How to evaluate bone tunnel widening after ACL reconstruction - a critical review

Michael, T Hirschmann

doi:10.11138/mltj/2017.7.2.230

Cited by 18 publications

(3 citation statements)

References 49 publications

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“… 26 Three-dimensional CT has been employed to evaluate the size of the bone tunnel in anterior cruciate ligament (ACL) reconstruction. 9 , 27 CT was chosen over magnetic resonance imaging because of the higher bony spatial resolution and the ease of choosing the image plane to accurately evaluate the distance between the anchor and the FOT. This distance was compared between the cohorts.…”

Section: Methodsmentioning

confidence: 99%

Sonographically Guided Anchor Placement in Anterior Talofibular Ligament Repair Is Anatomic and Accurate

Hattori

Onishi

Yano

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: Arthroscopic repair is a widely accepted surgical treatment for chronic ankle instability; however, recent studies have shown that arthroscopic repair is nonanatomic in its anchor placement and resultant biomechanics. Ultrasound may improve the accuracy of the anchor placement. Hypothesis: Our hypothesis was that the accuracy of anchor placement in sonographically guided anterior talofibular ligament (ATFL) repair will be comparable with that in open ATFL repair. Study Design: Cohort study; Level of evidence, 3. Methods: The study included 26 patients who received surgical treatment between April 2012 and October 2019 for chronic ankle instability. Fifteen patients underwent open modified Broström repair and 11 underwent sonographically guided ATFL repair. The distance between the anchor hole and the fibular obscure tubercle was measured using 3-dimensional computed tomography and was compared between the operative procedures. For comparison, a noninferiority trial was employed, with open modified Broström repair as the reference surgery. The noninferiority margin was defined as 5 mm. Results: The mean ± SD distance between the anchor and fibular obscure tubercle was 6.0 ± 2.7 mm in open repair and 5.6 ± 3.3 mm in sonographically guided repair. The mean difference in distance between the techniques ( open repair – sonographically guided repair) was 0.37 mm (95% CI, –2.1 to 2.9 mm). The lower margin of the confidence interval was within the noninferiority margin (–5 to 5 mm). Conclusion: Anchor placement under sonographically guided ATFL repair was equivalent to that of open ATFL repair and can be considered anatomic and accurate.

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Section: Methodsmentioning

confidence: 99%

Sonographically Guided Anchor Placement in Anterior Talofibular Ligament Repair Is Anatomic and Accurate

Hattori

Onishi

Yano

et al. 2020

Orthopaedic Journal of Sports Medicine

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“…Third, for bone tunnel size measurement, computed tomography (CT) was not employed. Recently, it has been reported that CT scans may be the most suitable tool to evaluate bone tunnel size [47]. CT scans could be more sensitive for detecting the early bone tunnel findings.…”

Section: Discussionmentioning

confidence: 99%

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

Tajima

Yamaguchi

Nagasawa

et al. 2019

BMC Musculoskelet Disord

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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...

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“…Several graft options have been described including allografts, patellar or quadricipital autologous tendons, but semitendinosus and gracilis flexor muscles are more frequently used. (2,8,12) Regardless of the type of graft used for reconstruction, all undergo a process known as ligamentization, in which the graft matures through revascularization and remodeling (2,13,20). However, little is known about how the graft evolves in terms of hypertrophy, hypotrophy, elongation or shortening in the immediate post-operative period.…”

Section: Introductionmentioning

confidence: 99%

Short term evaluation of the hamstring graft diameter after ACL reconstruction

Astur

Pires²,

Parente³

et al. 2019

Muscle Ligaments and Tendons J

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Background. Graft embodiment process that occurs in the twelve weeks following reconstruction surgery is well described. However, the short-term performance characteristics of graphs, in terms of graft size and diameter, used in anterior cruciate ligament reconstructions is currently unknown. The purpose of this study was to measure the diameter of quadruple hamstring autograft with an MRI at two weeks post-op, before it undergoes any of the ligamentization process, and to compare it with the intra-operative graft measure. Material and methods. A prospective, observational study design was used. The MRI measured hamstring graft diameter at two weeks post-op from 38 study participants was compared to intraoperative diameter measurement of hamstrings graft during the ACL reconstruction surgery. Coronal plane T2 imaging was used to capture images in the intercondylar region near the tibial tunnel. Results. The average of the intra-operative graft diameter measurements was 7.9 mm (SD: 0.7 mm; range: 6.5 -9 mm). The average post-operative measurement obtained via MRI imaging within two weeks post-op was 7.1 mm (SD: 0.8 mm; range: 5.1 -8.6 mm). There was a significant decrease in the diameters of the graft over the first two weeks postoperatively (p < 0.001). Conclusions. The diameters of quadruple hamstrings knee grafts used for reconstructions of the anterior cruciate ligament decreased by 9.68% on average between the moment of the surgery and two weeks after surgery. This information can be used to guide graft preparation, reconstruction planning, rehabilitation and post-operative counseling of the patient as to their risk of rupture.

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How to evaluate bone tunnel widening after ACL reconstruction - a critical review

Cited by 18 publications

References 49 publications

Sonographically Guided Anchor Placement in Anterior Talofibular Ligament Repair Is Anatomic and Accurate

Sonographically Guided Anchor Placement in Anterior Talofibular Ligament Repair Is Anatomic and Accurate

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

Short term evaluation of the hamstring graft diameter after ACL reconstruction

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