Eccentric Femoral Tunnel Widening in Anatomic Anterior Cruciate Ligament Reconstruction

Taketomi, Shuji; Inui, Hiroshi; Sanada, Takaki; Yamagami, Ryota; Tanaka, Sakae; Nakagawa, Takumi

doi:10.1016/j.arthro.2014.02.016

Cited by 40 publications

(43 citation statements)

References 41 publications

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“…The first modification was creating one bone tunnel on the femoral side. Previous reports have indicated that one reason for the poor graft-tunnel healing in DB reconstruction is the larger length-change of the PLB graft compared with that of the AMB graft [7,9,14]. In our procedure, the graft excursion still differs between the AMB and PLB; however, because both bundles are fixed together in the bone tunnel with a single Endobutton, there is less excursion of the PLB graft in the femoral bone tunnel.…”

Section: Discussionmentioning

confidence: 81%

Anatomic Oblong Double Bundle Anterior Cruciate Ligament Reconstruction

et al. 2016

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Double-bundle anterior cruciate ligament (ACL) reconstruction using hamstring tendon grafts is a standard procedure for ACL injury. However, its clinical effectiveness is not always satisfactory. One cause of this was problems with the graft-tunnel healing of the posterolateral bundle (PLB) on the femur. To solve this problem, we devised a new anatomic ACL reconstruction technique to improve the graft-tunnel healing of the femoral PLB by using a single-bundle with one bone tunnel on the femoral side and a double-bundle on the tibial side. We have performed 40 procedures with excellent results and no cases of intra- or postoperative complication. This procedure can help improve the graft-tunnel healing around the femoral bone tunnel aperture for the PLB.

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Section: Discussionmentioning

confidence: 81%

Anatomic Oblong Double Bundle Anterior Cruciate Ligament Reconstruction

et al. 2016

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“…The creation of the femoral tunnel, respecting the ACL native footprint, represents the most challenging aspect of ACL reconstruction; in fact, incorrect positioning of the femoral tunnel accounts for the majority of technical failures following ACL reconstruction. [28][29][30][31][32] In addition, the OTT technique spares the bone stock on the femoral side, which assumes importance in cases of revision surgery involving the femoral tunnel. The technique is also inexpensive, requiring only one staple for graft fixation, and it may be useful in cases of revision where the femoral bone stock is severely reduced or in cases of pediatric ACL reconstruction.…”

Section: Discussionmentioning

confidence: 99%

Over-the-Top Anterior Cruciate Ligament Reconstruction Using Single- or Double-Strand Hamstrings Autograft

Ruffilli¹,

Buda²,

Pagliazzi³

et al. 2015

Orthopedics

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The purpose of this study is to (1) report the long-term clinical and radiographic outcomes of a nonanatomical anterior cruciate ligament (ACL) reconstruction using an over-the-top (OTT) femoral route and (2) compare single-strand (1SHG) and double-strand (2SHG) hamstrings graft reconstruction. Fifty-one consecutive patients (mean age, 29.2±3.8 years) underwent nonanatomical ACL reconstruction using OTT femoral passage. Twenty patients underwent 1SHG reconstruction and 31 underwent 2SHG reconstruction. International Knee Documentation Committee (IKDC) score, Knee Injury and Osteoarthritis Outcome Score (KOOS), Tegner score, and KT-1000 (Medmetric Corporation, San Diego, California) evaluation were recorded at a mean follow-up of 12.1±1.6 years. At final follow-up, radiographic evaluation was performed according to the IKDC grading system. Mean IKDC subjective score at follow-up was 76.6±21.9 in the 1SHG group and 88.9±10.0 in the 2SHG (P=.009). Average KOOS was 82.6±18.7 in the 1SHG group and 92.4±9.2 in the 2SHG group (P=.016). Objective IKDC evaluation showed a higher percentage of normal knees in the 2SHG group (P=.018). Pivot shift testing revealed a significantly higher number of normal knees in the 2SHG group (P=.001). Radiographs showed fewer degenerative changes in the 2SHG group at final follow-up in the medial (P=.01) and lateral (P=.037) compartments. Nonanatomical ACL reconstruction using the OTT technique provided satisfactory results in terms of control of both static and dynamic instability at long-term follow-up, thus preventing degenerative joint disease. The 2SHG group showed better subjective and functional outcomes with fewer degenerative changes compared with the 1SHG group at long-term follow-up.

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“…Initial volume acquisition was made with 2-mm cuts from 10 cm above the femoral tunnel to 10 cm below the tibial tunnel. Three-dimensional images were reconstructed using a Virtual Place Lexus workstation (AZE, Tokyo, Japan) [7, 12, 13]. As the joint aperture site of the bone tunnels is reportedly enlarged after ACL reconstruction [12, 13], we evaluated both the femoral and the tibial tunnels at the aperture.…”

Section: Methodsmentioning

confidence: 99%

“…Three-dimensional images were reconstructed using a Virtual Place Lexus workstation (AZE, Tokyo, Japan) [7, 12, 13]. As the joint aperture site of the bone tunnels is reportedly enlarged after ACL reconstruction [12, 13], we evaluated both the femoral and the tibial tunnels at the aperture. The two groups were compared regarding the tunnel enlargement rates of the cross-sectional areas (CSAs) at the apertures of both the femoral and tibial tunnels from 1 week to 1 year postoperatively, and from 1 week to 2 years postoperatively.…”

Section: Methodsmentioning

confidence: 99%

Anatomic single-bundle anterior cruciate ligament reconstruction using a calcium phosphate-hybridized tendon graft: a randomized controlled trial with 2 years of follow-up

et al. 2018

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BackgroundTo improve tendon-to-bone healing in anterior cruciate ligament (ACL) reconstruction, a novel technique via calcium phosphate (CaP)-hybridized tendon graft using an alternate soaking process was developed. The purpose of this study was to evaluate the clinical results of anatomic single-bundle ACL reconstruction using the CaP-hybridized tendon graft with up to 2 years follow-up, and compare the outcome with conventional ACL reconstruction and preoperative data.MethodsNinety patients who required anatomic single-bundle ACL reconstruction were randomized to undergo either the CaP-hybridized tendon graft method (CaP group, n = 45) or the conventional method (conventional group, n = 45). At 1 and 2 years postoperatively, all patients were evaluated using KT-1000 arthrometry, pivot-shift test, International Knee Documentation Committee (IKDC) grade, Lysholm scale, and Tegner scale; at the same timepoints, bone tunnel enlargement was evaluated using computed tomography, and the tendon graft intensity was evaluated on magnetic resonance imaging. Tendon graft appearance was evaluated arthroscopically once after a period of up to 2 years postoperatively. Cases of re-rupture and adverse events were recorded in both groups.ResultsIn both groups, the KT-1000 arthrometry, pivot-shift test, IKDC grade, and Lysholm scale results at 1 and 2 years postoperatively were superior to preoperative data; these results did not significantly differ between groups at either timepoint. The rate of increase of the cross-sectional area of the femoral bone tunnel in the CaP group was smaller than that in the conventional group at 1 year postoperatively. The other results did not significantly differ between the two groups at any timepoint. There were two cases of re-rupture in the CaP group, and six cases of re-rupture in the conventional group. There were no adverse events during follow-up in either group.ConclusionsAnatomic single-bundle ACL reconstruction using a CaP-hybridized tendon graft was safe, and resulted in improved clinical outcomes at 2 years postoperatively compared with preoperative data; the outcomes were comparable with the conventional method. A longer follow-up is needed to clarify the clinical effects of the CaP-hybridized tendon graft in anatomic single-bundle ACL reconstruction.Trial registrationUMIN, UMIN000019788 Registered 14 November 2015—Retrospectively registered.

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Eccentric Femoral Tunnel Widening in Anatomic Anterior Cruciate Ligament Reconstruction

Cited by 40 publications

References 41 publications

Anatomic Oblong Double Bundle Anterior Cruciate Ligament Reconstruction

Anatomic Oblong Double Bundle Anterior Cruciate Ligament Reconstruction

Over-the-Top Anterior Cruciate Ligament Reconstruction Using Single- or Double-Strand Hamstrings Autograft

Anatomic single-bundle anterior cruciate ligament reconstruction using a calcium phosphate-hybridized tendon graft: a randomized controlled trial with 2 years of follow-up

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