Does bone impaction technique reduce tunnel enlargement in ACL reconstruction?

Abstract

The aim of this study was to investigate effects of bone impaction technique on tunnel enlargement after ACL reconstruction at a minimum 2 years follow-up. Two groups of patients who had been operated upon with the same arthroscopic technique with the exception of tibial tunnel constitution were compared. Twenty-one patients of group A (drilling to 6 mm followed enlargement to 8-9 mm by using dilators) and 23 patients of group B (directly drilling to the size of the graft) were evaluated clinically and radiographically based on multislice computerised tomography (MSCT) retrospectively. At follow-up, there was no statistical difference between tunnel diameters between two groups at the femoral site, but significant difference at the tibial site (p= 0.00192 for coronal; p=0.0171 for sagittal diameter). Both groups were comparable according pre-and postoperative Lysholm and IKDC scores (p<0.5 Mann-Whitney U test). Compacted tunnel walls may resist enlargement, suggesting this technique resulted in better tunnel diameter values especially with intratunnel fixation.

Tunnel widening prevention with the allo-Achilles tendon graft in anterior cruciate ligament reconstruction

“…Such injuries can loosen the tunnel wall and cause TW or fixation failure. A previous study used a dilator to create more compact bone on the tunnel wall and reported less TW than with reaming alone 19. We also used a bone dilator on the tibial tunnel to prevent TW, and our results also showed a successful reduction in TW.…”

“…These are known to cause TW. To prevent TW and to increase the compactness of the bone around the tunnel, a previous researcher had used a dilator with bone impaction 19. However, bone impaction using a dilator could result in a cortical bone fracture on the articular side.…”

Comparison of tunnel widening between interference screw and suture disc fixation after ACL reconstruction using CT scan

“…We have observed tunnel enlargement in the early postoperative period (2 weeks) probably because we have used extraction drilling. 29,30 A possible solution to this problem may be to drill 1 mm smaller than measured graft diameter and then enlarge to appropriate diameter with a tunnel dilator. 29 Another possible cause for early tunnel enlargement may be the early aggressive, braceless rehabilitation protocol that we have followed.…”

Technique of anatomical single bundle ACL reconstruction with rounded rectangle femoral dilator

“…Therefore, it may be possible to overcome the size constraints of anatomical single bundle ACL reconstruction if we use rounded rectangle ACL reconstruction. In addition, a drill heats the bone [21] , while a dilator does not heat the bone and may prevent tunnel widening by compressing the cancellous bone [22] . However, further investigation is needed to address these issues.…”