Skip to main content
Top
Published in: European Journal of Orthopaedic Surgery & Traumatology 6/2016

01-08-2016 | Original Article • KNEE - Arthroscopy

Correlation of tunnel widening and tunnel positioning with short-term functional outcomes in single-bundle anterior cruciate ligament reconstruction using patellar tendon versus hamstring graft: a prospective study

Authors: Udit Kumar Biswal, Gopisankar Balaji, Sandeep Nema, Murali Poduval, Jagdish Menon, Dilip Kumar Patro

Published in: European Journal of Orthopaedic Surgery & Traumatology | Issue 6/2016

Login to get access

Abstract

Objective

To study the correlation between tunnel widening and tunnel position with short-term functional outcomes post-ACL reconstruction with patellar tendon and hamstring autografts in young adults.

Materials and methods

A total of 33 patients who underwent ACL reconstruction between October 2013 and February 2015 were included and followed up for 6 months. A standardized surgical technique was used for each graft type. Intra-op arthroscopy findings and drilled tunnel diameters were noted. They were followed up for 3 and 6 months. Radiological assessment was done at 3 and 6 months with clinical score assessment at 6 months.

Results

At 6 months, clinical scores were comparable in both groups. Tunnel widening in both femoral and tibial tunnel at 3 and 6 months were significantly higher in STG group (p values <0.05). The rate of widening was higher in 0–3 months and reduced in 3–6 months. There was statistically significant negative correlation between femoral tunnel widening by CT and IKDC score at 6 months (p value 0.049). We found a positive correlation between posterior positioning of femoral tunnel and Lysholm and IKDC scores. The correlation with Lysholm scores was statistically significant (p value 0.046).

Conclusion

To conclude, tunnel widening is more with hamstrings graft. Femoral tunnel widening has significant negative correlation with that of IKDC scores at 6 months. Posterior femoral tunnel positioning and Lysholm scores at 6 months had significant correlation.
Literature
1.
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(3):138–145CrossRefPubMed 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(3):138–145CrossRefPubMed
2.
go back to reference Hersekli MA, Akpinar S, Ozalay M, Ozkoc G, Cesur N, Uysal M et al (2004) Tunnel enlargement after arthroscopic anterior cruciate ligament reconstruction: comparison of bone-patellar tendon-bone and hamstring autografts. Adv Ther 21(2):123–131CrossRefPubMed Hersekli MA, Akpinar S, Ozalay M, Ozkoc G, Cesur N, Uysal M et al (2004) Tunnel enlargement after arthroscopic anterior cruciate ligament reconstruction: comparison of bone-patellar tendon-bone and hamstring autografts. Adv Ther 21(2):123–131CrossRefPubMed
3.
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(4):234–238CrossRefPubMed 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(4):234–238CrossRefPubMed
4.
go back to reference Peyrache MD, Djian P, Christel P, Witvoet J (1996) Tibial tunnel enlargement after anterior cruciate ligament reconstruction by autogenous bone-patellar tendon-bone graft. Knee Surg Sports Traumatol Arthrosc 4(1):2–8CrossRefPubMed Peyrache MD, Djian P, Christel P, Witvoet J (1996) Tibial tunnel enlargement after anterior cruciate ligament reconstruction by autogenous bone-patellar tendon-bone graft. Knee Surg Sports Traumatol Arthrosc 4(1):2–8CrossRefPubMed
5.
go back to reference Buck DC, Simonian PT, Larson RV, Borrow J, Nathanson DA (2004) Timeline of tibial tunnel expansion after single-incision hamstring anterior cruciate ligament reconstruction. Arthrosc J Arthrosc Relat Surg 20(1):34–36CrossRef Buck DC, Simonian PT, Larson RV, Borrow J, Nathanson DA (2004) Timeline of tibial tunnel expansion after single-incision hamstring anterior cruciate ligament reconstruction. Arthrosc J Arthrosc Relat Surg 20(1):34–36CrossRef
6.
go back to reference Webster KE, Feller JA, Hameister KA (2001) 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 9(2):86–91CrossRefPubMed Webster KE, Feller JA, Hameister KA (2001) 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 9(2):86–91CrossRefPubMed
7.
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. Arthrosc J Arthrosc Relat Surg 21(11):1337–1341CrossRef 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. Arthrosc J Arthrosc Relat Surg 21(11):1337–1341CrossRef
8.
go back to reference Lopes OV Jr, de Freitas Spinelli L, Leite LH, Buzzeto BQ, Saggin PR, Kuhn A (2015) Femoral tunnel enlargement after anterior cruciate ligament reconstruction using RigidFix compared with extracortical fixation. Knee Surg Sports Traumatol Arthrosc 27:1–7 Lopes OV Jr, de Freitas Spinelli L, Leite LH, Buzzeto BQ, Saggin PR, Kuhn A (2015) Femoral tunnel enlargement after anterior cruciate ligament reconstruction using RigidFix compared with extracortical fixation. Knee Surg Sports Traumatol Arthrosc 27:1–7
9.
go back to reference Mermerkaya MU, Atay OA, Kaymaz B, Bekmez S, Karaaslan F, Doral MN (2015) Anterior cruciate ligament reconstruction using a hamstring graft: a retrospective comparison of tunnel widening upon use of two different femoral fixation methods. Knee Surg Sports Traumatol Arthrosc 23(8):2283–2291CrossRefPubMed Mermerkaya MU, Atay OA, Kaymaz B, Bekmez S, Karaaslan F, Doral MN (2015) Anterior cruciate ligament reconstruction using a hamstring graft: a retrospective comparison of tunnel widening upon use of two different femoral fixation methods. Knee Surg Sports Traumatol Arthrosc 23(8):2283–2291CrossRefPubMed
10.
go back to reference Mirzatolooei F, Alamdari MT, Khalkhali HR (2013) The impact of platelet-rich plasma on the prevention of tunnel widening in anterior cruciate ligament reconstruction using quadrupled autologous hamstring tendon A randomised clinical trial. Bone Jt J 95(1):65–69CrossRef Mirzatolooei F, Alamdari MT, Khalkhali HR (2013) The impact of platelet-rich plasma on the prevention of tunnel widening in anterior cruciate ligament reconstruction using quadrupled autologous hamstring tendon A randomised clinical trial. Bone Jt J 95(1):65–69CrossRef
11.
go back to reference Surer L, Yapici C, Guglielmino C, van Eck CF, Irrgang JJ, Fu FH (2016) Fibrin clot prevents bone tunnel enlargement after ACL reconstruction with allograft. Knee Surg Sports Traumatol Arthrosc 16:1–6 Surer L, Yapici C, Guglielmino C, van Eck CF, Irrgang JJ, Fu FH (2016) Fibrin clot prevents bone tunnel enlargement after ACL reconstruction with allograft. Knee Surg Sports Traumatol Arthrosc 16:1–6
12.
13.
go back to reference Iorio R, Vadalà A, Di Vavo I, De Carli A, Conteduca F, Argento G et al (2008) Tunnel enlargement after anterior cruciate ligament reconstruction in patients with post-operative septic arthritis. Knee Surg Sports Traumatol Arthrosc 16(10):921–927CrossRefPubMed Iorio R, Vadalà A, Di Vavo I, De Carli A, Conteduca F, Argento G et al (2008) Tunnel enlargement after anterior cruciate ligament reconstruction in patients with post-operative septic arthritis. Knee Surg Sports Traumatol Arthrosc 16(10):921–927CrossRefPubMed
14.
go back to reference Astur DC, Santos CV, Aleluia V, Astur Neto N, Arliani GG, Kaleka CC et al (2013) Characterization of cruciate ligament impingement: the influence of femoral or tibial tunnel positioning at different degrees of knee flexion. Arthrosc J Arthrosc Relat Surg 29(5):913–919CrossRef Astur DC, Santos CV, Aleluia V, Astur Neto N, Arliani GG, Kaleka CC et al (2013) Characterization of cruciate ligament impingement: the influence of femoral or tibial tunnel positioning at different degrees of knee flexion. Arthrosc J Arthrosc Relat Surg 29(5):913–919CrossRef
15.
go back to reference Sinha S, Naik A, Arya C, Arya R, Jain V, Upadhyay G (2015) Trans-tibial guide wire placement for femoral tunnel in single bundle anterior cruciate ligament reconstruction. Indian J Orthop 49(3):352CrossRefPubMedPubMedCentral Sinha S, Naik A, Arya C, Arya R, Jain V, Upadhyay G (2015) Trans-tibial guide wire placement for femoral tunnel in single bundle anterior cruciate ligament reconstruction. Indian J Orthop 49(3):352CrossRefPubMedPubMedCentral
16.
go back to reference Khalfayan EE, Sharkey PF, Alexander AH, Bruckner JD, Bynum EB (1996) The relationship between tunnel placement and clinical results after anterior cruciate ligament reconstruction. Am J Sports Med 24(3):335–341CrossRefPubMed Khalfayan EE, Sharkey PF, Alexander AH, Bruckner JD, Bynum EB (1996) The relationship between tunnel placement and clinical results after anterior cruciate ligament reconstruction. Am J Sports Med 24(3):335–341CrossRefPubMed
17.
go back to reference Garofalo R, Moretti B, Kombot C, Moretti L, Mouhsine E (2007) Femoral tunnel placement in anterior cruciate ligament reconstruction: rationale of the two incision technique. J Orthop Surg 21(2):10CrossRef Garofalo R, Moretti B, Kombot C, Moretti L, Mouhsine E (2007) Femoral tunnel placement in anterior cruciate ligament reconstruction: rationale of the two incision technique. J Orthop Surg 21(2):10CrossRef
18.
go back to reference Liu A, Sun M, Ma C, Chen Y, Xue X, Guo P et al (2015) Clinical outcomes of transtibial versus anteromedial drilling techniques to prepare the femoral tunnel during anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 1–9 Liu A, Sun M, Ma C, Chen Y, Xue X, Guo P et al (2015) Clinical outcomes of transtibial versus anteromedial drilling techniques to prepare the femoral tunnel during anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 1–9
Metadata
Title
Correlation of tunnel widening and tunnel positioning with short-term functional outcomes in single-bundle anterior cruciate ligament reconstruction using patellar tendon versus hamstring graft: a prospective study
Authors
Udit Kumar Biswal
Gopisankar Balaji
Sandeep Nema
Murali Poduval
Jagdish Menon
Dilip Kumar Patro
Publication date
01-08-2016
Publisher
Springer Paris
Published in
European Journal of Orthopaedic Surgery & Traumatology / Issue 6/2016
Print ISSN: 1633-8065
Electronic ISSN: 1432-1068
DOI
https://doi.org/10.1007/s00590-016-1809-4

Other articles of this Issue 6/2016

European Journal of Orthopaedic Surgery & Traumatology 6/2016 Go to the issue