The remnant preservation technique reduces the amount of bone tunnel enlargement following anterior cruciate ligament reconstruction

Kimura, Masashi; Hagiwara, Kaoru; Ogoshi, Atsuko; Nakagawa, Tomoyuki; Shiozawa, Hiroyuki; Ohsawa, Takashi; Chikuda, Hirotaka

doi:10.1007/s00167-017-4679-3

Cited by 27 publications

(40 citation statements)

References 57 publications

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“…Cross-sectional measurements were calculated, as previously described. 8,20,22 The CT scout view was used (at a level parallel to the outer rim of the lateral femoral condyle and the intercondylar fossa of the tibia). Sagittal reconstruction was performed at a level parallel to the outer rim of the lateral femoral condyle; the femoral bone tunnel area was measured as the cross-sectional area of a 2-mm deep slice made near the opening of the femoral bone tunnel ( Figure 1).…”

Section: Area Measurementmentioning

confidence: 99%

“…5 Thus, methods that reduce the risk of tunnel widening after ACLR are needed. 7,8 Tunnel widening likely occurs due to a complex interplay between mechanical and biological factors. The reported mechanical factors include the "bungee effect" due to extracortical femoral fixation 9,10 and bone tunnel positioning, [11][12][13] while the biological factors include synovial fluid-derived cytokines and inflammatory mediators, bone quality, graft choice, and cell necrosis from drilling.…”

Section: Introductionmentioning

confidence: 99%

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A steep coronal graft bending angle is associated with bone tunnel enlargement of the posterolateral bundle after anterior cruciate ligament reconstruction

Kimura¹,

Hagiwara²,

Ogoshi³

et al. 2019

J Orthop Surg (Hong Kong)

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Purpose: The correlation between the graft bending angle (GBA) of the anteromedial bundle and posterolateral bundle after anterior cruciate ligament reconstruction (ACLR) and postoperative tunnel enlargement was evaluated. Methods: Two hundred fifty-eight patients (137 males, 121 females; mean age 27.3 years) who had undergone doublebundle ACLR were included. Computed tomographic scans of the operated knee were obtained at 2 weeks and 6 months postoperatively. The area of the tunnel aperture for femoral anteromedial tunnel (FAMT) and femoral posterolateral tunnel (FPLT) was measured; the area at 2 weeks after ACLR was subtracted from the area at 6 months after ACLR and then divided by the area at 2 weeks after ACLR. The femoral tunnel angles were obtained with Cobb angle measurements. The femoral tunnel angle in the coronal plane was measured relative to the tibial plateau (coronal GBA). On the median value, the patients were divided into two groups in each of FAMT and FPLT; those with a coronal GBA of FAMT of !27 were classified as group A, while those with a coronal GBA of <27 were classified as group B, those with a coronal GBA of FPLT of !23 were classified as group C, while those with a coronal GBA of<23 were classified as group D. Results: Group A included 129 knees, while group B included 129 knees. Groups A and B did not significantly differ regarding FAMT enlargement. Group C included 133 knees, while group D included 125 knees. The percentage of FPLT enlargement in group C was significantly smaller than that in group D (p ¼ 0.001). Conclusions: A steep coronal GBA of the FPLT after ACLR results in greater FPLT enlargement. The present findings suggest that surgeons should avoid creating a steep GBA of the FPLT in the outside-in technique.

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Section: Area Measurementmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A steep coronal graft bending angle is associated with bone tunnel enlargement of the posterolateral bundle after anterior cruciate ligament reconstruction

Kimura¹,

Hagiwara²,

Ogoshi³

et al. 2019

J Orthop Surg (Hong Kong)

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“…In clinical setting, several investigators have developed ACL reconstructions with remnant tissue preservation, reporting better clinical outcomes. [18][19][20][21][22][23][24][25][26][27] However, the effects of remnant preservation remain controversial [28][29][30][31] (►Table 2).…”

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confidence: 99%

The Effect of Remnant Tissue Preservation in Anatomic Double-Bundle ACL Reconstruction on Knee Stability and Graft Maturation

et al. 2018

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Several investigators have developed anterior cruciate ligament reconstructions (ACLR) with remnant tissue preservation (RTP) and have reported better clinical outcomes. However, the effects of RTP remain controversial. To date, no reports have compared both clinical and radiological outcomes of anatomic double-bundle ACLR using the hamstring tendon and outside-in technique with/without RTP. This article evaluates the effectiveness of RTP in ACLR on knee stability and graft maturation. In total, 75 patients with unilateral ACL injury who had undergone anatomic double-bundle ACLR using autografted hamstring tendon either with RTP (Group P, = 43) or without (Group N, = 32) were enrolled. Clinical scores, pre- and postoperative side-to-side differences (SSDs) obtained using Telos, radiological evaluations of the grafted tendon using the signal/noise quotient (SNQ) measured using magnetic resonance imaging, and arthroscopic evaluations of the grafted tendon were retrospectively compared between the groups. Postoperative SSDs were smaller in the Group P (0.78 ± 1.90 mm) than in the Group N (1.29 ± 2.18 mm); however, this difference was not significant. Comparing two subgroups of the Group P, the SSD was significantly smaller in those with sufficient remnant coverage (-0.56 ± 1.38 mm) than in those without (1.48 ± 1.77 mm) ( = 0.019), as well as in the Group N patients ( = 0.019). The degree of synovial coverage of the anteromedial ( = 0.0064) and posterolateral ( = 0.032) bundle grafted tendon at the time of second-look arthroscopy was significantly better in the Group P than in the Group N. SNQ values of ACL grafted tendon at proximal ( = 0.049), middle, and distal ( = 0.039) one-third in Group P were better than those in Group N. RTP may enhance synovial coverage and maturation of the grafted tendon. Sufficient remnant tissue coverage may contribute to better knee stability. This is a Level III, retrospective comparative study.

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“…In our study, we did not differentiate patients in whom the remnants of the ACL were preserved, which could reduce the intra-tunnel synovial liquid and change the enlargement. 20 However, Hwang 13 compared ACL reconstruction with the hamstring and press-fit fixation, believing that this would reduce the intra-tunnel synovial fluid and would have a smaller increase of the total tunnel volume, but no difference was found compared to the conventional technique. Although the enlargement of the bone tunnels is common in ACL reconstruction and has no correlation with the clinical outcome 5 , 8 , 9 we did not compare clinically the patients among the different groups.…”

Section: Discussionmentioning

confidence: 99%

Bone Tunnel Enlargement With Non-Metallic Interference Screws in Acl Reconstruction

et al. 2018

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ObjectiveTo compare the widening of bone tunnels between poly-etheretherketone (PEEK), absorbable polylactic acid DL (PLDL) and tricalcium phosphate (TCP) interference screws in anterior cruciate ligament (ACL) reconstruction.MethodsThree groups of patients undergoing ACL reconstruction with at least 1 year of follow-up using the out-in drilling technique and hamstring as a graft were assessed. The patients were divided according to the type of interference screw used (PEEK, PLDL and TCP). Computed tomography (CT) was performed to measure the greatest femoral and tibial tunnel widening regarding to the initial tunnel, and then it was compared between groups.ResultsMean widening in group 1 (PEEK) was 39.56% (SD 16%) in the femoral tunnel and 33.65% (SD 20%) in the tibia. In group 2 (PLDL) mean widening was 48.43% in the femoral tunnel (SD 18%) and 35.24% (SD 13%) in the tibial tunnel. In group 3 (TCP) mean widening was 44.51% in the femur (SD 14%) and 36.83% in the tibia (SD 14%). The comparison between groups (PLDL-PEEK, PLDL-TCP, PEEK-TCP) shows no statistically significant difference.ConclusionBone tunnel enlargement values after ACL reconstruction with the use of different types of materials (bioinert and biomaterials) of interference screws (PEEK, PLDL and TCP) were similar. Level of Evidence III, Comparative retrospective study.

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The remnant preservation technique reduces the amount of bone tunnel enlargement following anterior cruciate ligament reconstruction

Abstract: II.

Cited by 27 publications

References 57 publications

A steep coronal graft bending angle is associated with bone tunnel enlargement of the posterolateral bundle after anterior cruciate ligament reconstruction

A steep coronal graft bending angle is associated with bone tunnel enlargement of the posterolateral bundle after anterior cruciate ligament reconstruction

The Effect of Remnant Tissue Preservation in Anatomic Double-Bundle ACL Reconstruction on Knee Stability and Graft Maturation

Bone Tunnel Enlargement With Non-Metallic Interference Screws in Acl Reconstruction

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