Length of the Tendon within the Tibial Tunnel Affects Tibial Tunnel Widening following Anatomic Anterior Cruciate Ligament Reconstruction Using a Bone–Patellar Tendon–Bone Graft

Shuji Taketomi; Hiroshi Inui; Ryota Yamagami; Kohei Kawaguchi; Keiu Nakazato; Kenichi Kono; Manabu Kawata; Takumi Nakagawa; Sakae Tanaka

doi:10.1055/s-0039-1681064

The Journal of Knee Surgery, Inhaltsverzeichnis

J Knee Surg 2020; 33(05): 445-451
DOI: 10.1055/s-0039-1681064

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Length of the Tendon within the Tibial Tunnel Affects Tibial Tunnel Widening following Anatomic Anterior Cruciate Ligament Reconstruction Using a Bone–Patellar Tendon–Bone Graft

Autoren

Shuji Taketomi

¹Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
Hiroshi Inui

¹Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
Ryota Yamagami

¹Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
Kohei Kawaguchi

¹Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
Keiu Nakazato

¹Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
Kenichi Kono

¹Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
Manabu Kawata

¹Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
Takumi Nakagawa

²Department of Orthopaedic Surgery, Teikyo University, Tokyo, Japan
Sakae Tanaka

¹Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan

Abstract

The purpose of this study was to retrospectively investigate the effects of variations in the length of the tendon within the tibial tunnel on tunnel widening (TW) following anatomical anterior cruciate ligament (ACL) reconstruction using a bone–patellar tendon–bone (BTB) graft. In total, 68 patients who underwent isolated ACL reconstructions using BTB grafts were included in this study. The patients were divided into two groups according to the length of the tendon within the tibial tunnel: group S (n = 30; tendon length, < 10 mm) and group L (n = 38; tendon length, ≥ 10 mm). Tunnel aperture area was measured using three-dimensional computed tomography (3D CT) at 1 week and 1 year postoperatively, and tibial TW (%) was calculated. The correlation coefficient between the length of the tendon within the tibial tunnel and tibial TW was also calculated. Clinical assessment was performed 1 year postoperatively, corresponding to the period of CT assessment, which involved the evaluation of the Lysholm's score, measurement of anterior knee stability using a KneeLax3 arthrometer, and the pivot-shift test. A weak positive correlation was observed between the length of the tendon within the tibial tunnel and tibial TW (r = 0.270, p = 0.026). Mean tibial tunnel aperture area increased by 19.3 ± 17.4% and 35.8 ± 25.4% in the groups S and L, respectively. TW in the group L was significantly greater than that in the group S (p = 0.004). No significant difference was observed between the two groups in any clinical outcomes. In conclusion, a longer tendinous portion within the tibial tunnel resulted in a greater tibial TW following anatomical ACL reconstructions using a BTB graft.

Keywords

tunnel widening - tibial tunnel - bone–patellar tendon–bone graft - anterior cruciate ligament

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Referenzen

References
1 Darabos N, Haspl M, Moser C, Darabos A, Bartolek D, Groenemeyer D. Intraarticular application of autologous conditioned serum (ACS) reduces bone tunnel widening after ACL reconstructive surgery in a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 2011; 19 (Suppl. 01) S36-S46
2 Höher J, Möller HD, Fu FH. Bone tunnel enlargement after anterior cruciate ligament reconstruction: fact or fiction?. Knee Surg Sports Traumatol Arthrosc 1998; 6 (04) 231-240
3 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 (06) 776-783
4 Baumfeld JA, Diduch DR, Rubino LJ. , et al. 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 (12) 1108-1113
5 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 (04) 234-238
6 Järvelä T, Moisala AS, Paakkala T, Paakkala A. Tunnel enlargement after double-bundle anterior cruciate ligament reconstruction: a prospective, randomized study. Arthroscopy 2008; 24 (12) 1349-1357
7 Wilson TC, Kantaras A, Atay A, Johnson DL. Tunnel enlargement after anterior cruciate ligament surgery. Am J Sports Med 2004; 32 (02) 543-549
8 Nakagawa T, Takeda H, Nakajima K. , et al. Intraoperative 3-dimensional imaging-based navigation-assisted anatomic double-bundle anterior cruciate ligament reconstruction. Arthroscopy 2008; 24 (10) 1161-1167
9 Taketomi S, Nakagawa T, Takeda H. , et al. Anatomical placement of double femoral tunnels in anterior cruciate ligament reconstruction: anteromedial tunnel first or posterolateral tunnel first?. Knee Surg Sports Traumatol Arthrosc 2011; 19 (03) 424-431
10 Taketomi S, Inui H, Nakamura K. , et al. Secure fixation of femoral bone plug with a suspensory button in anatomical anterior cruciate ligament reconstruction with bone-patellar tendon-bone graft. Joints 2016; 3 (03) 102-108
11 Shino K, Nakata K, Nakamura N. , et al. Rectangular tunnel double-bundle anterior cruciate ligament reconstruction with bone-patellar tendon-bone graft to mimic natural fiber arrangement. Arthroscopy 2008; 24 (10) 1178-1183
12 Shino K, Suzuki T, Iwahashi T. , et al. The resident's ridge as an arthroscopic landmark for anatomical femoral tunnel drilling in ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2010; 18 (09) 1164-1168
13 Ferretti M, Ekdahl M, Shen W, Fu FH. Osseous landmarks of the femoral attachment of the anterior cruciate ligament: an anatomic study. Arthroscopy 2007; 23 (11) 1218-1225
14 Taketomi S, Inui H, Yamagami R. , et al. Bone-patellar tendon-bone autograft versus hamstring tendon autograft for anatomical anterior cruciate ligament reconstruction with three-dimensional validation of femoral and tibial tunnel positions. J Knee Surg 2018; 31 (09) 866-874
15 Shino K, Horibe S, Hamada M. , et al. Allograft anterior cruciate ligament reconstruction. Tech Knee Surg 2002; 1 (02) 78-85
16 Tensho K, Shimodaira H, Aoki T. , et al. Bony landmarks of the anterior cruciate ligament tibial footprint: a detailed analysis comparing 3-dimensional computed tomography images to visual and histological evaluations. Am J Sports Med 2014; 42 (06) 1433-1440
17 Siebold R, Schuhmacher P, Fernandez F. , et al. Flat midsubstance of the anterior cruciate ligament with tibial “C”-shaped insertion site. Knee Surg Sports Traumatol Arthrosc 2015; 23 (11) 3136-3142
18 Schneider CA, Rasband WS, Eliceiri KW. NIH Image to ImageJ: 25 years of image analysis. Nat Methods 2012; 9 (07) 671-675
19 Lysholm J, Gillquist J. Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med 1982; 10 (03) 150-154
20 Nakamura N, Takeuchi R, Sawaguchi T, Ishikawa H, Saito T, Goldhahn S. Cross-cultural adaptation and validation of the Japanese knee injury and osteoarthritis outcome score (KOOS). J Orthop Sci 2011; 16 (05) 516-523
21 Galway HR, MacIntosh DL. The lateral pivot shift: a symptom and sign of anterior cruciate ligament insufficiency. Clin Orthop Relat Res 1980; (147) 45-50
22 Hogervorst T, van der Hart CP, Pels Rijcken TH, Taconis WK. Abnormal bone scans of the tibial tunnel 2 years after patella ligament anterior cruciate ligament reconstruction: correlation with tunnel enlargement and tibial graft length. Knee Surg Sports Traumatol Arthrosc 2000; 8 (06) 322-328
23 Araki D, Kuroda R, Matsumoto T. , et al. Three-dimensional analysis of bone tunnel changes after anatomic double-bundle anterior cruciate ligament reconstruction using multidetector-row computed tomography. Am J Sports Med 2014; 42 (09) 2234-2241
24 Segawa H, Omori G, Tomita S, Koga Y. Bone tunnel enlargement after anterior cruciate ligament reconstruction using hamstring tendons. Knee Surg Sports Traumatol Arthrosc 2001; 9 (04) 206-210
25 Sabzevari S, Rahnemai-Azar AA, Shaikh HS, Arner JW, Irrgang JJ, Fu FH. Increased lateral tibial posterior slope is related to tibial tunnel widening after primary ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2017; 25 (12) 3906-3913
26 Yanagisawa S, Kimura M, Hagiwara K. , et al. Patient age as a preoperative factor associated with tunnel enlargement following double-bundle anterior cruciate ligament reconstruction using hamstring tendon autografts. Knee Surg Sports Traumatol Arthrosc 2018; 26 (04) 1230-1236
27 Kim YC, Tawonsawatruk T, Woon HH. , et al. The effect of different sagittal angles of the tibial guide on aperture widening of the tibial tunnel during modified transtibial anterior cruciate ligament reconstruction: a randomized in vivo study. Knee Surg Relat Res 2017; 29 (01) 26-32
28 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 (02) 80-85
29 Weber AE, Delos D, Oltean HN. , et al. Tibial and femoral tunnel changes after acl reconstruction: a prospective 2-year longitudinal MRI study. Am J Sports Med 2015; 43 (05) 1147-1156
30 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 (02) 86-91
31 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 (11) 1337-1341
32 Kuroda R, Hoshino Y, Araki D. , et al. Quantitative measurement of the pivot shift, reliability, and clinical applications. Knee Surg Sports Traumatol Arthrosc 2012; 20 (04) 686-691