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Published in: Knee Surgery, Sports Traumatology, Arthroscopy 11/2012

01-11-2012 | Knee

Analysis of tunnel widening after double-bundle ACL reconstruction

Authors: Yong Seuk Lee, Sheen-Woo Lee, Shin Woo Nam, Won Seok Oh, Jae Ang Sim, Ji Hoon Kwak, Beom Koo Lee

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 11/2012

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Abstract

Purpose

The purpose of this study was to evaluate the tunnel widening using a multi-planar reformation of MRI (Magnetic Resonance Imaging) in the orientation of the tunnel. The hypotheses of this study were as follows: (1) tunnel widening would be reduced with the above-mentioned technique, (2) the degree of tunnel widening would be different at the site of the tunnels, and (3) the time interval from surgery to MRI acquisition would affect the magnitude of tunnel widening.

Methods

Forty double-bundle ACL reconstructed patients who underwent postoperative MRI were enrolled in this study. The postoperative MRI was performed at 26.7 ± 7.4 months in terms of time. The tunnel widening was examined using a multi-planar reformation of MRI in the orientation of the tunnel. Site-specific analysis was performed according to the depth (the entrance, mid, and exit portion) and wall (anterior, posterior, medial, and lateral walls). The correlation between MRI and widening was also evaluated.

Results

The mean tunnel widening of the femoral AM (Anteromedial), femoral PL (Posterolateral), tibial AM, and tibial PL in terms of the most widened diameter was 1.9 (25.4), 2.1 (30.8), 2.5 (32.8), and 3.2 mm (44.5%), respectively. The tibial PL tunnel showed significant widening than the other tunnels. At the entrance, tunnel widening occurred mostly, followed by the order of the mid and exit portion. Correlation analysis of the time interval of MRI acquisition and tunnel widening showed little association.

Conclusions

Tunnel widening after a double-bundle ACL reconstruction using an outside-in technique with press-fitting of the graft was acceptable compared to previously published studies. The tibial PL tunnel showed the most widening among the 4 tunnels examined with the tunnel entrance being most widened area.

Level of evidence

Therapeutic case series, Level IV.
Literature
1.
go back to reference Aglietti P, Giron F, Cuomo P, Losco M, Mondanelli N (2007) Single-and double-incision double-bundle ACL reconstruction. Clin Orthop Relat Res 454:108–113PubMedCrossRef Aglietti P, Giron F, Cuomo P, Losco M, Mondanelli N (2007) Single-and double-incision double-bundle ACL reconstruction. Clin Orthop Relat Res 454:108–113PubMedCrossRef
2.
go back to reference Ahn JH, Park JS, Lee YS, Cho YJ (2007) Femoral bioabsorbable cross-pin fixation in anterior cruciate ligament reconstruction. Arthroscopy 23:1093–1099PubMedCrossRef Ahn JH, Park JS, Lee YS, Cho YJ (2007) Femoral bioabsorbable cross-pin fixation in anterior cruciate ligament reconstruction. Arthroscopy 23:1093–1099PubMedCrossRef
3.
go back to reference Alentorn-Geli E, Samitier G, Alvarez P, Steinbacher G, Cugat R (2010) Anteromedial portal versus transtibial drilling techniques in ACL reconstruction: a blinded cross-sectional study at two- to five-year follow-up. Int Orthop 34:747–754PubMedCrossRef Alentorn-Geli E, Samitier G, Alvarez P, Steinbacher G, Cugat R (2010) Anteromedial portal versus transtibial drilling techniques in ACL reconstruction: a blinded cross-sectional study at two- to five-year follow-up. Int Orthop 34:747–754PubMedCrossRef
4.
go back to reference Baumfeld JA, Diduch DR, Rubino LJ, Hart JA, Miller MD, Barr MS, Hart JM (2008) 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 16:1108–1113PubMedCrossRef Baumfeld JA, Diduch DR, Rubino LJ, Hart JA, Miller MD, Barr MS, Hart JM (2008) 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 16:1108–1113PubMedCrossRef
5.
go back to reference Buelow JU, Siebold R, Ellermann A (2002) A prospective evaluation of tunnel enlargement in anterior cruciate ligament reconstruction with hamstrings: extracortical versus anatomical fixation. Knee Surg Sports Traumatol Arthrosc 10:80–85PubMedCrossRef Buelow JU, Siebold R, Ellermann A (2002) A prospective evaluation of tunnel enlargement in anterior cruciate ligament reconstruction with hamstrings: extracortical versus anatomical fixation. Knee Surg Sports Traumatol Arthrosc 10:80–85PubMedCrossRef
6.
go back to reference Chang CB, Yoo JH, Chung BJ, Seong SC, Kim TK (2010) Oblique femoral tunnel placement can increase risks of short femoral tunnel and cross-pin protrusion in anterior cruciate ligament reconstruction. Am J Sports Med 38:1237–1245PubMedCrossRef Chang CB, Yoo JH, Chung BJ, Seong SC, Kim TK (2010) Oblique femoral tunnel placement can increase risks of short femoral tunnel and cross-pin protrusion in anterior cruciate ligament reconstruction. Am J Sports Med 38:1237–1245PubMedCrossRef
7.
go back to reference Chen CH, Chang CH, Su CI, Wang KC, Liu HT, Yu CM, Wong CB, Wang IC (2010) Arthroscopic single-bundle anterior cruciate ligament reconstruction with periosteum-enveloping hamstring tendon graft: clinical outcome at 2–7 years. Arthroscopy 26:907–917PubMedCrossRef Chen CH, Chang CH, Su CI, Wang KC, Liu HT, Yu CM, Wong CB, Wang IC (2010) Arthroscopic single-bundle anterior cruciate ligament reconstruction with periosteum-enveloping hamstring tendon graft: clinical outcome at 2–7 years. Arthroscopy 26:907–917PubMedCrossRef
8.
go back to reference Clatworthy MG, Annear P, Bulow JU, Bartlett RJ (1999) Tunnel widening in anterior cruciate ligament reconstruction: a prospective evaluation of hamstring and patella tendon grafts. Knee Surg Sports Traumatol Arthrosc 7:138–145PubMedCrossRef Clatworthy MG, Annear P, Bulow JU, Bartlett RJ (1999) Tunnel widening in anterior cruciate ligament reconstruction: a prospective evaluation of hamstring and patella tendon grafts. Knee Surg Sports Traumatol Arthrosc 7:138–145PubMedCrossRef
9.
go back to reference Ebraheim NA, Liu J, Shafiq Q, Lu J, Pataparla S, Yeasting RA, Woldenberg L (2006) Quantitative analysis of changes in cervical intervertebral foramen size with vertebral translation. Spine (Phila Pa 1976) 31:E62–E65 Ebraheim NA, Liu J, Shafiq Q, Lu J, Pataparla S, Yeasting RA, Woldenberg L (2006) Quantitative analysis of changes in cervical intervertebral foramen size with vertebral translation. Spine (Phila Pa 1976) 31:E62–E65
10.
go back to reference Fauno P, Kaalund S (2005) Tunnel widening after hamstring anterior cruciate ligament reconstruction is influenced by the type of graft fixation used: a prospective randomized study. Arthroscopy 21:1337–1341PubMedCrossRef Fauno P, Kaalund S (2005) Tunnel widening after hamstring anterior cruciate ligament reconstruction is influenced by the type of graft fixation used: a prospective randomized study. Arthroscopy 21:1337–1341PubMedCrossRef
11.
go back to reference Forsythe B, Kopf S, Wong AK, Martins CA, Anderst W, Tashman S, Fu FH (2010) 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 92:1418–1426PubMedCrossRef Forsythe B, Kopf S, Wong AK, Martins CA, Anderst W, Tashman S, Fu FH (2010) 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 92:1418–1426PubMedCrossRef
12.
go back to reference Gavriilidis I, Motsis EK, Pakos EE, Georgoulis AD, Mitsionis G, Xenakis TA (2008) Transtibial versus anteromedial portal of the femoral tunnel in ACL reconstruction: a cadaveric study. Knee 15:364–367PubMedCrossRef Gavriilidis I, Motsis EK, Pakos EE, Georgoulis AD, Mitsionis G, Xenakis TA (2008) Transtibial versus anteromedial portal of the femoral tunnel in ACL reconstruction: a cadaveric study. Knee 15:364–367PubMedCrossRef
13.
go back to reference Gelber PE, Reina F, Torres R, Monllau JC (2010) Effect of femoral tunnel length on the safety of anterior cruciate ligament graft fixation using cross-pin technique: a cadaveric study. Am J Sports Med 38:1877–1884PubMedCrossRef Gelber PE, Reina F, Torres R, Monllau JC (2010) Effect of femoral tunnel length on the safety of anterior cruciate ligament graft fixation using cross-pin technique: a cadaveric study. Am J Sports Med 38:1877–1884PubMedCrossRef
14.
go back to reference Gold GE, Han E, Stainsby J, Wright G, Brittain J, Beaulieu C (2004) Musculoskeletal MRI at 3.0 T: relaxation times and image contrast. AJR Am J Roentgenol 183:343–351PubMed Gold GE, Han E, Stainsby J, Wright G, Brittain J, Beaulieu C (2004) Musculoskeletal MRI at 3.0 T: relaxation times and image contrast. AJR Am J Roentgenol 183:343–351PubMed
15.
go back to reference Hantes ME, Liantsis AK, Basdekis GK, Karantanas AH, Christel P, Malizos KN (2010) Evaluation of the bone bridge between the bone tunnels after anatomic double-bundle anterior cruciate ligament reconstruction: a multidetector computed tomography study. Am J Sports Med 38:1618–1625PubMedCrossRef Hantes ME, Liantsis AK, Basdekis GK, Karantanas AH, Christel P, Malizos KN (2010) Evaluation of the bone bridge between the bone tunnels after anatomic double-bundle anterior cruciate ligament reconstruction: a multidetector computed tomography study. Am J Sports Med 38:1618–1625PubMedCrossRef
16.
go back to reference Hoher J, Moller HD, Fu FH (1998) Bone tunnel enlargement after anterior cruciate ligament reconstruction: fact or fiction? Knee Surg Sports Traumatol Arthrosc 6:231–240PubMedCrossRef Hoher J, Moller HD, Fu FH (1998) Bone tunnel enlargement after anterior cruciate ligament reconstruction: fact or fiction? Knee Surg Sports Traumatol Arthrosc 6:231–240PubMedCrossRef
17.
go back to reference Jarvela T, Moisala AS, Paakkala T, Paakkala A (2008) Tunnel enlargement after double-bundle anterior cruciate ligament reconstruction: a prospective, randomized study. Arthroscopy 24:1349–1357PubMedCrossRef Jarvela T, Moisala AS, Paakkala T, Paakkala A (2008) Tunnel enlargement after double-bundle anterior cruciate ligament reconstruction: a prospective, randomized study. Arthroscopy 24:1349–1357PubMedCrossRef
18.
go back to reference Kopf S, Forsythe B, Wong AK, Tashman S, Anderst W, Irrgang JJ, Fu FH (2010) Nonanatomic tunnel position in traditional transtibial single-bundle anterior cruciate ligament reconstruction evaluated by three-dimensional computed tomography. J Bone Joint Surg Am 92:1427–1431PubMedCrossRef Kopf S, Forsythe B, Wong AK, Tashman S, Anderst W, Irrgang JJ, Fu FH (2010) Nonanatomic tunnel position in traditional transtibial single-bundle anterior cruciate ligament reconstruction evaluated by three-dimensional computed tomography. J Bone Joint Surg Am 92:1427–1431PubMedCrossRef
19.
go back to reference L’Insalata JC, Klatt B, Fu FH, Harner CD (1997) Tunnel expansion following anterior cruciate ligament reconstruction: a comparison of hamstring and patellar tendon autografts. Knee Surg Sports Traumatol Arthrosc 5:234–238PubMedCrossRef L’Insalata JC, Klatt B, Fu FH, Harner CD (1997) Tunnel expansion following anterior cruciate ligament reconstruction: a comparison of hamstring and patellar tendon autografts. Knee Surg Sports Traumatol Arthrosc 5:234–238PubMedCrossRef
20.
go back to reference Lee WA (2007) Endovascular abdominal aortic aneurysm sizing and case planning using the TeraRecon aquarius workstation. Vasc Endovascular Surg 41:61–67PubMedCrossRef Lee WA (2007) Endovascular abdominal aortic aneurysm sizing and case planning using the TeraRecon aquarius workstation. Vasc Endovascular Surg 41:61–67PubMedCrossRef
21.
go back to reference Lind M, Feller J, Webster KE (2009) Bone tunnel widening after anterior cruciate ligament reconstruction using EndoButton or EndoButton continuous loop. Arthroscopy 25:1275–1280PubMedCrossRef Lind M, Feller J, Webster KE (2009) Bone tunnel widening after anterior cruciate ligament reconstruction using EndoButton or EndoButton continuous loop. Arthroscopy 25:1275–1280PubMedCrossRef
22.
24.
go back to reference Mosher TJ (2006) Musculoskeletal imaging at 3T: current techniques and future applications. Magn Reson Imaging Clin N Am 14:63–76PubMedCrossRef Mosher TJ (2006) Musculoskeletal imaging at 3T: current techniques and future applications. Magn Reson Imaging Clin N Am 14:63–76PubMedCrossRef
25.
go back to reference Ramnath RR (2006) 3T MR imaging of the musculoskeletal system (part I): considerations, coils, and challenges. Magn Reson Imaging Clin N Am 14:27–40PubMedCrossRef Ramnath RR (2006) 3T MR imaging of the musculoskeletal system (part I): considerations, coils, and challenges. Magn Reson Imaging Clin N Am 14:27–40PubMedCrossRef
26.
go back to reference Ramnath RR (2006) 3T MR imaging of the musculoskeletal system (part II): clinical applications. Magn Reson Imaging Clin N Am 14:41–62PubMedCrossRef Ramnath RR (2006) 3T MR imaging of the musculoskeletal system (part II): clinical applications. Magn Reson Imaging Clin N Am 14:41–62PubMedCrossRef
27.
go back to reference Robinson J, Huber C, Jaraj P, Colombet P, Allard M, Meyer P (2006) Reduced bone tunnel enlargement post hamstring ACL reconstruction with poly-L-lactic acid/hydroxyapatite bioabsorbable screws. Knee 13:127–131PubMedCrossRef Robinson J, Huber C, Jaraj P, Colombet P, Allard M, Meyer P (2006) Reduced bone tunnel enlargement post hamstring ACL reconstruction with poly-L-lactic acid/hydroxyapatite bioabsorbable screws. Knee 13:127–131PubMedCrossRef
28.
go back to reference Siebold R (2007) Observations on bone tunnel enlargement after double-bundle anterior cruciate ligament reconstruction. Arthroscopy 23:291–298PubMedCrossRef Siebold R (2007) Observations on bone tunnel enlargement after double-bundle anterior cruciate ligament reconstruction. Arthroscopy 23:291–298PubMedCrossRef
29.
go back to reference Siebold R, Cafaltzis K (2010) Differentiation between intraoperative and postoperative bone tunnel widening and communication in double-bundle anterior cruciate ligament reconstruction: a prospective study. Arthroscopy 26:1066–1073PubMedCrossRef Siebold R, Cafaltzis K (2010) Differentiation between intraoperative and postoperative bone tunnel widening and communication in double-bundle anterior cruciate ligament reconstruction: a prospective study. Arthroscopy 26:1066–1073PubMedCrossRef
30.
go back to reference Silva A, Sampaio R, Pinto E (2010) Placement of femoral tunnel between the AM and PL bundles using a transtibial technique in single-bundle ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 18:1245–1251PubMedCrossRef Silva A, Sampaio R, Pinto E (2010) Placement of femoral tunnel between the AM and PL bundles using a transtibial technique in single-bundle ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 18:1245–1251PubMedCrossRef
31.
go back to reference Sim JA, Yang SH, Ahn BK, Lee BK (2009) Short-term follow-up of double bundle ACL reconstruction using autogenous hamstring tendons fixed with ligament plate. J Korean Orthop Assoc 44:311–319CrossRef Sim JA, Yang SH, Ahn BK, Lee BK (2009) Short-term follow-up of double bundle ACL reconstruction using autogenous hamstring tendons fixed with ligament plate. J Korean Orthop Assoc 44:311–319CrossRef
32.
go back to reference Simonian PT, Erickson MS, Larson RV, O’Kane JW (2000) Tunnel expansion after hamstring anterior cruciate ligament reconstruction with 1-incision EndoButton femoral fixation. Arthroscopy 16:707–714PubMedCrossRef Simonian PT, Erickson MS, Larson RV, O’Kane JW (2000) Tunnel expansion after hamstring anterior cruciate ligament reconstruction with 1-incision EndoButton femoral fixation. Arthroscopy 16:707–714PubMedCrossRef
33.
go back to reference Steiner ME, Battaglia TC, Heming JF, Rand JD, Festa A, Baria M (2009) Independent drilling outperforms conventional transtibial drilling in anterior cruciate ligament reconstruction. Am J Sports Med 37:1912–1919PubMedCrossRef Steiner ME, Battaglia TC, Heming JF, Rand JD, Festa A, Baria M (2009) Independent drilling outperforms conventional transtibial drilling in anterior cruciate ligament reconstruction. Am J Sports Med 37:1912–1919PubMedCrossRef
34.
go back to reference Wilson TC, Kantaras A, Atay A, Johnson DL (2004) Tunnel enlargement after anterior cruciate ligament surgery. Am J Sports Med 32:543–549PubMedCrossRef Wilson TC, Kantaras A, Atay A, Johnson DL (2004) Tunnel enlargement after anterior cruciate ligament surgery. Am J Sports Med 32:543–549PubMedCrossRef
35.
go back to reference Yasuda K, Kondo E, Ichiyama H, Tanabe Y, Tohyama H (2006) Clinical evaluation of anatomic double-bundle anterior cruciate ligament reconstruction procedure using hamstring tendon grafts: comparisons among 3 different procedures. Arthroscopy 22:240–251PubMedCrossRef Yasuda K, Kondo E, Ichiyama H, Tanabe Y, Tohyama H (2006) Clinical evaluation of anatomic double-bundle anterior cruciate ligament reconstruction procedure using hamstring tendon grafts: comparisons among 3 different procedures. Arthroscopy 22:240–251PubMedCrossRef
36.
go back to reference Yasuda K, Tanabe Y, Kondo E, Kitamura N, Tohyama H (2010) Anatomic double-bundle anterior cruciate ligament reconstruction. Arthroscopy 26:S21–S34PubMedCrossRef Yasuda K, Tanabe Y, Kondo E, Kitamura N, Tohyama H (2010) Anatomic double-bundle anterior cruciate ligament reconstruction. Arthroscopy 26:S21–S34PubMedCrossRef
37.
go back to reference Zysk SP, Fraunberger P, Veihelmann A, Dorger M, Kalteis T, Maier M, Pellengahr C, Refior HJ (2004) Tunnel enlargement and changes in synovial fluid cytokine profile following anterior cruciate ligament reconstruction with patellar tendon and hamstring tendon autografts. Knee Surg Sports Traumatol Arthrosc 12:98–103PubMedCrossRef Zysk SP, Fraunberger P, Veihelmann A, Dorger M, Kalteis T, Maier M, Pellengahr C, Refior HJ (2004) Tunnel enlargement and changes in synovial fluid cytokine profile following anterior cruciate ligament reconstruction with patellar tendon and hamstring tendon autografts. Knee Surg Sports Traumatol Arthrosc 12:98–103PubMedCrossRef
Metadata
Title
Analysis of tunnel widening after double-bundle ACL reconstruction
Authors
Yong Seuk Lee
Sheen-Woo Lee
Shin Woo Nam
Won Seok Oh
Jae Ang Sim
Ji Hoon Kwak
Beom Koo Lee
Publication date
01-11-2012
Publisher
Springer-Verlag
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 11/2012
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-011-1874-5

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