Femoral tunnel enlargement after anterior cruciate ligament reconstruction using RigidFix compared with extracortical fixation

Junior, Osmar Valadão Lopes; Spinelli, Leandro de Freitas; Leite, Luiz Henrique Cunha; Buzzeto, Bruce Quatrin; Saggin, Paulo Renato; Kühn, André

doi:10.1007/s00167-015-3888-x

Cited by 20 publications

(16 citation statements)

References 35 publications

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“…They showed that biomechanical properties were superior to other femoral fixation devices in hamstring ACL surgery, although Rose,et al [36] confute their hypothesis that the trasfixation technique leads to less laxity and therefore to a better clinical outcome when compared with the use of bioabsorbable screws. According to a recent study by Lopes et al, greater enlargment of the femoral bone tunnel was observed when a bioabsorbable trans-tunnel pin system was used with medial portal technique, compared to extracortical fixation [37]. Will a shorter graft and more rigid graft complex fixation produce less tunnel enlargement?…”

Section: Discussionmentioning

confidence: 99%

A Clinical and Magnetic Resonance Imaging Assessment of Anterior Cruciate Ligament Reconstruction with Different Fixation Techniques Using Gracilis and Semitendinosus Autograft

Apostolopoulos¹,

Pneumaticos²,

Korres³

et al. 2019

TOORTHJ

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Background: Hamstring tendons are widely used in anterior cruciate ligament reconstruction. Improvements in fixation materials have increased the success of the reconstruction procedures using this type of graft. The main advantage of the hamstring tendon autograft is the lower donor site morbidity associated with its harvesting. On the other hand, tunnel widening is reported more frequently with the use of hamstring tendon autograft compared to patellar or quadriceps tendons. The objective of the present study was to evaluate three different fixation techniques at a minimum of 2 years after Anterior Cruciate Ligament (ACL) reconstruction using gracilis and semitendinosus autograft. Methods: Between February 2012 and March 2016, 112 ACL reconstructions using double looped semitendinosus and gracilis graft were performed. Patients were divided into 3 groups in a randomized fashion. 98 patients were followed up for 2 years. In the first group (43 patients), suspensory fixation using Retrobutton (Arthrex, Inc, Naples, Florida) was used. In the second group (30 patients), transcondylar graft fixation Bio-Transfix (Arthrex, Naples, Florida) was performed, and in the third group (25 patients), aperture fixation using AperFix (Cayenne Medical, Scottdale, Arizona, Biomet) was performed. Clinical evaluation was performed using the International Knee Documentation Committee (IKDC) form, Lysholm knee and Tegner activity level scores, as well as arthometer measurements. Tunnel enlargement and graft integrity were evaluated using Magnetic Resonance Imaging (MRI) at 6, 12 and 24 months. Results: Ten patients were completely lost to follow up, and four had undergone a revision ACL reconstruction before the two-year follow up period, leaving 98 patients for analysis. No statistically significant differences between the three groups were noted other than that the first group tended to have more tunnel enlargement than the other two groups, especially at the femoral tunnel (p=.026), but not at the tibial tunnel (p>0.408). Our results showed that almost 90% of the patients in the three groups had functionally normal or near normal IKDC, Lysholm and Tegner scores. Conclusion: The three different techniques yielded equal results as regards improved patient performance. The functional results as well as knee stability tests were not related with tunnel enlargement, at least in the short term.

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Section: Discussionmentioning

confidence: 99%

A Clinical and Magnetic Resonance Imaging Assessment of Anterior Cruciate Ligament Reconstruction with Different Fixation Techniques Using Gracilis and Semitendinosus Autograft

Apostolopoulos¹,

Pneumaticos²,

Korres³

et al. 2019

TOORTHJ

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“…Another observation in our study was tunnel widening increased from 3 months to six months and then either remained constant or reduced in size. Other devices like rigid fix have been found to have greater degree of tunnel enlargement than endobutton as observed by Lopes et al & hence they were not considered [14] . Compression system also can have the tunnel widening if the graft is not fixed near the joint line leading to stress shielding of the unloaded proximal bone.…”

Section: Discussionmentioning

confidence: 99%

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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“…However, in all types of interference screws, the postoperative tunnel enlargement problem exists [4]. Depends on the level of local enlargement, it has been shown that the tunnel enlargement can affect the outcome of ACL reconstruction and complicate its revision surgery [5].…”

Section: Introductionmentioning

confidence: 99%

“…However, it is well-known that the tunnel local or cross-sectional region could widen in the first 12 weeks post-operation [4]. Furthermore, the researches on both tibial and femoral tunnel growth shown that after auto-graft ACL reconstruction the mechanical instabilities are the main contributed factor [5,8].…”

Section: Introductionmentioning

confidence: 99%

Biomechanical Modeling of a Bone Tunnel Enlargement Post ACL Reconstruction

Borjali

Mohseni

Chizari

2020

Preprint

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BackgroundBone tunnel enlargement is considered as a potential problem following ACL reconstruction and can cause a fixation failure and complicate its revision surgery. This study evaluates post tibial tunnel expansion in ACL reconstruction using an interference screw.MethodsA series of in-vitro experimental tests on animal bone and tissues were used to simulate post ACL reconstruction. The study believes an unbalanced lateral force can cause a local enlargement on the contact zone inside the tunnel. Grayscale X-ray images were used to assess the screw alignment inside the tunnel.ResultsThey showed a slight misalignment between the screw and the tunnel axis as the tendon strands moved along the side of the tunnel, and the screw had partial contact with the tendon and bone along the tunnel. According to the results, increased stress in the tunnel wall causes tunnel enlargement. Although the tunnel created away from the tibial central axis produced a higher strength, it results in higher stress on the wall of the tunnel which can increase the risk of tunnel expansion.ConclusionsThe current study believes the use of an unguided interference screw insertion potentially increases risks of the misaligned fixation and cause a tunnel enlargement. This risk may be controlled by restricting the post-operative rehabilitation.

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Femoral tunnel enlargement after anterior cruciate ligament reconstruction using RigidFix compared with extracortical fixation

Abstract: III.

Cited by 20 publications

References 35 publications

A Clinical and Magnetic Resonance Imaging Assessment of Anterior Cruciate Ligament Reconstruction with Different Fixation Techniques Using Gracilis and Semitendinosus Autograft

A Clinical and Magnetic Resonance Imaging Assessment of Anterior Cruciate Ligament Reconstruction with Different Fixation Techniques Using Gracilis and Semitendinosus Autograft

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

Biomechanical Modeling of a Bone Tunnel Enlargement Post ACL Reconstruction

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