Tunnel Enlargement after Anterior Cruciate Ligament Surgery

Wilson, Timothy C.; Kantaras, Anthony T.; Atay, Ahmet Özgür; Johnson, Darren L.

doi:10.1177/0363546504263151

Cited by 273 publications

(221 citation statements)

References 49 publications

(151 reference statements)

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“…Tunnel widening after anterior cruciate ligament (ACL) reconstruction is a well-described phenomenon. 8 The basis of tunnel widening is multifactorial, with several possible mechanical and biological contributing factors. 9 Among the possible causes, mechanical factors such as graft tunnel motion, stress deprivation of bone within the tunnel wall, improper graft tunnel placement, tunnel positioning, graft fixation method, resorbable implant degradation, access of joint fluid to the graft-bone interface, and bone quality and aggressive rehabilitation have been considered.…”

Section: Discussionmentioning

confidence: 99%

Comparative study between aperture and suspensary fixation of hamstring autografts on femoral side in ACL reconstruction: clinical and radiological outcome assessment

Kashid¹,

Rahool

Chaudhry³

et al. 2017

Int J Res Orthop

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Background: Arthroscopically aided anterior cruciate ligament reconstruction using hamstring graft can be fixed to femoral condyle by suspensory and aperture fixation methods. The following study was undertaken to investigate whether there is any difference in functional outcomes with these fixation methods as measured by the Lysholm knee score and to determine tunnel widening post operatively with these two methods and does it affect the functional outcome.Methods: 50 patients of clinically and radiologic ally diagnosed ACL tear fulfilling the inclusion and exclusion criteria were randomized into two groups to undergo arthroscopic ACL reconstruction using quadrupled hamstring graft with suspensory (n=25) and aperture (n=25) fixation methods on femoral side. They were compared post operatively with Lysholm score, clinical laxity tests and percentage of tunnel enlargement using computed tomograms at 01 year.Results: At the end of 6 months there was no much difference in Lysholm score between both the groups (P =0.663) and at the end of 01 year aperture group had slightly better outcome. However, the difference was not statistically significant (p =0.173). There was more tunnel widening in the suspensory group especially of the femoral tunnel in the coronal plane. However, the amount of tunnel widening in both the groups was not significant statistically (P =0.071 and P =0.963). Tunnel widening is not associated with inferior clinical outcomes or functional knee score.Conclusions: Aperture and Suspensory fixation methods of hamstring graft at femoral condyle in ACL reconstruction are comparable clinically and there is no advantage of one particular method over other. Although comparatively more tunnel widening is seen in suspensory fixation methods; it does not affect the final clinical outcomes or functional knee scores.

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Section: Discussionmentioning

confidence: 99%

Comparative study between aperture and suspensary fixation of hamstring autografts on femoral side in ACL reconstruction: clinical and radiological outcome assessment

Kashid¹,

Rahool

Chaudhry³

et al. 2017

Int J Res Orthop

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“…Functional clinical assessment scores did not demonstrate any significant differences, which may be due to the relatively low sensitivity and specificity demonstrated for clinical scores in the detection of minimal changes [17]. HGCS hamstring graft condition score Additional BPA could not prevent femoral TW although a reduction of interface micromotion, which is the predominant aetiological factor in theories on TW [10], due to superior biomechanical properties has been suggested. Several authors found fixation constructs augmented with cancellous bone plugs had higher stiffness values and pullout forces than fixation constructs alone [6,11].…”

Section: Discussionmentioning

confidence: 92%

“…at the time when TW occurs [18,19]. In that instance, TW was the result of stronger mechanical and biological mechanisms [10].…”

Section: Discussionmentioning

confidence: 99%

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Improved outcomes after anterior cruciate ligament reconstruction with quadrupled hamstring autografts and additional bone plug augmentation at five year follow-up

Nebelung

Deitmer²,

Gebing³

et al. 2012

International Orthopaedics (SICOT)

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Purpose Hybrid fixation has been proposed to improve outcomes of anterior cruciate ligament (ACL) reconstructions. This study evaluated midterm outcomes after transfemoral graft fixation using either a conventional or a modified technique using additional bone plug augmentation (BPA) of the femoral tunnel aperture. Methods Seventy-one consecutive patients undergoing ACL reconstruction using a quadrupled hamstring autograft with transfemoral graft fixation and tibial interference screw fixation were included. Of these, 56 patients could be followed up 61 months (range 52-69 months) after ACL reconstruction both clinically and by magnetic resonance imaging (group A, conventional technique, n034; group B, modified technique, n022). Anteroposterior (AP) laxity measurements and International Knee Documentation Committee (IKDC), Lysholm and Tegner activity scoring were performed, while imaging included assessment of bone tunnel diameters, graft condition and graft filling at the femoral bone tunnel aperture. Results Patients with additional BPA had a significantly higher degree of graft filling at the femoral bone tunnel aperture (p0.0135) and 'healthier' grafts (p0.0495). They also tended to display less AP laxity difference in terms of mean differences and total patient numbers. Lysholm, IKDC and Tegner activity index scores and bone tunnel diameters were not significantly different. Conclusions Additional BPA is an easy-to-perform, cheap and safe manoeuvre, which has the capacity to improve morphological and clinical outcomes at five year followup. However, femoral tunnel widening is unaffected by additional BPA.

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“…It results in potential higher knee laxity that could be an early sign of a bad postoperative result. Bone resorption and osteolytic processes in this area are the reasons for tunnel widening [24]. There is growing evidence that interleukin-1β (IL-1β) plays an important role in the pathogenesis of bone tunnel enlargement following ACL reconstruction [7,13,16].…”

mentioning

confidence: 99%

Correlation between synovial fluid and serum IL-1β levels after ACL surgery–preliminary report

Daraboš

Hundrić-Hašpl

Hašpl

et al. 2008

International Orthopaedics (SICOT)

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The possibility of controlling the harmful intraarticular influence of elevated interleukin (IL)-1β synovial fluid concentration after anterior cruciate ligament (ACL) surgery could be useful. We investigated the correlation between serum and synovial fluid IL-1β levels following ACL reconstruction. We measured IL-1β concentration periodically in three synovial fluid and four serum samples in each of 20 patients receiving either autologous conditioned serum (ACS) containing endogenous anti-inflammatory cytokines including IL-1Ra and several growth factors (group A) or placebo (group B). A decrease in IL-1β synovial fluid concentration appeared to be more pronounced in absolute terms in group A. In eight patients serum IL-1β was detected on the 6th postoperative day. In four of them whose synovial fluid levels were over 10 pg/ml on the 6th postoperative day, serum IL-1β was detected on the 10th postoperative day. The results were different in group B. Correlation between serum and synovial fluid IL-1β appearance persists in patients after ACL surgery and ACS application. This study is an example of ACS influence on the ACL healing process controlling the IL-1β levels on the basis of the serum IL-1β detection.

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Tunnel Enlargement after Anterior Cruciate Ligament Surgery

Cited by 273 publications

References 49 publications

Comparative study between aperture and suspensary fixation of hamstring autografts on femoral side in ACL reconstruction: clinical and radiological outcome assessment

Comparative study between aperture and suspensary fixation of hamstring autografts on femoral side in ACL reconstruction: clinical and radiological outcome assessment

Improved outcomes after anterior cruciate ligament reconstruction with quadrupled hamstring autografts and additional bone plug augmentation at five year follow-up

Correlation between synovial fluid and serum IL-1β levels after ACL surgery–preliminary report

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