The Effect of Different Sagittal Angles of the Tibial Guide on Aperture Widening of the Tibial Tunnel during Modified Transtibial Anterior Cruciate Ligament Reconstruction: A RandomizedIn VivoStudy

Abstract

PurposeThe effect of sagittal plane angle of the tibial tunnel on the severity of tibial intra-articular aperture expansion caused by iatrogenic re-reaming in anterior cruciate ligament (ACL) reconstruction using a modified transtibial technique is unknown. The purpose of this study was to compare the severity of intra-articular aperture widening at different angles (40°, 45°, and 50°) of the tibial guide (TG).Materials and MethodsNinety-seven patients who underwent modified transtibial ACL reconstruction were randomly allocated to TG 40°, 45°, and 50° groups. Intra-articular tibial aperture width (TW) and tibial tunnel length (TTL) were measured intraoperatively using an arthroscopic ruler and a depth gauge.ResultsThe TG 50° group had significantly greater tibial aperture widening than the TG 40° group. There was a significant difference among TG 40°, 45°, and 50° groups and the percentage of knees with TTL <35 mm was 8%, 9% and 3%, respectively. There were 2 females with TTL <35 mm in TG 40° and 45° groups each. The average mediolateral length of the tibial plateau was 75 mm.ConclusionsThis study shows that the TG angle of 40° would reduce the severity of intra-articular aperture widening of the tibial tunnel compared to 45° or 50° in modified transtibial ACL reconstruction.

Length of the Tendon within the Tibial Tunnel Affects Tibial Tunnel Widening following Anatomic Anterior Cruciate Ligament Reconstruction Using a Bone–Patellar Tendon–Bone Graft

“…5 Several other factors may affect tibial TW, such as age, tunnel location, tunnel angle, or the posterior slope of the tibia. [24][25][26][27] The length of the tendon within the tibial tunnel, tunnel location, and tunnel angle have been considered to be related with one another. Therefore, further investigation in a larger cohort using multivariate regression analyses of such factors must be performed in the future to clarify independent factors that affect tibial TW.…”

“…As previously mentioned, several other factors, such as tunnel location, tunnel angle, or the posterior slope of the tibia, may affect tibial TW. 24,25,27 Therefore, further investigations in larger cohorts using multivariate regression analyses of such factors must be performed in the future. Third, CT images were only acquired at two time points (1 week and 1 year postoperatively).…”