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Tunnel Enlargement and Coalition After Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction With Hamstring Tendon Autografts: A Computed Tomography Study.

Kawaguchi Y, Kondo E, Onodera J, Kitamura N, Sasaki T, Yagi T, Yasuda K - Orthop J Sports Med (2013)

Bottom Line: The grafts were simultaneously fixed at 10° of knee flexion with EndoButtons and spiked staples.All patients were examined with computed tomography and the standard clinical evaluation methods at 2 weeks and 1 year after surgery.On the femoral and tibial intra-articular surface, tunnel outlet coalition was found in 5% and 77% of the knees, respectively, at 1 year after surgery.

View Article: PubMed Central - PubMed

Affiliation: Department of Sports Medicine and Joint Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan.

ABSTRACT

Background: Tunnel enlargement and coalition following double-bundle anterior cruciate ligament (ACL) reconstruction with hamstring tendon autografts has not yet been sufficiently studied.

Hypothesis: The incidence and the degree of femoral tunnel enlargement will be significantly greater than those for tibial tunnel enlargement after anatomic double-bundle ACL reconstruction using hamstring tendon autografts. There will be no significant correlation between tunnel enlargement and coalition and the postoperative knee laxity.

Study design: Case series; Level of evidence, 4.

Methods: Thirty-nine patients who underwent anatomic double-bundle ACL reconstruction using semitendinosus and gracilis tendon autografts were followed up for 1 year after surgery. The grafts were simultaneously fixed at 10° of knee flexion with EndoButtons and spiked staples. All patients were examined with computed tomography and the standard clinical evaluation methods at 2 weeks and 1 year after surgery.

Results: The degree of tunnel enlargement of the femoral anteromedial and posterolateral tunnels averaged 10% to 11% and 7% to 9%, respectively, while that of the tibial anteromedial and posterolateral tunnels averaged 3% to 7% and 1% to 6%. The degree and incidence of the anteromedial and posterolateral tunnel enlargement were significantly greater in the femur than in the tibia (P < .0335 and P < .0405, respectively). On the femoral and tibial intra-articular surface, tunnel outlet coalition was found in 5% and 77% of the knees, respectively, at 1 year after surgery. There was no significant correlation between tunnel enlargement and coalition and the clinical outcome.

Conclusion: The incidence and the degree of each tunnel enlargement in the femur were significantly greater than that in the tibia. However, the incidence of tunnel coalition in the femur was significantly less than that in the tibia after double-bundle ACL reconstruction with a transtibial technique. There was no significant correlation between tunnel enlargement and coalition and the clinical outcome.

Clinical relevance: The present study provides orthopaedic surgeons with important information on double-bundle ACL reconstruction with hamstring tendons.

No MeSH data available.


Related in: MedlinePlus

Three-dimensional computed tomography scan of (A) the femur and (B) the tibia with anatomic double-bundle anterior cruciate ligament reconstruction at 1 year after surgery.
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fig4-2325967113486441: Three-dimensional computed tomography scan of (A) the femur and (B) the tibia with anatomic double-bundle anterior cruciate ligament reconstruction at 1 year after surgery.

Mentions: All patients underwent CT examination at 2 weeks and 1 year after surgery. The CT scans of the knee were taken in standard axial, sagittal, and coronal views for the purpose of measuring tunnel widening.8,10,25 The 2-dimensional (2D) and 3-dimensional (3D) CT images were taken using a 64-slice multidetector CT (Aquilion 64; Toshiba Medical Systems, Tochigi, Japan), and the images were processed using a work station (Ziostation 2; Ziosoft, Tokyo, Japan). With the knee in full extension, scanning was performed from proximal to the femoral tunnel to distal to the tibial tunnel to visualize the position of the autograft fixation. The 0.5-mm sections were secondarily reconstructed with a bony algorithm to allow multiplanar reconstructions (1-mm thickness per 1-mm interval) from the axial data set. The minimum change in tunnel diameter that can be detected reliably is 0.35 mm. Coronal reconstructions were performed to a level parallel to a line joining the posterior femoral condyles, and sagittal reconstructions were performed to a level parallel to the outer rim of the lateral femoral condyle (Figures 2 and 3). The 3D images were also reconstructed with a soft tissue algorithm using the volume-rendering technique (Figure 4).


Tunnel Enlargement and Coalition After Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction With Hamstring Tendon Autografts: A Computed Tomography Study.

Kawaguchi Y, Kondo E, Onodera J, Kitamura N, Sasaki T, Yagi T, Yasuda K - Orthop J Sports Med (2013)

Three-dimensional computed tomography scan of (A) the femur and (B) the tibia with anatomic double-bundle anterior cruciate ligament reconstruction at 1 year after surgery.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License 1 - License 2 - License 3
Show All Figures
getmorefigures.php?uid=PMC4555502&req=5

fig4-2325967113486441: Three-dimensional computed tomography scan of (A) the femur and (B) the tibia with anatomic double-bundle anterior cruciate ligament reconstruction at 1 year after surgery.
Mentions: All patients underwent CT examination at 2 weeks and 1 year after surgery. The CT scans of the knee were taken in standard axial, sagittal, and coronal views for the purpose of measuring tunnel widening.8,10,25 The 2-dimensional (2D) and 3-dimensional (3D) CT images were taken using a 64-slice multidetector CT (Aquilion 64; Toshiba Medical Systems, Tochigi, Japan), and the images were processed using a work station (Ziostation 2; Ziosoft, Tokyo, Japan). With the knee in full extension, scanning was performed from proximal to the femoral tunnel to distal to the tibial tunnel to visualize the position of the autograft fixation. The 0.5-mm sections were secondarily reconstructed with a bony algorithm to allow multiplanar reconstructions (1-mm thickness per 1-mm interval) from the axial data set. The minimum change in tunnel diameter that can be detected reliably is 0.35 mm. Coronal reconstructions were performed to a level parallel to a line joining the posterior femoral condyles, and sagittal reconstructions were performed to a level parallel to the outer rim of the lateral femoral condyle (Figures 2 and 3). The 3D images were also reconstructed with a soft tissue algorithm using the volume-rendering technique (Figure 4).

Bottom Line: The grafts were simultaneously fixed at 10° of knee flexion with EndoButtons and spiked staples.All patients were examined with computed tomography and the standard clinical evaluation methods at 2 weeks and 1 year after surgery.On the femoral and tibial intra-articular surface, tunnel outlet coalition was found in 5% and 77% of the knees, respectively, at 1 year after surgery.

View Article: PubMed Central - PubMed

Affiliation: Department of Sports Medicine and Joint Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan.

ABSTRACT

Background: Tunnel enlargement and coalition following double-bundle anterior cruciate ligament (ACL) reconstruction with hamstring tendon autografts has not yet been sufficiently studied.

Hypothesis: The incidence and the degree of femoral tunnel enlargement will be significantly greater than those for tibial tunnel enlargement after anatomic double-bundle ACL reconstruction using hamstring tendon autografts. There will be no significant correlation between tunnel enlargement and coalition and the postoperative knee laxity.

Study design: Case series; Level of evidence, 4.

Methods: Thirty-nine patients who underwent anatomic double-bundle ACL reconstruction using semitendinosus and gracilis tendon autografts were followed up for 1 year after surgery. The grafts were simultaneously fixed at 10° of knee flexion with EndoButtons and spiked staples. All patients were examined with computed tomography and the standard clinical evaluation methods at 2 weeks and 1 year after surgery.

Results: The degree of tunnel enlargement of the femoral anteromedial and posterolateral tunnels averaged 10% to 11% and 7% to 9%, respectively, while that of the tibial anteromedial and posterolateral tunnels averaged 3% to 7% and 1% to 6%. The degree and incidence of the anteromedial and posterolateral tunnel enlargement were significantly greater in the femur than in the tibia (P < .0335 and P < .0405, respectively). On the femoral and tibial intra-articular surface, tunnel outlet coalition was found in 5% and 77% of the knees, respectively, at 1 year after surgery. There was no significant correlation between tunnel enlargement and coalition and the clinical outcome.

Conclusion: The incidence and the degree of each tunnel enlargement in the femur were significantly greater than that in the tibia. However, the incidence of tunnel coalition in the femur was significantly less than that in the tibia after double-bundle ACL reconstruction with a transtibial technique. There was no significant correlation between tunnel enlargement and coalition and the clinical outcome.

Clinical relevance: The present study provides orthopaedic surgeons with important information on double-bundle ACL reconstruction with hamstring tendons.

No MeSH data available.


Related in: MedlinePlus