully established and is still unclear.…”

Section: Introductionmentioning

confidence: 99%

Bone tunnel widening following arthroscopic reconstruction of anterior cruciate ligament (Acl) using hamstring tendon autograft and its functional consequences

Raj¹,

Ram²,

Venkateswaran³

et al. 2018

Int. J. Orthop. Sci.

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Background: To evaluate the correlation between bone tunnel diameter following Anterior cruciate ligament (ACL) reconstruction measured by computed tomography (CT) using multiplanar reconstruction (MPR) and functional outcome. Materials and methods:This study is a prospective study. Fifteen patients (14 men and 1 women, with mean age 30.27 years) who had undergone ACL reconstruction with hamstring tendon auto graft had subsequent CT scan during their follow up (mean follow up is 11.27 months) were included in this study. The diameter of both tunnels (femoral and tibial) were measured using MPR (multiplanar reconstruction) technique. Functional outcome was evaluated with International Knee Documentation Committee grade. Statistical analysis of the correlation between the diameter of the tunnels and IKDC grade were investigated. Results: The tibial and femoral bone tunnels were found to be significantly widened. There was no significant correlation between the diameter of bone tunnels and functional outcome (IKDC grade). Conclusion: Neither the diameter nor its widening during interval follow-up is correlated with functional outcome (IKDC Grade).

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Comparisons of femoral tunnel enlargement in 169 patients between single-bundle and anatomic double-bundle anterior cruciate ligament reconstructions with hamstring tendon grafts

Abstract: Prospective comparative cohort study, Level II.

Cited by 68 publications

References 43 publications

Radiological and clinical evaluation amongst types of tibial tunnel widening and choice of graft fixation implants in ACL reconstruction

Radiological and clinical evaluation amongst types of tibial tunnel widening and choice of graft fixation implants in ACL reconstruction

How to evaluate bone tunnel widening after ACL reconstruction - a critical review

Bone tunnel widening following arthroscopic reconstruction of anterior cruciate ligament (Acl) using hamstring tendon autograft and its functional consequences

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