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, 27 (4), 247-54

The Correlation of Tunnel Position, Orientation and Tunnel Enlargement in Outside-in Single-Bundle Anterior Cruciate Ligament Reconstruction

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The Correlation of Tunnel Position, Orientation and Tunnel Enlargement in Outside-in Single-Bundle Anterior Cruciate Ligament Reconstruction

Young Won Ko et al. Knee Surg Relat Res.

Abstract

Purpose: Tunnel widening after anterior cruciate ligament (ACL) reconstruction is a frequently described phenomenon. The possible etiology is multi-factorial with some mechanical and biological factors. Among those, we intended to determine the relation between the location and orientation of the femoral tunnel and the femoral tunnel enlargement after outside-in single-bundle ACL reconstruction.

Materials and methods: A retrospective study including 42 patients who received single-bundle ACL reconstruction with the outside-in technique was conducted. Femoral and tibial tunnel locations were evaluated with the quadrant method and bird's-eye view using volume-rendering computed tomography. The angle and diameter of bone tunnel and the degree of tunnel enlargement were evaluated using standard radiographs.

Results: The degree of femoral tunnel enlargements were 42% and 36% on the anteroposterior (AP) and lateral radiographs, respectively, and the degree of tibial tunnel enlargements were 22% and 23%, respectively. Shallower location of the femoral tunnel was significantly correlated with greater femoral tunnel enlargement on the AP radiograph (r=0.998, p=0.004) and the lateral radiograph (r=0.72, p=0.005) as was the higher location of the femoral tunnel on the AP radiograph (r=-0.47, p=0.01) and the lateral radiograph (r=-0.36, p=0.009) at 12 months after surgery.

Conclusions: This study revealed that more anterior and higher location and more horizontal orientation of the femoral tunnel in coronal plane could result in widening of the femoral tunnel in outside-in single-bundle ACL reconstruction.

Keywords: Anterior cruciate ligament; Knee; Outside-in technique; Tunnel enlargement.

Conflict of interest statement

Conflict of Interest: No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1. The location of the center of the femoral tunnel was defined as the percentage of the distance from the most posterior contour in reference to the total length of the lateral condyle parallel to the Blumensaat's line and the percentage of the distance from the intercondylar roof with respect to the total depth of the intercondylar notch perpendicular to the Blumensaat's line. H: perpendicular to the Blumensaat's line, D: parallel to the Blumensaat's line.
Fig. 2
Fig. 2. The location of the center of the tibial tunnel was defined as the percentage of the distance from the most medial contour with respect to the mediolateral (ML) width of the tibial plateau and the percentage of the distance from the most anterior contour with respect to the anteroposterior (AP) length of the tibial plateau.
Fig. 3
Fig. 3. (A) The femoral and tibial tunnel angles on the anteroposterior radiographs were defined as the angles between the tunnel axis and each joint surface. (B) The femoral tunnel angle on the lateral radiograph was defined as the angle between the femoral tunnel axis and the femoral shaft axis. The tibial tunnel angle on the lateral radiograph was defined as the angle between the tibial tunnel axis and the tibial joint surface.
Fig. 4
Fig. 4. The bone tunnel diameters on the anteroposterior radiograph (A) and the lateral radiograph (B) were defined as the distances between the two sclerotic bony margins at the widest diameter perpendicular to the tunnel axis.

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References

    1. Siebold R. Observations on bone tunnel enlargement after double-bundle anterior cruciate ligament reconstruction. Arthroscopy. 2007;23:291–298. - PubMed
    1. Wilson TC, Kantaras A, Atay A, Johnson DL. Tunnel enlargement after anterior cruciate ligament surgery. Am J Sports Med. 2004;32:543–549. - PubMed
    1. Forsythe B, Kopf S, Wong AK, Martins CA, Anderst W, Tashman S, Fu FH. The location of femoral and tibial tunnels in anatomic double-bundle anterior cruciate ligament reconstruction analyzed by three-dimensional computed tomography models. J Bone Joint Surg Am. 2010;92:1418–1426. - PubMed
    1. Ahn JH, Jeong HJ, Ko CS, Ko TS, Kim JH. Three-dimensional reconstruction computed tomography evaluation of tunnel location during single-bundle anterior cruciate ligament reconstruction: a comparison of transtibial and 2-incision tibial tunnel-independent techniques. Clin Orthop Surg. 2013;5:26–35. - PMC - PubMed
    1. Kopf S, Forsythe B, Wong AK, Tashman S, Anderst W, Irrgang JJ, Fu FH. Nonanatomic tunnel position in traditional transtibial single-bundle anterior cruciate ligament reconstruction evaluated by three-dimensional computed tomography. J Bone Joint Surg Am. 2010;92:1427–1431. - PMC - PubMed

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