Skip to main content
Top
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 1/2011

01-12-2011 | Knee

Full knee extension magnetic resonance imaging for the evaluation of intercondylar roof impingement after anatomical double-bundle anterior cruciate ligament reconstruction

Authors: Takanori Iriuchishima, Kenji Shirakura, Takashi Horaguchi, Yusuke Morimoto, Freddie H. Fu

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Special Issue 1/2011

Login to get access

Abstract

Purpose

The purpose of this study was to reveal the relationship between anatomically placed anterior cruciate ligament (ACL) graft and the intercondylar roof using magnetic resonance imaging (MRI).

Methods

Twenty patients undergoing anatomical double-bundle ACL reconstruction were included in this study. Anatomical double-bundle ACL reconstruction was performed with two femoral tunnels (antero-medial; AM and postero-lateral; PL) and two tibial tunnels. Hamstring autograft was used in all cases. More than 6 months after operation, MRI was performed with full knee extension. The relationship between the graft and the intercondylar roof was evaluated using an axial view of the T2 image at the most distal slice of the intercondylar roof. Qualitative evaluation of the ACL graft was performed with a sagittal view of the T2 image. Tunnel placement was evaluated with three-dimensional computed tomography (3D-CT) and radiographs. The extension angle of the knee was also evaluated with 3D-CT.

Results

In 12 subjects, the ACL graft touched the roof (Touch group) but no graft deformation was observed. In 8 subjects, no roof–graft contact was observed (Non-touch group). In 1 case, the ACL graft was bowed posteriorly. Signal intensity alteration of the graft was observed in 3 cases. No significant difference in femoral and tibial tunnel placement was observed between the Touch and Non-touch groups. All subjects attained full knee extension.

Conclusion

Although graft–roof impingement after anatomical double-bundle ACL reconstruction was suspected in some cases after the MRI evaluation, no extension loss in the knee was observed. In these suspected cases of impingement, long-term follow-up will be needed to determine the connection between any potential pathological effects. For the clinical relevance, MRI is an effective tool to determine the status of roof impingement in anatomical double-bundle ACL reconstruction.

Level of evidence

Case controlled study, Level III.
Literature
1.
go back to reference Bencardino JT, Beltran J, Feldman MI, Rose DJ (2009) MR imaging of complications of anterior cruciate ligament graft reconstruction. Radiographics 29:2115–2126PubMedCrossRef Bencardino JT, Beltran J, Feldman MI, Rose DJ (2009) MR imaging of complications of anterior cruciate ligament graft reconstruction. Radiographics 29:2115–2126PubMedCrossRef
2.
go back to reference Bernard M, Hertel P, Hornung H, Cierpinski TH (1997) Femoral insertion of the ACL: radiographic quadrant method. Am J Knee Surg 10:14–22PubMed Bernard M, Hertel P, Hornung H, Cierpinski TH (1997) Femoral insertion of the ACL: radiographic quadrant method. Am J Knee Surg 10:14–22PubMed
3.
go back to reference Brophy RH, Selby RM, Altchek DW (2006) Anterior cruciate ligament revision: double-bundle augmentation of primary vertical graft. Arthroscopy 22:683 e1–683 e5 Brophy RH, Selby RM, Altchek DW (2006) Anterior cruciate ligament revision: double-bundle augmentation of primary vertical graft. Arthroscopy 22:683 e1–683 e5
4.
go back to reference Buoncristiani AM, Tjoumakaris FP, Starman JS, Ferretti M, Fu FH (2006) Anatomic double-bundle anterior cruciate ligament reconstruction. Arthroscopy 22:1000–1006PubMedCrossRef Buoncristiani AM, Tjoumakaris FP, Starman JS, Ferretti M, Fu FH (2006) Anatomic double-bundle anterior cruciate ligament reconstruction. Arthroscopy 22:1000–1006PubMedCrossRef
5.
go back to reference Cuomo P, Edwards A, Giron F, Bull AMJ, Amis AA, Aglietti P (2006) Validation of the 65° howell guide for anterior cruciate ligament reconstruction. Arthroscopy 22:70–75PubMedCrossRef Cuomo P, Edwards A, Giron F, Bull AMJ, Amis AA, Aglietti P (2006) Validation of the 65° howell guide for anterior cruciate ligament reconstruction. Arthroscopy 22:70–75PubMedCrossRef
6.
go back to reference Darcy SP, Kilger RH, Woo SL, Debski RF (2006) Estimation of ACL forces by reproducing knee kinematics between sets of knees: a novel noninvasive methodology. J Biomech 39:2371–2377PubMedCrossRef Darcy SP, Kilger RH, Woo SL, Debski RF (2006) Estimation of ACL forces by reproducing knee kinematics between sets of knees: a novel noninvasive methodology. J Biomech 39:2371–2377PubMedCrossRef
7.
go back to reference Ferretti M, Ekdahl M, Shen W, Fu FH (2007) Osseous landmarks of the femoral attachment of the anterior cruciate ligament: an anatomic study. Arthroscopy 23:1218–1225PubMedCrossRef Ferretti M, Ekdahl M, Shen W, Fu FH (2007) Osseous landmarks of the femoral attachment of the anterior cruciate ligament: an anatomic study. Arthroscopy 23:1218–1225PubMedCrossRef
8.
go back to reference Fithian DC, Paxton EW, Stone ML et al (2005) Prospective trial of a treatment algorithm for the management of the anterior cruciate ligament-injured knee. Am J Sports Med 33:335–346PubMedCrossRef Fithian DC, Paxton EW, Stone ML et al (2005) Prospective trial of a treatment algorithm for the management of the anterior cruciate ligament-injured knee. Am J Sports Med 33:335–346PubMedCrossRef
9.
go back to reference Fu FH, Bennett CH, Ma B, Menetrey J, Lattermann C (2000) Current trends in anterior cruciate ligament reconstruction: Part II. Operative procedures and clinical correlations. Am J Sports Med 28:124–130PubMed Fu FH, Bennett CH, Ma B, Menetrey J, Lattermann C (2000) Current trends in anterior cruciate ligament reconstruction: Part II. Operative procedures and clinical correlations. Am J Sports Med 28:124–130PubMed
10.
go back to reference Fung DT, Zhang LQ (2003) Modeling of ACL impingement against the intercondylar notch. Clin Biomech 18:933–941CrossRef Fung DT, Zhang LQ (2003) Modeling of ACL impingement against the intercondylar notch. Clin Biomech 18:933–941CrossRef
11.
go back to reference Goss BC, Howell SM, Hull ML (1998) Quadriceps load aggravates and roofplasty mitigates active impingement of anterior cruciate ligament grafts against the intercondylar roof. J Orthopaed Res 16:611–617CrossRef Goss BC, Howell SM, Hull ML (1998) Quadriceps load aggravates and roofplasty mitigates active impingement of anterior cruciate ligament grafts against the intercondylar roof. J Orthopaed Res 16:611–617CrossRef
12.
go back to reference Goss BC, Hull ML, Howell SM (1997) Contact pressure and tension in anterior cruciate ligament grafts subjected to roof impingement during passive extension. J Orthopaed Res 15:263–268CrossRef Goss BC, Hull ML, Howell SM (1997) Contact pressure and tension in anterior cruciate ligament grafts subjected to roof impingement during passive extension. J Orthopaed Res 15:263–268CrossRef
13.
go back to reference Griffin LY, Agel J, Albohm MJ et al (2000) Noncontact anterior cruciate ligament injuries. J Am Acad Orthop Surg 8:141–150PubMed Griffin LY, Agel J, Albohm MJ et al (2000) Noncontact anterior cruciate ligament injuries. J Am Acad Orthop Surg 8:141–150PubMed
14.
go back to reference Harner CD, Vogrin TM (2002) What’s new in sports medicine. J Bone Joint Surg Am 84:1095–1099PubMed Harner CD, Vogrin TM (2002) What’s new in sports medicine. J Bone Joint Surg Am 84:1095–1099PubMed
15.
go back to reference Hame SL, Markolf KL, Hunter DM, Oakes DA, Zoric B (2003) Effects of notchplasty and femoral tunnel position on excursion patterns of an anterior cruciate ligament graft. Arthroscopy 19:340–345PubMedCrossRef Hame SL, Markolf KL, Hunter DM, Oakes DA, Zoric B (2003) Effects of notchplasty and femoral tunnel position on excursion patterns of an anterior cruciate ligament graft. Arthroscopy 19:340–345PubMedCrossRef
16.
go back to reference Howell SM (1998) Principles for placing the tibial tunnel and avoiding roof impingement during reconstruction of a torn anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc 6:S49–S55PubMedCrossRef Howell SM (1998) Principles for placing the tibial tunnel and avoiding roof impingement during reconstruction of a torn anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc 6:S49–S55PubMedCrossRef
17.
go back to reference Inoue M, Tokuyasu S, Kuwahara S et al (2010) Tunnel location in transparent 3-dimentional CT in anatomic double-bundle anterior cruciate ligament reconstruction with the trans-tibial technique. Knee Surg Sports Traumatol Arthrosc 18:1176–1183PubMedCrossRef Inoue M, Tokuyasu S, Kuwahara S et al (2010) Tunnel location in transparent 3-dimentional CT in anatomic double-bundle anterior cruciate ligament reconstruction with the trans-tibial technique. Knee Surg Sports Traumatol Arthrosc 18:1176–1183PubMedCrossRef
18.
go back to reference Iriuchishima T, Tajima G, Ingham SJ et al (2009) Intercondylar roof impingement pressure after anterior cruciate ligament reconstruction in a porcine model. Knee Surg Sports Traumatol Arthrosc 17:590–594PubMedCrossRef Iriuchishima T, Tajima G, Ingham SJ et al (2009) Intercondylar roof impingement pressure after anterior cruciate ligament reconstruction in a porcine model. Knee Surg Sports Traumatol Arthrosc 17:590–594PubMedCrossRef
19.
go back to reference Iriuchishima T, Ingham SJ, Tajima G et al (2010) Evaluation of the tunnel placement in the anatomical double-bundle ACL reconstruction: a cadaver study. Knee Surg Sports Traumatol Arthrosc 18:1226–1231PubMedCrossRef Iriuchishima T, Ingham SJ, Tajima G et al (2010) Evaluation of the tunnel placement in the anatomical double-bundle ACL reconstruction: a cadaver study. Knee Surg Sports Traumatol Arthrosc 18:1226–1231PubMedCrossRef
20.
go back to reference Iriuchishima T, Tajima G, Ingham SJ, Shen W, Smolinski P, Fu FH (2010) Impingement pressure in the anatomical and non anatomical anterior cruciate ligament reconstruction: a cadaver study. Am J Sports Med 38:1611–1617PubMedCrossRef Iriuchishima T, Tajima G, Ingham SJ, Shen W, Smolinski P, Fu FH (2010) Impingement pressure in the anatomical and non anatomical anterior cruciate ligament reconstruction: a cadaver study. Am J Sports Med 38:1611–1617PubMedCrossRef
21.
go back to reference Iriuchishima T, Horaguchi T, Kubomura T, Morimoto Y, Fu FH (2010) Evaluation of the intercondylar roof impingement after anatomical double-bundle anterior cruciate ligament reconstruction using 3D-CT. Knee Surg Sports Traumatol Arthrosc 19:674–679 Iriuchishima T, Horaguchi T, Kubomura T, Morimoto Y, Fu FH (2010) Evaluation of the intercondylar roof impingement after anatomical double-bundle anterior cruciate ligament reconstruction using 3D-CT. Knee Surg Sports Traumatol Arthrosc 19:674–679
22.
go back to reference Jagodzinski M, Leis A, Iselborn KW, Mall G, Nerlich M, Bosch U (2003) Impingement pressure and tension forces of the anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc 11:85–90PubMed Jagodzinski M, Leis A, Iselborn KW, Mall G, Nerlich M, Bosch U (2003) Impingement pressure and tension forces of the anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc 11:85–90PubMed
23.
go back to reference Jagodzinski M, Richter GM, Passler HH (2000) Biomechanical analysis of knee hyperextension and of the impingement of the anterior cruciate ligament: a cinematographic MRI study with impact on tibial tunnel positioning in anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 8:11–19PubMedCrossRef Jagodzinski M, Richter GM, Passler HH (2000) Biomechanical analysis of knee hyperextension and of the impingement of the anterior cruciate ligament: a cinematographic MRI study with impact on tibial tunnel positioning in anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 8:11–19PubMedCrossRef
24.
go back to reference Loh JC, Fukuda Y, Tsuda E, Steadman RJ, Fu FH, Woo SL (2003) Knee stability and graft function following anterior cruciate ligament reconstruction: comparison between 11 o’clock and 10 o’clock femoral tunnel placement. Arthroscopy 19:297–304PubMedCrossRef Loh JC, Fukuda Y, Tsuda E, Steadman RJ, Fu FH, Woo SL (2003) Knee stability and graft function following anterior cruciate ligament reconstruction: comparison between 11 o’clock and 10 o’clock femoral tunnel placement. Arthroscopy 19:297–304PubMedCrossRef
25.
go back to reference Mae T, Shino K, Miyama T et al (2001) Single versus two-femoral socket anterior cruciate ligament reconstruction technique: biomechanical analysis using a robotic simulator. Arthroscopy 17:708–716PubMedCrossRef Mae T, Shino K, Miyama T et al (2001) Single versus two-femoral socket anterior cruciate ligament reconstruction technique: biomechanical analysis using a robotic simulator. Arthroscopy 17:708–716PubMedCrossRef
26.
go back to reference Muneta T, Koga H, Mochizuki T et al (2007) A prospective randomized study of 4-strand semitendinosus tendon anterior cruciate ligament reconstruction comparing single-bundle and double bundle techniques. Arthroscopy 23:618–628PubMedCrossRef Muneta T, Koga H, Mochizuki T et al (2007) A prospective randomized study of 4-strand semitendinosus tendon anterior cruciate ligament reconstruction comparing single-bundle and double bundle techniques. Arthroscopy 23:618–628PubMedCrossRef
27.
go back to reference Muneta T, Yamamoto H, Ishibashi T, Asahina S, Murakami S, Furuya K (1995) The effects of tibial tunnel placement and roofplasty on reconstructed anterior cruciate ligament knees. Arthroscopy 11:57–62PubMedCrossRef Muneta T, Yamamoto H, Ishibashi T, Asahina S, Murakami S, Furuya K (1995) The effects of tibial tunnel placement and roofplasty on reconstructed anterior cruciate ligament knees. Arthroscopy 11:57–62PubMedCrossRef
28.
go back to reference Papakonstantinou O, Chung CB, Chanchairujura K, Resnick DL (2003) Complications of anterior cruciate ligament reconstruction: MR imaging. Eur Radiol 13:1106–1117PubMed Papakonstantinou O, Chung CB, Chanchairujura K, Resnick DL (2003) Complications of anterior cruciate ligament reconstruction: MR imaging. Eur Radiol 13:1106–1117PubMed
29.
go back to reference Simmons R, Howell SM, Hull ML (2003) Effect of the angle of the femoral and tibial tunnels in the coronal plane and incremental excision of the posterior cruciate ligament graft. J Bone Joint Surg Am 85A:1018–1029 Simmons R, Howell SM, Hull ML (2003) Effect of the angle of the femoral and tibial tunnels in the coronal plane and incremental excision of the posterior cruciate ligament graft. J Bone Joint Surg Am 85A:1018–1029
30.
go back to reference Sonnery-Cottet B, Lavoie F, Ogasawasa R et al (2010) Clinical and operative characteristics of cyclops syndrome after double-bundle anterior cruciate ligament reconstruction. Arthroscopy 26:1483–1488PubMedCrossRef Sonnery-Cottet B, Lavoie F, Ogasawasa R et al (2010) Clinical and operative characteristics of cyclops syndrome after double-bundle anterior cruciate ligament reconstruction. Arthroscopy 26:1483–1488PubMedCrossRef
31.
go back to reference Staubli HU, Rauschning W (1994) Tibial attachment area of the anterior cruciate ligament in the extended knee position, anatomy and cryosections in vitro complemented by magnetic resonance arthrography in vivo. Knee Surg Sports Traumatol Arthrosc 2:138–146PubMedCrossRef Staubli HU, Rauschning W (1994) Tibial attachment area of the anterior cruciate ligament in the extended knee position, anatomy and cryosections in vitro complemented by magnetic resonance arthrography in vivo. Knee Surg Sports Traumatol Arthrosc 2:138–146PubMedCrossRef
32.
go back to reference Steiner ME, Murray MM, Rodeo SA (2008) Strategies to improve anterior cruciate ligament healing and graft placement. Am J Sports Med 36:176–189PubMedCrossRef Steiner ME, Murray MM, Rodeo SA (2008) Strategies to improve anterior cruciate ligament healing and graft placement. Am J Sports Med 36:176–189PubMedCrossRef
33.
go back to reference Strobel MJ, Castillo RJ, Weiler A (2001) Reflex extension loss after anterior cruciate ligament reconstruction due to femoral “high noon” graft placement. Arthroscopy 17:408–411PubMedCrossRef Strobel MJ, Castillo RJ, Weiler A (2001) Reflex extension loss after anterior cruciate ligament reconstruction due to femoral “high noon” graft placement. Arthroscopy 17:408–411PubMedCrossRef
34.
go back to reference Takeda Y, Sato R, Ogawa T, Fujii K, Naruse A (2009) In vivo magnetic resonance imaging measurement of tibiofemoral relation with different knee flexion angles after single- and double-bundle anterior cruciate ligament reconstructions. Arthroscopy 25:733–741PubMedCrossRef Takeda Y, Sato R, Ogawa T, Fujii K, Naruse A (2009) In vivo magnetic resonance imaging measurement of tibiofemoral relation with different knee flexion angles after single- and double-bundle anterior cruciate ligament reconstructions. Arthroscopy 25:733–741PubMedCrossRef
35.
go back to reference Yagi M, Wong EK, Kanamori A, Debski RE, Fu FH, Woo SL (2002) Biomechanical analysis of anatomic anterior cruciate ligament reconstruction. Am J Sports Med 30:660–666PubMed Yagi M, Wong EK, Kanamori A, Debski RE, Fu FH, Woo SL (2002) Biomechanical analysis of anatomic anterior cruciate ligament reconstruction. Am J Sports Med 30:660–666PubMed
36.
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
37.
go back to reference Zantop T, Wellmann M, Fu FH, Peterson W (2008) Tunnel positioning of anteromedial and posterolateral bundles in anatomic anterior cruciate ligament reconstruction: anatomic and radiographic findings. Am J Sports Med 36:65–72PubMedCrossRef Zantop T, Wellmann M, Fu FH, Peterson W (2008) Tunnel positioning of anteromedial and posterolateral bundles in anatomic anterior cruciate ligament reconstruction: anatomic and radiographic findings. Am J Sports Med 36:65–72PubMedCrossRef
Metadata
Title
Full knee extension magnetic resonance imaging for the evaluation of intercondylar roof impingement after anatomical double-bundle anterior cruciate ligament reconstruction
Authors
Takanori Iriuchishima
Kenji Shirakura
Takashi Horaguchi
Yusuke Morimoto
Freddie H. Fu
Publication date
01-12-2011
Publisher
Springer-Verlag
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue Special Issue 1/2011
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-011-1504-2

Other articles of this Special Issue 1/2011

Knee Surgery, Sports Traumatology, Arthroscopy 1/2011 Go to the issue