Early weight-bearing after anterior cruciate ligament reconstruction with hamstring grafts induce femoral bone tunnel enlargement: a prospective clinical and radiographic study

Abstract

Background Bone tunnel enlargement following primary anterior cruciate ligament (ACL) reconstruction with soft tissue graft might be a severe disadvantage for revision surgery. The postoperative rehabilitation protocol including the non-weight-bearing periods were different depending on the surgeon or institute. To determine the relationship between femoral bone tunnel enlargement and the postoperative non-weight-bearing period after double-bundle ACL reconstruction with hamstring grafts. Methods Forty-two patients who underwent primary double-bundle ACL reconstruction with hamstring grafts were divided into two postoperative non-weight-bearing protocol groups: 1-week non-weight-bearing postoperatively (group A, n = 19); and 2-week non-weight-bearing (group B, n = 18). Five cases were excluded due to additional knee injury, pregnancy, and lost to follow-up. Bone tunnel enlargement was evaluated by computed digital radiographs (anteroposterior (A-P) and lateral views) taken on the first postoperative day and at 12 months. Each tunnel diameter was shown as a percentage to the maximum joint width of the proximal tibia in the A-P view, or a percentage of the maximum diameter of the patella in the lateral view. To determine the incidence of tunnel enlargement, percentage diameter changes of more than 10% were defined as an enlarged tunnel. The magnitude of tunnel enlargement and the standard clinical evaluation were also evaluated. Results There were no significant differences between groups in the incidences of anteromedial and posterolateral bone tunnel enlargement, both in the A-P and lateral views (2 × 2 Chi-squared test). The magnitude of femoral posterolateral bone tunnel enlargement was significantly greater in group A in the A-P view ( p = 0.01) and lateral view ( p = 0.03) (Mann Whitney U-test). Twelve months after surgery, the Lysholm score and Tegner activity level scale were not significantly different between the groups. Conclusions This prospective, clinical and radiographical study showed that early weight-bearing protocol after double-bundle ACL reconstruction with hamstring grafts might have the potential risk of significant postoperative femoral bone tunnel enlargement of the posterolateral bundle. There was no significant difference in clinical outcomes by postoperative non-weight-bearing period. To reduce and prevent the femoral bone tunnel enlargement, the comprehensive management could be considered and required to establish the suitable early stage rehabilitation protocol after surgery. Trial registration Trial registration number; UMIN000036212 . Scientific title: Prospective comparisons of femoral tunnel enlargement with two different postoperative non weight bearing periods after double-bundle anterior c...

A retrospective study to compare the clinical effects of individualized anatomic single- and double-bundle anterior cruciate ligament reconstruction surgery

“…The postoperative International Knee Documentation Committee (IKDC), Lysholm and Tegner scores were significantly improved in both groups compared to the pre-operative status (P < 0. (4)(5)(6)(7)(8)(9) in the DBR group. But there was no significant difference between the two groups (P > 0.05, Table 2).…”

“…However, several studies indicated that the number of bundles did not seem to influence clinical and subjective outcomes 7 , 8 . In addition, the drawbacks of DB reconstruction, such as extended operation time, high cost, increased risk of bone bridge fractures, and challenge in revision surgery, etc., also urge us to reconsider the necessity of this technique 9 .…”

Delayed versus Accelerated Weight-bearing Rehabilitation Protocol Following Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis

“…In total, 911 studies were eligible (Fig. 1), but only 9 studies qualified for inclusion (1,8,(11)(12)(13)(14)(15)(16)(17) (Table I). Due to the considerable variation in rehabilitation protocols across studies, for the purposes of the current study accelerated weight-bearing was defined as full weight-bearing within 2 weeks, and delayed weightbearing was defined as full weight-bearing beyond 2 weeks.…”

Arthroscopic reconstruction of anterior cruciate ligaments with allograft: Single-tunnel double-bundle versus single-tunnel single-bundle

“…However, a DTDB is di cult to perform for surgeons and more traumatic for patients compared to STSB reconstruction. It requires a long operative time, tunnel positioning is prone to error, the risk of lateral femoral condyle and bone bridge fractures is increased, and challenging in revision surgery [8,9]. Taking these factors into account, some surgeons have explored a single-tunnel double-bundle (STDB) reconstruction with the goal of restoring the anatomical double-bundle (DB) structure of the ACL within a single tunnel [10][11][12][13].…”