Prospective Comparisons of Femoral Tunnel Enlargement With 3 Different Postoperative Immobilization Periods After Double-Bundle Anterior Cruciate Ligament Reconstruction With Hamstring Grafts

Tajima, Takuya; Chosa, Etsuo; Kawahara, Katsuhiro; Yamaguchi, Nami

doi:10.1016/j.arthro.2014.10.015

Cited by 13 publications

(16 citation statements)

References 32 publications

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“…For every patient who was enrolled in this study, an arthroscopically diagnostic was performed to ensure that complete ACL tear was present and to examine for other possible findings; medial and lateral meniscal injuries or articular cartilage injuries in the knee. The anatomical double-bundle ACL reconstruction with hamstring procedure was described previously [27]. Femoral tunnels were created under trans-portal technique and inside-out fashion in all cases.…”

Section: Methodsmentioning

confidence: 99%

“…A percentage change between the two different periods was defined as percentage tunnel enlargement in diameter. To determine the incidence of tunnel enlargement, a percentage diameter change of more and less than 10% as an enlarged tunnel and a reduced tunnel, respectively [17, 27, 29]. The magnitude of percent femoral bone tunnel enlargement compared to the original size was also evaluated, with the original size considered as 100%.…”

Section: Methodsmentioning

confidence: 99%

“…Previously, from clinical and radiographic findings of a prospective study, 1 week was recommended as a suitable postoperative immobilization period after ACL reconstruction with a hamstring autograft. A longer immobilization period, such as 2weeks, did not significantly reduce femoral bone tunnel enlargement, both in incidence and magnitude [27].…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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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“…However, femoral bone tunnels enlargement occurred with a high incidence and magnitude. 28 Better stability and fewer complications including less bone tunnel enlargement and less donor site morbidity are ideal postoperative outcomes for primary ACL reconstruction. To take advantage and compensate for the disadvantages of both types of grafts in the double-bundle concept, we propose a modified double-bundle technique with small-size BPTB and gracilis (G) autografts for Asian ACL-deficient patients.…”

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confidence: 99%

Clinical and Radiographic Outcomes of Double-Bundle Anterior Cruciate Ligament Reconstruction for Asian Patients with Bone-Patellar Tendon-Bone and Gracilis Tendon Grafts: A Matched-Control Comparison

et al. 2020

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For anterior cruciate ligament (ACL)-deficient patients, using a single bone-patellar tendon-bone (BPTB) graft for the double-bundle concept is one of the suitable approaches for acquiring better stability and reducing bone tunnel enlargement compared with the use of hamstring grafts. At least 10-mm width of BPTB autograft is needed to achieve this concept; however, it is larger than one-third of the patellar tendon width for small or middle physique patients. This study aimed to assess the clinical and radiographic outcomes of BPTB and gracilis (G) composite autografts for primary double-bundle ACL reconstruction in Asian athletes. Thirty-two Asian patients undergoing double-bundle ACL reconstruction with 7.0 to 7.5 mm of BPTB and 5.0 to 5.5 mm of G composite grafts were compared with 43 double-bundle ACL reconstruction with hamstring graft cases. The BPTB graft was used for the anteromedial bundle (AMB), with the G graft for the posterolateral bundle (PLB). Percentage of femoral bone tunnel enlargement compared with the original size was determined by computed digital radiographs on the first postoperative day and at 12 months in the anteroposterior (AP) and lateral views. Standard clinical evaluations, including the limb symmetry index (LSI), were also performed. Less PLB tunnel enlargement was found in the BPTB + G group than in the hamstring group in the AP (101.9 ± 22.9 vs.113.7 ± 20.6%, p = 0.031) and lateral views (104.4 ± 18.1 vs. 120.6 ± 23.4%, p < 0.01).There was no significant difference between the groups in 12-month postoperative clinical outcomes (Lysholm's score, Tegner's activity level scale, and International Knee Documentation Committee subjective knee evaluation score).The side-to-side difference was significantly less in the BPTB + G group (0.2 ± 1.3 vs. 0.9 ± 1.1 mm, p = 0.026). Despite the small sizes of the BPTB and G grafts, there was no significant difference in the knee extensor LSI between the groups (92.9 ± 10.1 vs. 93.3 ± 12.2%, p = 0.707), whereas the knee flexor LSI was significantly higher in the BPTB + G group (97.7 ± 14.8 vs. 90.1 ± 13.3%, p = 0.033). Double-bundle ACL reconstruction with a small size BPTB and G composite graft procedure provided good clinical outcomes and significantly less femoral bone tunnel enlargement than the hamstring procedure 12 months after surgery. It is thus a useful surgical option for ACL-deficient Asian athletes. This study reflects level of evidence III.

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“…In addition, biomechanical forces have an important effect on the tendon-to-bone healing process. While some clinical studies demonstrate that immobilization does not have an effect on anterior-posterior laxity or bone tunnel enlargement after ACL reconstruction using hamstring tendon, 7,8 several animal studies have demonstrated that a period of immobilization improves tendon-to-bone healing. 9–11 In prior work in our laboratory, we demonstrated that a period of immobilization following ACL reconstruction had positive effects on inflammation and bone formation along the healing tendon-bone interface compared with immediate motion after surgery.…”

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Duration of postoperative immobilization affects MMP activity at the healing graft–bone interface: Evaluation in a mouse ACL reconstruction model

Nakagawa

Lebaschi

Wada

et al. 2018

Journal Orthopaedic Research

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Excessive MMP activity may impair tendon-to-bone healing. However, little is known about the effect of joint motion on MMP activity after ACL reconstruction. The aim of this study was to determine the effect of different durations of knee immobilization on MMP activity in a mouse ACL reconstruction model using a fluorescent MMP probe which detects MMP 2, 3, 9, and 13 and near-infra red in vivo imaging. Sixty C57BL male mice underwent ACL reconstruction. Post-operatively, the animals were treated with free cage activity (Group 1), or with the use of an external fixator to restrict knee motion and weight bearing for 5 days (Group 2), 14 days (Group 3), and 28 days (Group 4). At days 3, 7, 16, 23, and 30, five mice underwent IVIS imaging. At days 3, 7, 16, and 30, histological analysis was also performed. Probe signal intensity in the whole limb peaked at day 7, followed by a decrease at day 16, and maintenance up to day 30. There was no significant difference among groups at any time point based on IVIS, but histologic localization of MMP probe signal showed significantly less activity in Group 2 and Group 3 compared to Group 4 in the bone tunnel at day 30. We demonstrated that short-term immobilization led to less MMP activity around the bone tunnel compared with prolonged immobilization. A short period of immobilization after ACL reconstruction might enhance graft-bone interface healing by mitigating excess MMP expression. These findings have implications for post-operative rehabilitation protocols following ACL reconstruction. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res

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Prospective Comparisons of Femoral Tunnel Enlargement With 3 Different Postoperative Immobilization Periods After Double-Bundle Anterior Cruciate Ligament Reconstruction With Hamstring Grafts

Cited by 13 publications

References 32 publications

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

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

Clinical and Radiographic Outcomes of Double-Bundle Anterior Cruciate Ligament Reconstruction for Asian Patients with Bone-Patellar Tendon-Bone and Gracilis Tendon Grafts: A Matched-Control Comparison

Duration of postoperative immobilization affects MMP activity at the healing graft–bone interface: Evaluation in a mouse ACL reconstruction model

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