Tunnel Widening After Anterior Cruciate Ligament Reconstruction: A Prospective Randomized Computed Tomography–Based Study Comparing 2 Different Femoral Fixation Methods for Hamstring Graft

Sabat, Dhananjaya; Kundu, Kundan; Arora, Sumit; Kumar, Vinod

doi:10.1016/j.arthro.2011.02.009

Cited by 70 publications

(59 citation statements)

References 32 publications

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“…The effect of mechanical load influences the cellular and molecular cascade of tendon-tobone healing. It has been illustrated that the closer the fixation to the joint, the lower the incidence of tunnel widening [36,37]. The graft motion influenced the proximal site of the graft more greatly than the distal site.…”

Section: Discussionmentioning

confidence: 99%

Cationised gelatin and hyaluronic acid coating enhances polyethylene terephthalate artificial ligament graft osseointegration in porcine bone tunnels

Cho

Chen

et al. 2012

International Orthopaedics (SICOT)

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Purpose The aim of this study was to investigate whether cationised gelatin and hyaluronic acid (CH) coating could induce polyethylene terephthalate (PET) artificial ligament graft osseointegration in the bone tunnel. Methods Surface modification of PET artificial ligament graft was performed by layer-by-layer (LBL) self-assembly CH coating. Six pigs underwent anterior cruciate ligament (ACL) reconstruction on the right knees, with three pigs receiving the CH-coated PET grafts and the other three pigs non-CH-coated PET grafts as controls. They were sacrificed at three months after surgery and the graft-bone complexes were acquired for computed tomography (CT) scan and histological examination. Results CT scans showed a significant difference at the distal femoral site (p00.031) or at the distal tibial site (p00.0078), but no significant difference in the bone tunnel areas' enlargement at other sites (p>0.05) between the CH group and the control group. Histologically, application of CH coating induced new bone formation between graft and bone at three months compared with the controls at the distal site. The interface width of the CH group was significantly lower than that of the control group at the distal femoral site (p00.0327) and at the distal tibial site (p00.0047). ConclusionsThe study has shown that CH coating on the PET artificial ligament surface has a positive biological effect in the induction of artificial ligament osseointegration within the bone tunnel at the distal site of the bone tunnel.

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Section: Discussionmentioning

confidence: 99%

Cationised gelatin and hyaluronic acid coating enhances polyethylene terephthalate artificial ligament graft osseointegration in porcine bone tunnels

Cho

Chen

et al. 2012

International Orthopaedics (SICOT)

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“…Extracortical suspension fixation presented a higher risk than other fixation devices [5, 11, 14]. However, it is a widely used strategy in ACL reconstruction with hamstring tendon in our country, as it is cost-effective and simple.…”

Section: Discussionmentioning

confidence: 99%

Bone tunnel impaction reduced the tibial tunnel enlargement

Zheng

Jin

2017

Open Medicine

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AbstractThe purpose of this study was to investigate whether the bone tunnel impaction technique performed by dilators could dwindle the tibial tunnel enlargement after anterior cruciate ligament (ACL) reconstruction with hamstring tendon using both extracortical suspensory fixation devices at femoral and tibial site.Thirty-one consecutive patients undergoing primary ACL reconstruction with the hamstring autograft were enrolled in this research. Patients were randomly allotted to group A (bone tunnel impaction technique using dilators) or group B (regular extraction bone tunnel drilling).ResultsThe average follow-up was 16.2 months. The mean femoral tunnel widening was 1.05 mm and 1.02 mm respectively in group A and B. The mean tibial tunnel widening was 0.61 mm and 1.08 mm respectively in group A and B. There was no statistical difference for tunnel enlargement between the two groups at the femoral site (P = 0.62) but significant difference at the tibial site (P < 0.0001).ConclusionBone tunnel impaction technique leaded to a reduction of tibial bone tunnel enlargement after ACL reconstruction with hamstring tendon using both extracortical suspensory fixation devices at femoral and tibial site.

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“…Cortical suspensory fixation/endobutton on the femoral side, overcomes problem associated with the confluence of tunnel. However, it carries the risk of significant tunnel widening later on 27. Biointerference screw causes least tunnel widening.…”

Section: Discussionmentioning

confidence: 99%

Outcome of double bundle anterior cruciate ligament reconstruction using crosspin and aperture fixation

Joshi

Jain

Goyal

et al. 2014

IJOO

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Background:Double bundle anterior cruciate ligament (DBACL) reconstruction is said to reproduce the native anterior cruciate ligament (ACL) anatomy better than single bundle anterior cruciate ligament, whether it leads to better functional results is debatable. Different fixation methods have been used for DBACL reconstruction, the most common being aperture fixation on tibial side and cortical suspensory fixation on the femoral side. We present the results of DBACL reconstruction technique, wherein on the femoral side anteromedial (AM) bundle is fixed with a crosspin and aperture fixation was done for the posterolateral (PL) bundle.Materials and Methods:Out of 157 isolated ACL injury patients who underwent ACL reconstruction, 100 were included in the prospective study. Arthroscopic DBACL reconstruction was done using ipsilateral hamstring autograft. AM bundle was fixed using Transfix (Arthrex, Naples, FL, USA) on the femoral side and bio interference screw (Arthrex, Naples, FL, USA) on the tibial side. PL bundle was fixed on femoral as well as on tibial side with a biointerference screw. Patients were evaluated using KT-1000 arthrometer, Lysholm score, International Knee Documentation Committee (IKDC) Score and isokinetic muscle strength testing.Methods:Out of 157 isolated ACL injury patients who underwent ACL reconstruction, 100 were included in the prospective study. Arthroscopic DBACL reconstruction was done using ipsilateral hamstring autograft. AM bundle was fixed using Transfix (Arthrex, Naples, FL, USA) on the femoral side and bio interference screw (Arthrex, Naples, FL, USA) on the tibial side. PL bundle was fixed on femoral as well as on tibial side with a biointerference screw. Patients were evaluated using KT-1000 arthrometer, Lysholm score, International Knee Documentation Committee (IKDC) Score and isokinetic muscle strength testing.Results:The KT-1000 results were evaluated using paired t test with the P value set at 0.001. At the end of 1 year, the anteroposterior side to side translation difference (KT-1000 manual maximum) showed mean improvement from 5.1 mm ± 1.5 preoperatively to 1.6 mm ± 1.2 (P < 0.001) postoperatively. The Lysholm score too showed statistically significant (P < 0.001) improvement from 52.4 ± 15.2 (range: 32-76) preoperatively to a postoperative score of 89.1 Â± 3.2 (range 67-100). According to the IKDC score 90% patients had normal results (Category A and B). The AM femoral tunnel initial posterior blow out was seen in 4 patients and confluence in the intraarticular part of the femoral tunnels was seen in 6 patients intraoperatively. The quadriceps strength on isokinetic testing had an average deficit of 10.3% while the hamstrings had a 5.2% deficit at the end of 1 year as compared with the normal side.Conclusion:Our study revealed that the DBACL reconstruction using crosspin fixation for AM bundle and aperture fixation for PL bundle on the femoral side resulted in significant improvement in KT 1000, Lysholm and IKDC scores.

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Tunnel Widening After Anterior Cruciate Ligament Reconstruction: A Prospective Randomized Computed Tomography–Based Study Comparing 2 Different Femoral Fixation Methods for Hamstring Graft

Cited by 70 publications

References 32 publications

Cationised gelatin and hyaluronic acid coating enhances polyethylene terephthalate artificial ligament graft osseointegration in porcine bone tunnels

Cationised gelatin and hyaluronic acid coating enhances polyethylene terephthalate artificial ligament graft osseointegration in porcine bone tunnels

Bone tunnel impaction reduced the tibial tunnel enlargement

Outcome of double bundle anterior cruciate ligament reconstruction using crosspin and aperture fixation

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