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High incidence of tunnel widening after anterior cruciate ligament reconstruction with transtibial femoral tunnel placement.

Abstract：

BACKGROUND:This study evaluated the incidence, amount, morphology and clinical significance of bone tunnel widening (TW) at a mean 5-year period after anterior cruciate ligament reconstruction (ACLR) with a transtibial drilling technique. METHODS:Fifty-nine patients undergoing primary ACLR using quadrupled hamstring autografts, biodegradable transfemoral pins for femoral-sided and 2-mm oversized interference screws for tibial-sided graft fixation were followed up at a mean 61 months postoperatively. Patients were examined clinically and by MRI. Tunnel cross-sectional areas (CSA) were related to drill diameters, which were significantly correlated with radiographic tunnel sizes. Tunnel morphologies were assessed and their positions determined using an anatomical coordinate system. RESULTS:CSA had more than doubled in all segments measured (p < 0.0001) except at the femoral notch level. Greatest CSA increases were found at the femoral graft suspension point (122 %) and at the central tibial tunnel segment (134 %). 54 (92) and 56 (95 %) patients had significant TW, i.e., CSA increase of more than 50 %, in at least one tunnel segment femorally and tibially. Four different tunnel morphologies were observed, of which the linear type was most often encountered on either side. Mean side-to-side difference in anterior-posterior laxity was 1.0 ± 1.4 mm, while Lysholm, IKDC and Tegner activity scores were 90 ± 12, 84 ± 15 and 4 (1-9); clinical outcomes were not found to be correlated with tunnel sizes and morphologies as were tunnel positions and tunnel sizes. CONCLUSIONS:This study demonstrates that considerable TW occurs in virtually all patients in the mid term after ACLR using a transtibial drilling technique with 'high' femoral tunnel positions. Yet, neither amount nor morphology or tunnel position does affect knee stability or function.

journal_name

Arch Orthop Trauma Surg

journal_title

Archives of orthopaedic and trauma surgery

authors

Nebelung S,Deitmer G,Gebing R,Reichwein F,Nebelung W

doi

10.1007/s00402-012-1596-2

subject

Has Abstract

pub_date

2012-11-01 00:00:00

pages

1653-63

issue

eissn

0936-8051

issn

1434-3916

journal_volume

132

pub_type

杂志文章

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High incidence of tunnel widening after anterior cruciate ligament reconstruction with transtibial femoral tunnel placement.