MRI evaluation of the four tunnels of double-bundle ACL reconstruction

Kiekara, Tommi; Järvelä, Timo; Huhtala, Heini; Paakkala, Antti

doi:10.1177/0284185113502743

Cited by 11 publications

(14 citation statements)

References 29 publications

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“…12,13 Previously, tunnel communication has been seen either intraoperatively, caused by drilling, 5,13 or postoperatively, caused by tunnel enlargement. 5,6 In previous studies, tunnel communication has been seen in the femur in 11% to 19% of patients and in the tibia in 24% to 29% of patients. 5,6 This study shows that in a relatively short follow-up period, the patients who had findings of tunnel communication seen on MRI did not have more knee laxity in clinical evaluation than did those patients with intact tunnels seen on MRI.…”

Section: Discussionmentioning

confidence: 89%

“…4 Intraoperative drilling or bone tunnel widening may lead to tunnel communication. 5,6 Previously, tunnel communication has been seen in 11% to 19% of patients in the femur and in 24% to 29% of patients in the tibia. 5,6 Magnetic resonance imaging (MRI) is widely used for the postoperative evaluation of ACL reconstruction.…”

mentioning

confidence: 99%

“…5,6 Previously, tunnel communication has been seen in 11% to 19% of patients in the femur and in 24% to 29% of patients in the tibia. 5,6 Magnetic resonance imaging (MRI) is widely used for the postoperative evaluation of ACL reconstruction. According to the literature, normal DB ACL grafts should be hypointense on proton-density (PD)-weighted and T2-weighted MR images after the revascularization period 1 to 2 years postoperatively.…”

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confidence: 99%

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Tunnel Communication and Increased Graft Signal Intensity on Magnetic Resonance Imaging of Double-Bundle Anterior Cruciate Ligament Reconstruction

Kiekara

Järvelä

Huhtala

et al. 2014

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Section: Discussionmentioning

confidence: 89%

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confidence: 99%

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confidence: 99%

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Tunnel Communication and Increased Graft Signal Intensity on Magnetic Resonance Imaging of Double-Bundle Anterior Cruciate Ligament Reconstruction

Kiekara

Järvelä

Huhtala

et al. 2014

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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“… 18 , 19 , 20 , 21 , 22 , 23 , 24 However, evaluation with MRI is noninvasive and convenient. In some reports on the ACL graft evaluation by MRI, 21 , 23 , 25 the grafts were evaluated subjectively by examiners. To evaluate the graft more objectively, some researchers reported usefulness of SNQ.…”

Section: Discussionmentioning

confidence: 99%

Graft quality and clinical outcomes of intraoperative bone tunnel communication in anatomic double-bundle anterior cruciate ligament reconstruction

Ichiba

Tokuyama

Makuya

et al. 2016

Asia-Pacific Journal of Sports Medicine, Arthroscopy, Rehabilit

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Background/objectiveIn anatomic double-bundle anterior cruciate ligament reconstruction, it is crucial to create two separate bone tunnels within the footprints of the anterior cruciate ligament at the femur and tibia. This can occasionally be difficult to accomplish and the adverse effects of bone tunnel communication are unclear. The purpose of this study was to examine the effects of intraoperative bone tunnel communication on graft quality and clinical outcome.MethodsFifty-two patients (52 knees) who underwent anatomic double-bundle anterior cruciate ligament reconstruction with hamstring tendons were included. The mean age of the patients was 30.7 years. Clinical assessments were performed 1 year after surgery. Bone tunnel communication was evaluated using computed tomography 10 days after surgery. Graft quality was evaluated using magnetic resonance imaging 6 months after surgery and the signal/noise quotient was calculated using the region of interest technique.ResultsBone tunnel communication was observed in the femur of one knee (1.9%) and the tibias of 10 knees (30.8%). The knees with tibial bone communication were classified into Group C (N = 16), and the knees without tibial bone tunnel communication were classified into Group N (N = 36). No significant differences were observed between Groups C and N in terms of clinical outcome. The signal/noise quotient of the distal portion of the posterolateral graft in Group C was significantly higher than that of Group N.ConclusionBone tunnel communication in anatomic double-bundle anterior cruciate ligament reconstruction did not affect clinical outcome, but it did affect posterolateral graft quality.Level of evidenceLevel 4, case series, therapeutic studies.

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“…The use of the modified quadrant method with MRI has been recently described in detail 21. In brief, first the centers of the tunnels were measured from sagittal images referring to Blumensaat’s line and to the posterior femoral condyle (Figure 1).…”

Section: Methodsmentioning

confidence: 99%

Effect of tunnel placements on clinical and magnetic resonance imaging findings 2 years after anterior cruciate ligament reconstruction using the double-bundle technique

Suomalainen¹,

Kiekara²,

Moisala³

et al. 2014

OAJSM

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PurposeThe purpose of the study reported here was to find out if the clinical and magnetic resonance imaging (MRI) findings of a reconstructed anterior cruciate ligament (ACL) have an association. Our hypothesis, which was based on the different functions of the ACL bundles, was that the visibility of the anteromedial graft would have an impact on anteroposterior stability, and the visibility of the posterolateral graft on rotational stability of the knee.MethodsThis study is a level II, prospective clinical and MRI study (NCT02000258). The study involved 75 patients. One experienced orthopedic surgeon performed all double-bundle ACL reconstructions. Two independent examiners made the clinical examinations at 2-year follow-up: clinical examination of the knee; KT-1000, International Knee Documentation Committee and Lysholm knee evaluation scores; and International Knee Documentation Committee functional score. The MRI evaluations were made by two musculoskeletal radiologists separately, and the means of these measurements were used.ResultsWe found that the location of the graft in the tibia had an impact on the MRI visibility of the graft at 2-year follow-up. There were significantly more partially or totally invisible grafts if the insertion of the graft was more anterior in the tibia. No association was found between the clinical results and the graft locations.ConclusionAnterior graft location in the tibia can cause graft invisibility in the MRI 2 years after ACL reconstruction, but this has no effect on the clinical recovery of the patient.

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MRI evaluation of the four tunnels of double-bundle ACL reconstruction

Abstract: The tunnel locations of DB ACL reconstruction can be evaluated with MRI. Tunnel location was associated with tunnel enlargement that in turn was associated with tunnel communication.

Cited by 11 publications

References 29 publications

Tunnel Communication and Increased Graft Signal Intensity on Magnetic Resonance Imaging of Double-Bundle Anterior Cruciate Ligament Reconstruction

Tunnel Communication and Increased Graft Signal Intensity on Magnetic Resonance Imaging of Double-Bundle Anterior Cruciate Ligament Reconstruction

Graft quality and clinical outcomes of intraoperative bone tunnel communication in anatomic double-bundle anterior cruciate ligament reconstruction

Effect of tunnel placements on clinical and magnetic resonance imaging findings 2 years after anterior cruciate ligament reconstruction using the double-bundle technique

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