Flexible Versus Rigid Reaming Systems for Independent Femoral Tunnel Reaming During ACL Reconstruction: Minimum 2-Year Clinical Outcomes

Abstract

Background: Radiographic and cadaveric studies have suggested that anatomic anterior cruciate ligament reconstruction (ACLR) femoral tunnel drilling with the use of a flexible reaming system through an anteromedial portal (AM-FR) may result in a different graft and femoral tunnel position compared with using a rigid reamer through an accessory anteromedial portal with hyperflexion (AAM-RR). No prior studies have directly compared clinical outcomes between the use of these 2 techniques for femoral tunnel creation during ACLR. Purpose: To compare revision rates at a minimum of 2 years postoperatively for patients who underwent ACLR with AM-FR versus AAM-RR. The secondary objectives were to compare functional testing and patient-reported outcomes between the cohorts. Study Design: Cohort study; Level of evidence, 3. Methods: Included were consecutive patients at a single academic institution between 2013 and 2018 who underwent primary ACLR without additional ligamentous reconstruction. Patients were separated into 2 groups based on the type of anatomic femoral tunnel drilling: AM-FR or AAM-RR. Graft failure, determined by revision ACLR, was assessed with a minimum 2 years of postoperative follow-up. The authors also compared patient-reported outcome scores (International Knee Documentation Committee [IKDC] and Knee injury and Osteoarthritis Outcome Score [KOOS]) and functional performance testing performed at 6 months postoperatively. Results: A total of 284 (AAM-RR, 232; AM-FR, 52) patients were included. The mean follow-up time was 3.7 ± 1.5 years, with a minimum 2-year follow-up rate of 90%. There was no significant difference in the rate of revision ACLR between the AAM-RR and AM-FR groups (10.8% vs 9.6%, respectively; P = .806). At 6 months postoperatively, there were no significant between-group differences in peak knee extension strength, peak knee flexion strength, limb symmetry indices, or hop testing, as well as no significant differences in IKDC (AAM-RR, 81.1; AM-FR, 78.9; P = .269) or KOOS (AAM-RR, 89.0; AM-FR, 86.7; P = .104). Conclusion: In this limited study, independent femoral tunnel drilling for ACLR using rigid or flexible reaming systems resulted in comparable rates of revision ACLR at a minimum of 2 years postoperatively, with no significant differences in strength assessments or patient-reported outcomes at 6 months postoperatively.

Beneficial Effect of Curved Dilator System for Femoral Tunnel Creation in Preventing Femoral Tunnel Widening after Anterior Cruciate Ligament Reconstruction

“…Moreover, it may necessitate complex, staged management for revision ACL surgery, including initial bone grafting procedures to fill the widened tunnels [ 10 , 22 , 23 ]. This complication is not only related to surgical techniques but also to the type of fixation devices, graft selection, and demographic factors [ 12 , 15 , 16 , 19 , 24 , 25 ]. The relation between tunnel widening and clinical outcomes remains uncertain.…”

“…Some studies have hypothesized that tunnel widening potentially serves as an early finding of graft failure. However, many recent studies could not find any relationship between tunnel enlargement and the clinical results after surgery, and only a few have demonstrated the impact on the clinical outcome of tunnel widening [ 15 , 16 , 21 , 25 , 26 , 27 ].…”

The changing trends of the knee function after anterior and posterior cruciate ligaments reconstruction with all-inside arthroscopy technique

“…Thomas E Moran et al concluded that no significant differences in strength assessments or patient-reported outcomes at 6 months postoperatively in Flexible Versus Rigid Reaming Systems for Independent Femoral Tunnel making research 18 , some researchers confirmed that the flexible reamer system can be considered a safe and effective method for reconstruction surgery 19 . For Flexible reamer in our research, no associated complications were found , in addition to its safeness, we found some other advantages: (1) All-inside arthroscopic operation become possible.…”