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

Kiekara, Tommi; Järvelä, Timo; Huhtala, Heini; Moisala, Anna-Stina; Suomalainen, Piia; Paakkala, Antti

doi:10.1016/j.arthro.2014.06.031

Cited by 26 publications

(25 citation statements)

References 17 publications

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“…Kiekara et al 10 observed bone tunnel communication in 10% of patients at the femur and in 15% of patients at the tibia. These authors also reported on the relationship between MRI bone tunnel communication findings and clinical outcome.…”

Section: Discussionmentioning

confidence: 97%

“…To evaluate the graft more objectively, some researchers reported usefulness of SNQ. 10 , 18 , 19 , 26 Weilar et al 18 demonstrated that SNQ of the graft on MRI had a negative correlation with biomechanical parameters.…”

Section: Discussionmentioning

confidence: 99%

“…Bone tunnel communication is one of the weak points of DB ACL reconstruction, and surgeons should pay special attention to this issue. There are some reports of bone tunnel communication in DB ACL reconstruction, 6 , 8 , 9 , 10 but studies on the adverse effects of bone tunnel communication are currently ongoing.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

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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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“…The results of the 2-year MRI evaluation of 66 patients have been published previously. 19 , 20 In the 2-year evaluation, a 1.5-T MRI (Signa Excite HD imager; GE Healthcare) was used. The 1.5-T imaging protocol included sagittal T1-weighted images with a repetition time/echo time of 2800/19 ms and a slice thickness/gap of 4.0/1.0 mm, sagittal proton density (PD)–weighted images (2320/24 ms and 4.0/1.0 mm), sagittal T2-weighted images (3740/78 ms and 4.0/1.0 mm), coronal T1-weighted images (500/16 ms and 4.0/1.0 mm), coronal fat-suppressed (FS) images (3300/74 ms and 4.0/1.0 mm), axial FS PD-weighted images (1940/40 ms and 4.0/1.0 mm), and oblique sagittal and coronal T1-weighted images along the AM graft plane (660/16 ms and 3.0/0.3 mm).…”

Section: Methodsmentioning

confidence: 99%

“… 5 , 14 , 30 Tunnel enlargement may lead to tunnel communication after DB ACLR. 19 Nonsymptomatic tunnel communication seen on MRI has been reported in 10% to 19% of patients in the femur and in 24% to 29% of patients in the tibia in 1- to 2-year follow-up. 19 , 20 , 30 The long-term consequences of tunnel communication are unknown, but knee instability has been hypothesized to occur.…”

mentioning

confidence: 99%

Femoral and Tibial Tunnel Diameter and Bioabsorbable Screw Findings After Double-Bundle ACL Reconstruction in 5-Year Clinical and MRI Follow-up

Kiekara

Paakkala

Suomalainen

et al. 2017

Orthopaedic Journal of Sports Medicine

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Background:Tunnel enlargement is frequently seen in short-term follow-up after anterior cruciate ligament reconstruction (ACLR). According to new evidence, tunnel enlargement may be followed by tunnel narrowing, but the long-term evolution of the tunnels is currently unknown.Hypothesis/Purpose:The hypothesis was that tunnel enlargement is followed by tunnel narrowing caused by ossification as seen in follow-up using magnetic resonance imaging (MRI). The purpose of this study was to evaluate the ossification pattern of the tunnels, the communication of the 2 femoral and 2 tibial tunnels, and screw absorption findings in MRI.Study Design:Case series; Level of evidence, 4.Methods:Thirty-one patients underwent anatomic double-bundle ACLR with hamstring grafts and bioabsorbable interference screw fixation and were followed with MRI and clinical evaluation at 2 and 5 years postoperatively.Results:The mean tunnel enlargement at 2 years was 58% and reduced to 46% at 5 years. Tunnel ossification resulted in evenly narrowed tunnels in 44%, in conical tunnels in 48%, and fully ossified tunnels in 8%. Tunnel communication increased from 13% to 23% in the femur and from 19% to 23% in the tibia between 2 and 5 years and was not associated with knee laxity. At 5 years, 54% of the screws were not visible, with 35% of the screws replaced by a cyst and 19% fully ossified. Tunnel cysts were not associated with worse patient-reported outcomes or knee laxity. Patients with a tibial anteromedial tunnel cyst had higher Lysholm scores than patients without a cyst (93 and 84, P = .03).Conclusion:Tunnel enlargement was followed by tunnel narrowing in 5-year follow-up after double-bundle ACLR. Tunnel communication and tunnel cysts were frequent MRI findings and not associated with adverse clinical evaluation results.

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Emerging Techniques for Tendon and Ligament MRI

Fleming

Biercevicz

Murray

et al. 2017

Magnetic Resonance Imaging in Tissue Engineering

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

Cited by 26 publications

References 17 publications

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

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

Femoral and Tibial Tunnel Diameter and Bioabsorbable Screw Findings After Double-Bundle ACL Reconstruction in 5-Year Clinical and MRI Follow-up

Emerging Techniques for Tendon and Ligament MRI

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