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Tibial tunnel widening following anterior cruciate ligament reconstruction: A retrospective seven-year study evaluating the effects of initial graft tensioning and graft selection.

ABSTRACT: PURPOSE:To investigate tibial tunnel widening in ACL reconstruction patients over seven years to establish the effects of initial graft tension on tibial widening and clinical outcomes when using both patellar tendon (BTB) and hamstring tendon (HS) grafts. METHODS:Ninety patients, who were reconstructed with BTB or HS autografts, were randomized using one of two initial graft tension protocols; 1) tensioned to restore normal anteroposterior laxity ("low-tension"; n?=?46) and 2) tensioned to over-constrain anteroposterior (AP) laxity by two millimeters ("high-tension"; n?=?44). Seventy patients had post-surgical data with 45 available for review at seven years. Tunnel widening was assessed via radiographs at one-, three-, and seven-year follow-up. Patient-reported outcomes were compared. RESULTS:The mean?±?95% confidence intervals of the initial diameters for the BTB autografts were 10.3?±?0.5?mm (Low-tension) and 10.2?±?0.6?mm (High-tension) with final diameters of 10.8?±?0.6?mm (Low-tension) and 9.9?±?0.6?mm (High-tension). The initial diameters for HS autografts were 8.1?±?0.9?mm (Low-tension) and 8.4?±?0.7?mm (High-tension) with final diameters of 11.5?±?1.1?mm (Low-tension) and 11.1?±?0.9?mm (High-tension). For subjects with HS autografts, mean tunnel diameters significantly changed over time (p?

SUBMITTER: DeFroda SF

PROVIDER: S-EPMC6286238 | biostudies-literature | 2018 Dec

REPOSITORIES: biostudies-literature

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Tibial tunnel widening following anterior cruciate ligament reconstruction: A retrospective seven-year study evaluating the effects of initial graft tensioning and graft selection.

DeFroda Steven F SF Karamchedu Naga Padmini NP Owens Brett D BD Bokshan Steven L SL Sullivan Kayleigh K Fadale Paul D PD Hulstyn Michael J MJ Shalvoy Robert M RM Badger Gary J GJ Fleming Braden C BC

The Knee 20181107 6

<h4>Purpose</h4>To investigate tibial tunnel widening in ACL reconstruction patients over seven years to establish the effects of initial graft tension on tibial widening and clinical outcomes when using both patellar tendon (BTB) and hamstring tendon (HS) grafts.<h4>Methods</h4>Ninety patients, who were reconstructed with BTB or HS autografts, were randomized using one of two initial graft tension protocols; 1) tensioned to restore normal anteroposterior laxity ("low-tension"; n = 46) and 2) te ...[more]

PMID: 30414786

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Project description:PurposeThe consequence of tunnel widening after ACL reconstructions is foremost of importance in case of revision surgery. Tunnel expansion leads to bone loss close to the joint, and additional surgery with bone grafting prior to revision surgery might be necessary. The purpose of the study was to measure widening of the tunnels in single-bundle (SB) and double-bundle (DB) ACL reconstructed knees during the first year after surgery, detected by a novel, semi-automated 3D CT imaging modality. Our hypothesis was that there would be a difference between the initial tunnel size and the size measured one year post-operatively due to the tunnel widening process. Further, the purpose was to evaluate whether there were any differences in the amount of tunnel widening between the two surgical techniques.MethodsTwenty patients who underwent DB ACL reconstruction, and 22 patients who underwent SB ACL reconstruction, performed a CT scan of the bony tunnels, during their first days after surgery and one year post-operatively. The CT scans were transformed into 3D CT reconstructions, and the tunnels were measured with the "best-fit cylinder" method, measurements at the level of tunnel aperture and 10.0 mm from the joint line.ResultsAll tunnels in the DB and SB ACL reconstructed knees exhibited widening during the first year after the operation (p < 0.001). The SB femoral tunnels showed more widening compared to the DB femoral AM tunnels (1.4 ± 0.9 vs. 0.5 ± 0.6 mm) (p < 0.001), and the SB tibial tunnels widened more compared to the DB tibial PL tunnels (1.0 ± 1.0 vs. 0.5 ± 0.6) (p < 0.043).ConclusionAll tunnels widened during the first year after the ACL reconstruction with a larger amount of widening in the SB tunnels compared to the DB femoral AM tunnels and the DB tibial PL tunnels. This is the first study to detect tunnel widening in DB reconstructed knees through a semi-automated 3D CT imaging modality.Level of evidenceProspective cohort study, Level III.

Dataset Information

Tibial tunnel widening following anterior cruciate ligament reconstruction: A retrospective seven-year study evaluating the effects of initial graft tensioning and graft selection.

Publications

Tibial tunnel widening following anterior cruciate ligament reconstruction: A retrospective seven-year study evaluating the effects of initial graft tensioning and graft selection.

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