Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
권호 표지
DOI QR코드

DOI QR Code

Bone Tunnel Diameter Measured with CT after Anterior Cruciate Ligament Reconstruction Using Double-Bundle Auto-Hamstring Tendons: Clinical Implications

  • Yoon, Soo Jeong (Department of Radiology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Yoon, Young Cheol (Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Bae, So Young (Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Wang, Joon Ho (Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • Received : 2015.02.16
  • Accepted : 2015.07.21
  • Published : 2015.11.01
⟨ Previous Next ⟩

Abstract

Objective: To evaluate the correlation between bone tunnel diameter after anterior cruciate ligament (ACL) reconstruction measured by computed tomography (CT) using multiplanar reconstruction (MPR) and stability or clinical scores. Materials and Methods: Forty-seven patients (41 men and 6 women, mean age: 34 years) who had undergone ACL reconstruction with the double bundle technique using auto-hamstring graft and had subsequently received CT scans immediately after the surgery (T1: range, 1-4 days, mean, 2.5 days) and at a later time (T2: range, 297-644 days, mean, 410.4 days) were enrolled in this study. The diameter of each tunnel (two femoral and two tibial) at both T1 and T2 were independently measured using MPR technique by two radiologists. Stability and clinical scores were evaluated with a KT-2000 arthrometer, International Knee Documentation Committee objective scores, and the Lysholm score. Statistical analysis of the correlation between the diameter at T2 or the interval diameter change ratio ([T2 - T1] / T1) and clinical scores or stability was investigated. Results: The tibial bone tunnels for the anteromedial bundles were significantly widened at T2 compared with T1 (observer 1, 0.578mm to 0.698mm, p value of < 0.001; observer 2, 0.581mm to 0.707mm, p value of < 0.001). There was no significant correlation between the diameter at T2 and stability or clinical scores and between the interval change ratio ([T2 - T1] / T1) and stability or clinical scores (corrected p values for all were 1.0). Intraobserver agreement for measurements was excellent (> 0.8) for both observers. Interobserver agreement for measurement was excellent (> 0.8) except for the most distal portion of the femoral bone tunnel for anterior medial bundle in immediate postoperative CT, which showed moderate agreement (concordance correlation coefficient = 0.6311). Conclusion: Neither the diameter nor its change ratio during interval follow-up is correlated with stability or clinical scores.

Keywords

References

  1. Marchant MH Jr, Willimon SC, Vinson E, Pietrobon R, Garrett WE, Higgins LD. Comparison of plain radiography, computed tomography, and magnetic resonance imaging in the evaluation of bone tunnel widening after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2010;18:1059-1064 https://doi.org/10.1007/s00167-009-0952-4
  2. Iorio R, Di Sanzo V, Vadalà A, Conteduca J, Mazza D, Redler A, et al. ACL reconstruction with hamstrings: how different technique and fixation devices influence bone tunnel enlargement. Eur Rev Med Pharmacol Sci 2013;17:2956-2961
  3. Struewer J, Efe T, Frangen TM, Schwarting T, Buecking B, Ruchholtz S, et al. Prevalence and influence of tibial tunnel widening after isolated anterior cruciate ligament reconstruction using patella-bone-tendon-bone-graft: longterm follow-up. Orthop Rev (Pavia) 2012;4:e21 https://doi.org/10.4081/or.2012.e21
  4. Wilson TC, Kantaras A, Atay A, Johnson DL. Tunnel enlargement after anterior cruciate ligament surgery. Am J Sports Med 2004;32:543-549 https://doi.org/10.1177/0363546504263151
  5. Kawaguchi Y, Kondo E, Kitamura N, Kai S, Inoue M, Yasuda K. Comparisons of femoral tunnel enlargement in 169 patients between single-bundle and anatomic double-bundle anterior cruciate ligament reconstructions with hamstring tendon grafts. Knee Surg Sports Traumatol Arthrosc 2011;19:1249-1257 https://doi.org/10.1007/s00167-011-1455-7
  6. Iorio R, Vadalà A, Di Vavo I, De Carli A, Conteduca F, Argento G, et al. Tunnel enlargement after anterior cruciate ligament reconstruction in patients with post-operative septic arthritis. Knee Surg Sports Traumatol Arthrosc 2008;16:921-927 https://doi.org/10.1007/s00167-008-0575-1
  7. Chen CH, Chang CH, Su CI, Wang KC, Liu HT, Yu CM, et al. Arthroscopic single-bundle anterior cruciate ligament reconstruction with periosteum-enveloping hamstring tendon graft: clinical outcome at 2 to 7 years. Arthroscopy 2010;26:907-917 https://doi.org/10.1016/j.arthro.2009.11.011
  8. Plaweski S, Rossi J, Merloz P. Anterior cruciate ligament reconstruction: assessment of the hamstring autograft femoral fixation using the EndoButton CL. Orthop Traumatol Surg Res 2009;95:606-613 https://doi.org/10.1016/j.otsr.2009.09.011
  9. Webster KE, Feller JA, Hameister KA. Bone tunnel enlargement following anterior cruciate ligament reconstruction: a randomised comparison of hamstring and patellar tendon grafts with 2-year follow-up. Knee Surg Sports Traumatol Arthrosc 2001;9:86-91 https://doi.org/10.1007/s001670100191
  10. Moisala AS, Järvelä T, Paakkala A, Paakkala T, Kannus P, Järvinen M. Comparison of the bioabsorbable and metal screw fixation after ACL reconstruction with a hamstring autograft in MRI and clinical outcome: a prospective randomized study. Knee Surg Sports Traumatol Arthrosc 2008;16:1080-1086 https://doi.org/10.1007/s00167-008-0593-z
  11. Buelow JU, Siebold R, Ellermann A. A prospective evaluation of tunnel enlargement in anterior cruciate ligament reconstruction with hamstrings: extracortical versus anatomical fixation. Knee Surg Sports Traumatol Arthrosc 2002;10:80-85 https://doi.org/10.1007/s00167-001-0267-6
  12. Ito MM, Tanaka S. Evaluation of tibial bone-tunnel changes with X-ray and computed tomography after ACL reconstruction using a bone-patella tendon-bone autograft. Int Orthop 2006;30:99-103 https://doi.org/10.1007/s00264-006-0078-y
  13. Fink C, Zapp M, Benedetto KP, Hackl W, Hoser C, Rieger M. Tibial tunnel enlargement following anterior cruciate ligament reconstruction with patellar tendon autograft. Arthroscopy 2001;17:138-143 https://doi.org/10.1053/jars.2001.21509
  14. Vitkus L, Fiodorovas M, Pocius G. [Knee joint evaluation after anterior cruciate ligament plasty]. Medicina (Kaunas) 2002;38:510-514
  15. Siebold R, Kiss ZS, Morris HG. Effect of compaction drilling during ACL reconstruction with hamstrings on postoperative tunnel widening. Arch Orthop Trauma Surg 2008;128:461-468 https://doi.org/10.1007/s00402-007-0443-3
  16. Webster KE, Chiu JJ, Feller JA. Impact of measurement error in the analysis of bone tunnel enlargement after anterior cruciate ligament reconstruction. Am J Sports Med 2005;33:1680-1687 https://doi.org/10.1177/0363546505275489
  17. Webster KE, Feller JA, Elliott J, Hutchison A, Payne R. A comparison of bone tunnel measurements made using computed tomography and digital plain radiography after anterior cruciate ligament reconstruction. Arthroscopy 2004;20:946-950 https://doi.org/10.1016/S0749-8063(04)00655-3
  18. Saupe N, White LM, Chiavaras MM, Essue J, Weller I, Kunz M, et al. Anterior cruciate ligament reconstruction grafts: MR imaging features at long-term follow-up--correlation with functional and clinical evaluation. Radiology 2008;249:581-590 https://doi.org/10.1148/radiol.2492071651
  19. Park WH, Kim DK, Yoo JC, Lee YS, Hwang JH, Chang MJ, et al. Correlation between dynamic postural stability and muscle strength, anterior instability, and knee scale in anterior cruciate ligament deficient knees. Arch Orthop Trauma Surg 2010;130:1013-1018 https://doi.org/10.1007/s00402-010-1080-9
  20. Ilaslan H, Sundaram M, Miniaci A. Imaging evaluation of the postoperative knee ligaments. Eur J Radiol 2005;54:178-188 https://doi.org/10.1016/j.ejrad.2005.01.021
  21. Neddermann A, Willbold E, Witte F, Hurschler C, Hankemeier S, Stübig T, et al. Tunnel widening after anterior cruciate ligament reconstruction: an experimental study in sheep. Am J Sports Med 2009;37:1609-1617 https://doi.org/10.1177/0363546509332251
  22. Fahey M, Indelicato PA. Bone tunnel enlargement after anterior cruciate ligament replacement. Am J Sports Med 1994;22:410-414 https://doi.org/10.1177/036354659402200318
  23. Fauno P, Kaalund S. Tunnel widening after hamstring anterior cruciate ligament reconstruction is influenced by the type of graft fixation used: a prospective randomized study. Arthroscopy 2005;21:1337-1341 https://doi.org/10.1016/j.arthro.2005.08.023
  24. Ghazikhanian V, Beltran J, Nikac V, Feldman M, Bencardino JT. Tibial tunnel and pretibial cysts following ACL graft reconstruction: MR imaging diagnosis. Skeletal Radiol 2012;41:1375-1379 https://doi.org/10.1007/s00256-012-1486-2
  25. Meuffels DE, Potters JW, Koning AH, Brown CH Jr, Verhaar JA, Reijman M. Visualization of postoperative anterior cruciate ligament reconstruction bone tunnels: reliability of standard radiographs, CT scans, and 3D virtual reality images. Acta Orthop 2011;82:699-703 https://doi.org/10.3109/17453674.2011.623566

Cited by

  1. Computed tomography value and tunnel enlargement of round and rounded rectangular femoral bone tunnel for anterior cruciate ligament reconstruction vol.136, pp.11, 2015, https://doi.org/10.1007/s00402-016-2541-6
  2. Postoperative Evaluation after Anterior Cruciate Ligament Reconstruction: Measurements and Abnormalities on Radiographic and CT Imaging vol.17, pp.6, 2015, https://doi.org/10.3348/kjr.2016.17.6.919
  3. Selection and Reporting of Statistical Methods to Assess Reliability of a Diagnostic Test: Conformity to Recommended Methods in a Peer-Reviewed Journal vol.18, pp.6, 2017, https://doi.org/10.3348/kjr.2017.18.6.888
  4. Predicting the graft diameter of the peroneus longus tendon for anterior cruciate ligament reconstruction vol.97, pp.44, 2015, https://doi.org/10.1097/md.0000000000012672
  5. Comparison of the aperture and midportion femoral tunnel widening after anterior cruciate ligament reconstruction : A systematic review and meta-analyses vol.98, pp.26, 2015, https://doi.org/10.1097/md.0000000000016121
  6. Tunnel osteolysis post-ACL reconstruction: a systematic review examining select diagnostic modalities, treatment options and rehabilitation protocols vol.27, pp.2, 2015, https://doi.org/10.1007/s00167-018-5142-9