DOI QR코드

DOI QR Code

Does Second-Generation Suspensory Implant Negate Tunnel Widening of First-Generation Implant Following Anterior Cruciate Ligament Reconstruction?

  • Received : 2018.01.11
  • Accepted : 2018.08.01
  • Published : 2018.12.01

Abstract

Purpose: Tunnel widening following anterior cruciate ligament (ACL) reconstruction is commonly observed. Graft micromotion is an important contributing factor. Unlike fixed-loop devices that require a turning space, adjustable-loop devices fit the graft snugly in the tunnel. The purpose of this study is to compare tunnel widening between these devices. Our hypothesis is that the adjustable-loop device will create lesser tunnel widening. Materials and Methods: Ninety-eight patients underwent ACL reconstruction from January 2013 to December 2014. An adjustable-loop device was used in 54 patients (group 1) and a fixed-loop device was used in 44 patients (group 2). Maximum tunnel widening at 1 year was measured by the L'Insalata's method. Functional outcome was measured at 2-year follow-up. Results: The mean widening was 4.37 mm (standard deviation [SD], 2.01) in group 1 and 4.09 mm (SD, 1.98) in group 2 (p=0.511). The average International Knee Documentation Committee score was 78.40 (SD, 9.99) in group 1 and 77.11 (SD, 12.31) in group 2 (p=0.563). The average Tegner-Lysholm score was 87.25 (SD, 3.97) in group 1 and 87.29 in group 2 (SD, 4.36) (p=0.987). There was no significant difference in tunnel widening and functional outcome between the groups. Conclusions: The adjustable-loop device did not decrease the amount of tunnel widening when compared to the fixed-loop device. There was no significant difference in outcome between the two fixation devices. Level of Evidence: Level 3, Retrospective Cohort.

Keywords

References

  1. Nebelung W, Becker R, Merkel M, Ropke M. Bone tunnel enlargement after anterior cruciate ligament reconstruction with semitendinosus tendon using Endobutton fixation on the femoral side. Arthroscopy. 1998;14:810-5. https://doi.org/10.1016/S0749-8063(98)70015-5
  2. Sabat D, Kundu K, Arora S, Kumar V. Tunnel widening after anterior cruciate ligament reconstruction: a prospective randomized computed tomography: based study comparing 2 different femoral fixation methods for hamstring graft. Arthroscopy. 2011;27:776-83. https://doi.org/10.1016/j.arthro.2011.02.009
  3. Baumfeld JA, Diduch DR, Rubino LJ, Hart JA, Miller MD, Barr MS, Hart JM. Tunnel widening following anterior cruciate ligament reconstruction using hamstring autograft: a comparison between double cross-pin and suspensory graft fixation. Knee Surg Sports Traumatol Arthrosc. 2008;16:1108-13. https://doi.org/10.1007/s00167-008-0606-y
  4. Fahey M, Indelicato PA. Bone tunnel enlargement after anterior cruciate ligament replacement. Am J Sports Med. 1994;22:410-4. https://doi.org/10.1177/036354659402200318
  5. Clatworthy MG, Annear P, Bulow JU, Bartlett RJ. Tunnel widening in anterior cruciate ligament reconstruction: a prospective evaluation of hamstring and patella tendon grafts. Knee Surg Sports Traumatol Arthrosc. 1999;7:138-45. https://doi.org/10.1007/s001670050138
  6. 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;17:138-43. https://doi.org/10.1053/jars.2001.21509
  7. Hoher J, Moller HD, Fu FH. Bone tunnel enlargement after anterior cruciate ligament reconstruction: fact or fiction? Knee Surg Sports Traumatol Arthrosc. 1998;6:231-40. https://doi.org/10.1007/s001670050105
  8. Hantes ME, Mastrokalos DS, Yu J, Paessler HH. The effect of early motion on tibial tunnel widening after anterior cruciate ligament replacement using hamstring tendon grafts. Arthroscopy. 2004;20:572-80. https://doi.org/10.1016/j.arthro.2004.04.069
  9. Silva A, Sampaio R, Pinto E. Femoral tunnel enlargement after anatomic ACL reconstruction: a biological problem? Knee Surg Sports Traumatol Arthrosc. 2010;18:1189-94. https://doi.org/10.1007/s00167-010-1046-z
  10. Giorgio N, Moretti L, Pignataro P, Carrozzo M, Vicenti G, Moretti B. Correlation between fixation systems elasticity and bone tunnel widening after ACL reconstruction. Muscles Ligaments Tendons J. 2016;6:467-72.
  11. Jansson KA, Harilainen A, Sandelin J, Karjalainen PT, Aronen HJ, Tallroth K. Bone tunnel enlargement after anterior cruciate ligament reconstruction with the hamstring autograft and endobutton fixation technique. A clinical, radiographic and magnetic resonance imaging study with 2 years follow-up. Knee Surg Sports Traumatol Arthrosc. 1999;7:290-5. https://doi.org/10.1007/s001670050166
  12. Choi NH, Oh JS, Jung SH, Victoroff BN. Correlation between endobutton loop length and tunnel widening after hamstring anterior cruciate ligament reconstruction. Am J Sports Med. 2013;41:101-6. https://doi.org/10.1177/0363546512466384
  13. Mermerkaya MU, Atay OA, Kaymaz B, Bekmez S, Karaaslan F, Doral MN. Anterior cruciate ligament reconstruction using a hamstring graft: a retrospective comparison of tunnel widening upon use of two different femoral fixation methods. Knee Surg Sports Traumatol Arthrosc. 2015;23:2283-91. https://doi.org/10.1007/s00167-014-3034-1
  14. Lind M, Feller J, Webster KE. Bone tunnel widening after anterior cruciate ligament reconstruction using EndoButton or EndoButton continuous loop. Arthroscopy. 2009;25:1275-80. https://doi.org/10.1016/j.arthro.2009.06.003
  15. Choi NH, Yang BS, Victoroff BN. Clinical and Radiological Outcomes After Hamstring Anterior Cruciate Ligament Reconstructions: Comparison Between Fixed-Loop and Adjustable-Loop Cortical Suspension Devices. Am J Sports Med. 2017;45:826-31. https://doi.org/10.1177/0363546516674183
  16. L'Insalata JC, Klatt B, Fu FH, Harner CD. Tunnel expansion following anterior cruciate ligament reconstruction: a comparison of hamstring and patellar tendon autografts. Knee Surg Sports Traumatol Arthrosc. 1997;5:234-8. https://doi.org/10.1007/s001670050056
  17. 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;10:80-5. https://doi.org/10.1007/s00167-001-0267-6
  18. Nebelung S, Deitmer G, Gebing R, Reichwein F, Nebelung W. High incidence of tunnel widening after anterior cruciate ligament reconstruction with transtibial femoral tunnel placement. Arch Orthop Trauma Surg. 2012;132:1653-63. https://doi.org/10.1007/s00402-012-1596-2
  19. Wilson TC, Kantaras A, Atay A, Johnson DL. Tunnel enlargement after anterior cruciate ligament surgery. Am J Sports Med. 2004;32:543-9. https://doi.org/10.1177/0363546504263151
  20. Ko YW, Rhee SJ, Kim IW, Yoo JD. The Correlation of tunnel position, orientation and tunnel enlargement in outsidein single-bundle anterior cruciate ligament reconstruction. Knee Surg Relat Res. 2015;27:247-54. https://doi.org/10.5792/ksrr.2015.27.4.247
  21. Hwang DH, Shetty GM, Kim JI, Kwon JH, Song JK, Munoz M, Lee JS, Nha KW. Does press-fit technique reduce tunnel volume enlargement after anterior cruciate ligament reconstruction with autologous hamstring tendons? A prospective randomized computed tomography study. Arthroscopy. 2013;29:83-8. https://doi.org/10.1016/j.arthro.2012.07.007
  22. Saygi B, Karaman O, Sirin E, Arslan I, Demir A, Oztermeli A. Comparison of different femoral fixation implants and fit techniques for tunnel widening and clinical outcome in ACL reconstruction using hamstring autograft. Arch Orthop Trauma Surg. 2016;136:241-7. https://doi.org/10.1007/s00402-015-2348-x
  23. Colombet P, Graveleau N, Jambou S. Incorporation of hamstring grafts within the tibial tunnel after anterior cruciate ligament reconstruction: magnetic resonance imaging of suspensory fixation versus interference screws. Am J Sports Med. 2016;44:2838-45. https://doi.org/10.1177/0363546516656181
  24. Barrow AE, Pilia M, Guda T, Kadrmas WR, Burns TC. Femoral suspension devices for anterior cruciate ligament reconstruction: do adjustable loops lengthen? Am J Sports Med. 2014;42:343-9. https://doi.org/10.1177/0363546513507769
  25. Rodeo SA, Kawamura S, Kim HJ, Dynybil C, Ying L. Tendon healing in a bone tunnel differs at the tunnel entrance versus the tunnel exit: an effect of graft-tunnel motion? Am J Sports Med. 2006;34:1790-800. https://doi.org/10.1177/0363546506290059
  26. Dyer CR, Elrod BF. Tibial and femoral bone tunnel enlargement following allograft replacement of the anterior cruciate ligament. Arthroscopy. 1995;11:353-4.
  27. Peyrache MD, Djian P, Christel P, Witvoet J. Tibial tunnel enlargement after anterior cruciate ligament reconstruction by autogenous bone-patellar tendon-bone graft. Knee Surg Sports Traumatol Arthrosc. 1996;4:2-8. https://doi.org/10.1007/BF01565989
  28. 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;20:946-50. https://doi.org/10.1016/S0749-8063(04)00655-3

Cited by

  1. What Has Been Learned in Anterior Cruciate Ligament Reconstruction during the Past 20 Years? vol.56, pp.1, 2018, https://doi.org/10.4055/jkoa.2021.56.1.1
  2. A prospective randomized study of arthroscopic ACL reconstruction with adjustable- versus fixed-loop device for femoral side fixation vol.33, pp.1, 2018, https://doi.org/10.1186/s43019-021-00124-0