Morphological changes in femoral tunnels after anatomic anterior cruciate ligament reconstruction

Tachibana, Yuta; Mae, Tatsuo; Shino, Konsei; Kanamoto, Takashi; Sugamoto, Kazuomi; Yoshikawa, Hideki; Nakata, Ken

doi:10.1007/s00167-014-3252-6

Cited by 48 publications

(60 citation statements)

References 53 publications

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“…16 Less encouragingly, the knee may be overconstrained initially, 17 and, when compared with single-bundle grafts, both double-bundle and triple-bundle grafts show inferior graft-tunnel healing on oblique coronal magnetic resonance images at 6 months postoperatively. 18 It has also been shown that during the first postoperative year, both of the femoral tunnels enlarge anteriorly and distally 19 and the most posterior tibial tunnel enlarges posterolaterally. 20 Shino's group have performed second-look arthroscopies, typically between 6 and 24 months postoperatively.…”

Section: See Related Article On Page 896mentioning

confidence: 99%

“…21,22 They have reported that the morphology of triple-bundle grafts resembles that of the native ACL, but they have also noted incomplete synovial coverage of the graft, particularly of the posterolateral bundle, with complete or substantial rupture of 10% of the posterolateral bundles. 19 Recently Mae et al 22 have also reported that a triple-bundle hamstring tendon graft results in worse synovial coverage and more graft damage than a single-bundle bone-patellar tendon-bone graft. Moreover, at the femoral aperture they noted a space around 33% of their triple-bundle grafts but none of their single-bundle grafts.…”

Section: See Related Article On Page 896mentioning

confidence: 99%

See 1 more Smart Citation

Editorial Commentary: Triple-Bundle Anterior Cruciate Ligament Reconstruction: More Is More or Less Is More?

Servant¹

2019

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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We need ambitious pioneers to explore the frontiers of surgical technique, but the surgeons that follow are wise to wait for independent and robust evidence of clinical benefit. Double-bundle anterior cruciate ligament reconstruction has struggled to establish its role, and triple-bundle reconstruction is perhaps even less likely to gain widespread acceptance, given that cadaveric research has shown only a small biomechanical advantage over a double-bundle or even a single-bundle technique and there is no convincing evidence of improved clinical outcomes.

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Section: See Related Article On Page 896mentioning

confidence: 99%

Section: See Related Article On Page 896mentioning

confidence: 99%

Editorial Commentary: Triple-Bundle Anterior Cruciate Ligament Reconstruction: More Is More or Less Is More?

Servant¹

2019

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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“…The circumference of the tunnel was traced with a minimum of 15 reference points and the cross-sectional area was automatically calculated 32 . Tachibana et al determined the femoral tunnel crosssection area by measuring at three planes, perpendicular to the long axis, created at the aperture site, 5 and 10 mm from the aperture site on a 3D model 41 . Slice thickness used was 0.625 mm 41 .…”

Section: Radiographsmentioning

confidence: 99%

“…Tachibana et al determined the femoral tunnel crosssection area by measuring at three planes, perpendicular to the long axis, created at the aperture site, 5 and 10 mm from the aperture site on a 3D model 41 . Slice thickness used was 0.625 mm 41 . Robbrecht et al and Yang et al used axial CT images (0.625 mm thick) to segment and reconstruct the bone into a 3D model by a computer program; the femoral and tibial tunnels were separately analyzed by the program 31,47 .…”

Section: Radiographsmentioning

confidence: 99%

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

Michael

2017

MLTJ

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SummaryBackground: Comparing different imaging modalities and methods for assessment tunnel widening after ACL reconstruction and providing a detailed evidence-based literature overview. Methods: PubMed was searched from 1970 to 2016 using the terms "ACL reconstruction" and "tunnel" and "imaging" or "CT" or "computerized tomography" or "MRI" or "magnetic resonance imaging" or "radiographs". 647 studies were found. 575 articles were excluded due to absence of specific radiological measurement methods of tunnel widening and 40 due to repetition of a previously published radiological measurement method. 32 articles were included reporting interand intraobserver reliabilities of tunnel measurement methods after ACL reconstruction. Results: A variety of different algorithms and measurement methods using radiographs, magnetic resonance imaging, computed tomography or SPECT/CT evaluating tunnel position and bone tunnel enlargement have been described. Tunnel delination restricts an exact analysis using X-ray. Measurements using CT or MR were mostly obtained perpendicular to the tunnel axis or using specialized software for tunnel volume calculation in 3D. Based on the review the width of the femoral and tibial tunnels should be assessed perpendicular to the tunnel axis at different levels in relation to the joint. At least one measurement should be performed at the tunnel entrance, exit and midpoint of the tunnel. Conclusion: CT should be considered the gold standard assessing tunnel widening in patients after ACL reconstruction. If specialized software is available calculating the tunnel volume, measurements should be preferably performed in 3D CT. Level of evidence: II.

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“…The HST graft is also a suitable alternative. While harvest graft site morbidity is lower with the HST, tendon-to-bone tunnel integration is less successful, as evidenced by postoperative femoral tunnel enlargement observed in second-look arthroscopy or CT [ 9 , 10 ] (Fig. 3 ).…”

Section: Graft Selectionmentioning

confidence: 99%

Anatomic ACL reconstruction: rectangular tunnel/bone–patellar tendon–bone or triple-bundle/semitendinosus tendon grafting

Shino

Mae

Tachibana

2015

Journal of Orthopaedic Science

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Anatomic ACL reconstruction is the reasonable approach to restore stability without loss of motion after ACL tear. To mimic the normal ACL like a ribbon, our preferred procedures is the anatomic rectangular tunnel (ART) technique with a bone-patellar tendon-bone (BTB) graft or the anatomic triple bundle (ATB) procedure with a hamstring (HS) tendon graft. It is important to create tunnel apertures inside the attachment areas to lessen the tunnel widening. To identify the crescent-shaped ACL femoral attachment area, the upper cartilage margin, the posterior cartilage margin and the resident’s ridge are used as landmarks. To delineate the C-shaped tibial insertion, medial intercondylar ridge, Parson’s knob and anterior horn of the lateral meniscus are helpful. In ART-BTB procedure which is suitable for male patients engaged in contact sports, the parallelepiped tunnels with rectangular apertures are made within the femoral and tibial attachment areas. In ATB-HS technique which is mainly applied to female athletes engaged in non-contact sports including skiing or basketball, 2 femoral and 3 tibial round tunnels are created inside the attachment areas. These techniques make it possible for the grafts to run as the native ACL without impingement to the notch or PCL. After femoral fixation with an interference screw or cortical fixation devices including Endobutton, the graft is pretensioned in situ by repetitive manual pulls at 15–20° of flexion, monitoring the graft tension with tensioners on a tensioning boot installed on the calf. Tibial fixation with pullout sutures is achieved using Double Spike Plate and a screw at the pre-determined amount of tension of 10–20N. While better outcomes with less failure rate are being obtained compared to those in the past, higher graft tear rate remains a problem. Improved preventive training may be required to avoid secondary ACL injuries.

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Morphological changes in femoral tunnels after anatomic anterior cruciate ligament reconstruction

Abstract: Case series, Level IV.

Cited by 48 publications

References 53 publications

Editorial Commentary: Triple-Bundle Anterior Cruciate Ligament Reconstruction: More Is More or Less Is More?

Editorial Commentary: Triple-Bundle Anterior Cruciate Ligament Reconstruction: More Is More or Less Is More?

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

Anatomic ACL reconstruction: rectangular tunnel/bone–patellar tendon–bone or triple-bundle/semitendinosus tendon grafting

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