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J Knee Surg 2017; 30(06): 501-508
DOI: 10.1055/s-0036-1593367
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Relationship between Widening and Position of the Tunnels and Clinical Results of Anterior Cruciate Ligament Reconstruction to Knee Osteoarthritis: 30 Patients at a Minimum Follow-Up of 10 Years

Juan Diego Ayala-Mejias
1   Department of Orthopaedic Surgery, Hospital San Rafael, Madrid, Spain
,
Benjamin Garcia-Gonzalez
1   Department of Orthopaedic Surgery, Hospital San Rafael, Madrid, Spain
,
Luis Alcocer-Perez-España
2   Sanatorio Quirúrgico Virgen del Mar, Madrid, Spain
,
Jorge Hugo Villafañe
3   IRCCS Don Gnocchi Foundation, Milan, Italy
,
Pedro Berjano
4   IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
› Institutsangaben
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Publikationsverlauf

22. Oktober 2015

11. August 2016

Publikationsdatum:
29. September 2016 (online)

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Abstract

To evaluate the relationship between tunnel position and widening and long-term clinical results in anterior cruciate ligament (ACL) reconstruction, a retrospective cohort of 30 patients undergoing ACL reconstruction with double semitendinous plus double gracilis (SAC technique) with longer than 10-year follow-up was selected. CT scans in the first 3 months and at final follow-up was evaluated. Position, angle, and widening of tunnels including Nebelung criteria were recorded in all CT scans. Physical, KT-1000, and clinical evaluation were performed at final follow-up. Outcomes and knee arthritis severity were evaluated at final follow-up. Mean follow-up was 11.2 ± 1.2. At final follow-up, 85 and 57% of tibial and femoral tunnels, respectively, developed some degree of enlargement. Frontal tibial angle (mean) was 72°, sagittal tibial angle 63°, frontal femoral angle 47°, sagittal femoral angle 20°, and tunnels divergence angle 36°. Preoperatively, KT-1000 30L and Lachman test scores were 5.52 and 5.79 respectively. In the last follow-up, 30L and manual Lachman test scores were 0.97 and 1.13, respectively (p < 0.001). In IKDC scale, pivot shift and Jerk tests showed 83 and 84% grade A results, respectively (p < 0.0001). In Fairbank scale, 23% worsened one grade and 27% worsened more than one grade (p < 0.005). Tibial tunnels widened more than femoral tunnels and further dilatation was found between intermediate and final follow-up. Higher incidence of tibial tunnel widening was observed in patients with tunnel verticalization. Tibial tunnel dilation was associated with long-term degenerative changes but not with final knee instability.

Keywords

ACL - reconstruction - tunnel position - tunnel widening