Top

Published in:

Open Access 01-12-2015 | Research article

Press-fit fixation using autologous bone in the tibial canal causes less enlargement of bone tunnel diameter in ACL reconstruction - a CT scan analysis three months postoperatively

Authors: Ralph Akoto, Jonas Müller-Hübenthal, Maurice Balke, Malte Albers, Bertil Bouillon, Philip Helm, Marc Banerjee, Jürgen Höher

Published in: BMC Musculoskeletal Disorders | Issue 1/2015

Abstract

Background

Bone tunnel enlargement is a phenomenon present in all anterior cruciate ligament (ACL)- reconstruction techniques. It was hypothesized that press-fit fixation using a free autograft bone plug reduces the overall tunnel size in the tibial tunnel.

Methods

In a prospective cohort study twelve patients who underwent primary ACL reconstruction using an autologous quadriceps tendon graft and adding a free bone block for press-fit fixation (PF) in the tibial tunnel were matched to twelve patients who underwent ACL reconstruction with a hamstring graft and interference screw fixation (IF). The diameters of the bone tunnels were analysed by a multiplanar reconstruction technique (MPR) in a CT scan three months postoperatively. Manual and instrumental laxity (Lachman test, Pivot-shift test, Rolimeter) and functional outcome scores (International Knee Documentation Committee sore, Tegner activity level) were measured after one year follow up.

Results

In the PF group the mean bone tunnel diameter at the level of the joint entrance was not significantly enlarged. One and two centimeter distal to the bone tunnel diameter was reduced by 15 % (p = .001). In the IF group the bone tunnel at the level of the joint entrance was enlarged by 14 % (p = .001). One and two centimeter distal to the joint line the IF group showed a widening of the bone tunnel by 21 % (p < .001) One and two centimeter below the joint line the bone tunnel was smaller in the PF group when compared to the IF group (p < .001). No significant difference for laxity test and functional outcome scores could be shown.

Conclusion

This study demonstrates that press-fit fixation with free autologous bone plugs in the tibial tunnel results in significantly smaller diameter of the tibial tunnel compared to interference screw fixation.

Hoeher J, Moeller HD, Fu FH. Bone tunnel enlargement after anterior cruciate ligament reconstruction: fact or fiction? Knee Surg Sports Traumatol Arthrosc. 1998;6(4):231–40.CrossRef

Clatworthy MG, Annear P, Bulow JU, Bartlett RJ. Tunnel widening in anterior cruciate ligament reconstruction: a prospective evaluation of hamstring and patella tendon grafts. Knee Surg Sports Traumatol Arthrosc. 1999;7(3):138–45.CrossRefPubMed

Webster KE, Feller JA, Hameister KA. 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. 2001;9(2):86–91.CrossRefPubMed

Fauno P, Kaalund S. Tunnel widening after hamstring anterior cruciate ligament reconstruction is influenced by the type of graft fixation used: A prospective randomized study. Arthroscopy J Arthroscopic Relat Sur. 2005;21(11):1337–41. doi:10.1016/j.arthro.2005.08.023.

Dave LY, Leong OK, Karim SA, Chong CH. Tunnel enlargement 5 years after anterior cruciate ligament reconstruction: a radiographic and functional evaluation. Eur J Orthop Surg Traumatol. 2014;24(2):217–23. doi:10.1007/s00590-013-1175-4.CrossRefPubMed

Buelow JU, Siebold R, Ellermann A. A prospective evaluation of tunnel enlargement in anterior cruciate ligament reconstruction with hamstrings: extracortical versus anatomical fixation. Knee Surg Sports Traumatol Arthrosc. 2002;10(2):80–5. doi:10.1007/s00167-001-0267-6.CrossRefPubMed

Jansson KA, Harilainen A, Sandelin J, Karjalainen PT, Aronen HJ, Tallroth K. Bone tunnel enlargement after anterior cruciate ligament reconstruction with the hamstring autograft and endobutton fixation technique. A clinical, radiographic and magnetic resonance imaging study with 2 years follow-up. Knee Surg Sports Traumatol Arthrosc. 1999;7(5):290–5.CrossRefPubMed

Maak TG, Voos JE, Wickiewicz TL, Warren RF. Tunnel Widening in Revision Anterior Cruciate Ligament Reconstruction. J Am Acad Orthop Sur. 2010;18(11):695–706.CrossRef

Franceschi F, Papalia R, Di Martino A, Rizzello G, Allaire R, Denaro V. A new harvest site for bone graft in anterior cruciate ligament revision surgery. Arthroscopy J Arthroscopic Relat Sur. 2007;23(5). doi:ARTN 558.e1 doi:10.1016/j.arthro.2006.07.054.

10.

Battaglia TC, Miller MD. Management of bony deficiency in revision anterior cruciate ligament reconstruction using allograft bone dowels: Surgical technique. Arthroscopy J Arthroscopic Relat Sur. 2005;21(6):6. doi:10.1016/J.Artho.2005.03.029.

11.

Wilson TC, Kantaras A, Atay A, Johnson DL. Tunnel enlargement after anterior cruciate ligament surgery. Am J Sports Med. 2004;32(2):543–9.CrossRefPubMed

12.

Paessler HH, Mastrokalos DS. Anterior cruciate ligament reconstruction using semitendinosus and gracilis tendons, bone patellar tendon, or quadriceps tendon-graft with press-fit fixation without hardware. A new and innovative procedure. Orthop Clin N Am. 2003;34(1):49–64.CrossRef

13.

Akoto R, Hoeher J. Anterior cruciate ligament (ACL) reconstruction with quadriceps tendon autograft and press-fit fixation using an anteromedial portal technique. BMC Musculoskelet Disord. 2012;13(1):161. doi:10.1186/1471-2474-13-161.CrossRefPubMedPubMedCentral

14.

Barie A, Kargus S, Huber J, Schmitt H, Streich NA. Anterior cruciate ligament reconstruction using quadriceps tendon autograft and press-fit fixation. Unfallchirurg. 2010;113(8):629–34. doi:10.1007/s00113-010-1854-0.CrossRefPubMed

15.

Felmet G. Implant-free press-fit fixation for bone-patellar tendon-bone ACL reconstruction: 10-year results. Arch Orthop Trauma Surg. 2010;130(8):985–92. doi:10.1007/s00402-010-1050-2.CrossRefPubMed

16.

Hertel P, Behrend H, Cierpinski T, Musahl V, Widjaja G. ACL reconstruction using bone-patellar tendon-bone press-fit fixation: 10-year clinical results. Knee Surg Sports Traumatol Arthrosc. 2005;13(4):248–55. doi:10.1007/s00167-004-0606-5.CrossRefPubMed

17.

Boszotta H. Arthroscopic reconstruction of anterior cruciate ligament using BTB patellar ligament in the press-fit technique. Surg Technol Int. 2003;11:249–53.PubMed

18.

Forkel P, Petersen W. Anatomic reconstruction of the anterior cruciate ligament with the autologous quadriceps tendon. Primary and revision surgery. Oper Orthop Traumatol. 2014;26(1):30–42. doi:10.1007/s00064-013-0261-4.CrossRefPubMed

19.

Jagodzinski M, Geiges B, von Falck C, Knobloch K, Haasper C, Brand J, et al. Biodegradable screw versus a press-fit bone plug fixation for hamstring anterior cruciate ligament reconstruction: a prospective randomized study. Am J Sports Med. 2010;38(3):501–8. doi:0363546509350325 [pii] doi:10.1177/0363546509350325.

20.

Kim SJ, Bae JH, Song SH, Lim HC. Bone tunnel widening with autogenous bone plugs versus bioabsorbable interference screws for secondary fixation in ACL reconstruction. J Bone Joint Surg Am. 2013;95(2):103–8. doi:10.2106/JBJS.L.00356.CrossRefPubMed

21.

Matsumoto A, Howell SM, Liu-Barba D. Time-related changes in the cross-sectional area of the tibial tunnel after compaction of an autograft bone dowel alongside a hamstring graft. Arthroscopy. 2006;22(8):855–60. doi:10.1016/j.arthro.2006.04.092.CrossRefPubMed

22.

Silva A, Sampaio R, Pinto E. ACL reconstruction: Effect of bone dowel on tibial tunnel enlargement. Knee. 2013;20(3):203–7. doi:10.1016/j.knee.2012.05.012.CrossRefPubMed

23.

Fink C, Zapp M, Benedetto KP, Hackl W, Hoser C, Rieger M. Tibial tunnel enlargement following anterior cruciate ligament reconstruction with patellar tendon autograft. Arthroscopy. 2001;17(2):138–43. doi:10.1053/jars.2001.21509.CrossRefPubMed

24.

Peyrache MD, Djian P, Christel P, Witvoet J. Tibial tunnel enlargement after anterior cruciate ligament reconstruction by autogenous bone-patellar tendon-bone graft. Knee Surg Sports Traumatol Arthrosc. 1996;4(1):2–8.CrossRefPubMed

25.

Weber AE, Delos D, Oltean HN, Vadasdi K, Cavanaugh J, Potter HG, et al. Tibial and Femoral Tunnel Changes After ACL Reconstruction: A Prospective 2-Year Longitudinal MRI Study. Am J Sports Med. 2015. doi:10.1177/0363546515570461.

26.

L'Insalata JC, Klatt B, Fu FH, Harner CD. Tunnel expansion following anterior cruciate ligament reconstruction: a comparison of hamstring and patellar tendon autografts. Knee Surg Sports Traumatol Arthrosc. 1997;5(4):234–8. doi:10.1007/s001670050056.CrossRefPubMed

27.

Weiler A, Hoffmann RF, Bail HJ, Rehm O, Sudkamp NP. Tendon healing in a bone tunnel. Part II: Histologic analysis after biodegradable interference fit fixation in a model of anterior cruciate ligament reconstruction in sheep. Arthroscopy. 2002;18(2):124–35.CrossRefPubMed

28.

Hoher J, Livesay GA, Ma CB, Withrow JD, Fu FH, Woo SLY. Hamstring graft motion in the femoral bone tunnel when using titanium button/polyester tape fixation. Knee Surg Sport Tr A. 1999;7(4):215–9. doi:10.1007/s001670050151.

29.

Marchant Jr MH, Willimon SC, Vinson E, Pietrobon R, Garrett WE, Higgins LD. Comparison of plain radiography, computed tomography, and magnetic resonance imaging in the evaluation of bone tunnel widening after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2010;18(8):1059–64. doi:10.1007/s00167-009-0952-4.CrossRefPubMed

30.

Jarvela T, Moisala AS, Paakkala T, Paakkala A. Tunnel Enlargement After Double-Bundle Anterior Cruciate Ligament Reconstruction: A Prospective, Randomized Study. Arthroscopy J Arthroscopic Relat Sur. 2008;24(12):1349–57. doi:10.1016/j.arthro.2008.07.018.

31.

Allen CR, Giffin JR, Harner CD. Revision anterior cruciate ligament reconstruction. Orthop Clin N Am. 2003;34(1):79. −+. doi:Pii S0030-5898(02)00066-4 doi:10.1016/S0030-5898(02)00066-4.

32.

Marquass B, Engel T, Hepp P, Theopold JD, Josten C. One- and two-stage procedure for revision after failure of anterior cruciate ligamenruciate ligament reconstruction. Z Orthop Unfall. 2007;145(6):712–8. doi:10.1055/S-2007-965805.

33.

Hui C, Salmon LJ, Kok A, Maeno S, Linklater J, Pinczewski LA. Fifteen-Year Outcome of Endoscopic Anterior Cruciate Ligament Reconstruction With Patellar Tendon Autograft for "Isolated'' Anterior Cruciate Ligament Tear. Am J Sport Med. 2011;39(1):89–98. doi:10.1177/0363546510379975.

34.

Barrett AM, Craft JA, Replogle WH, Hydrick JM, Barrett GR. Anterior Cruciate Ligament Graft Failure A Comparison of Graft Type Based on Age and Tegner Activity Level. Am J Sport Med. 2011;39(10):2194–8. doi:10.1177/0363546511415655.

35.

Ahlden M, Samuelsson K, Sernert N, Forssblad M, Karlsson J, Kartus J. The Swedish National Anterior Cruciate Ligament Register A Report on Baseline Variables and Outcomes of Surgery for Almost 18,000 Patients. Am J Sport Med. 2012;40(10):2230–5. doi:10.1177/0363546512457348.

36.

Drogset JO, Grontvedt T, Myhr G. Magnetic resonance imaging analysis of bioabsorbable interference screws used for fixation of bone-patellar tendon-bone autografts in endoscopic reconstruction of the anterior cruciate ligament. Am J Sports Med. 2006;34(7):1164–9. doi:10.1177/0363546505285384.CrossRefPubMed

37.

Suzuki T, Shino K, Nakagawa S, Nakata K, Iwahashi T, Kinugasa K, et al. Early integration of a bone plug in the femoral tunnel in rectangular tunnel ACL reconstruction with a bone-patellar tendon-bone graft: a prospective computed tomography analysis. Knee Surg Sports Traumatol Arthrosc. 2011;19 Suppl 1:S29–35. doi:10.1007/s00167-011-1481-5.CrossRefPubMed

38.

Chen CH, Chuang TY, Wang KC, Chen WJ, Shih CH. Arthroscopic anterior cruciate ligament reconstruction with quadriceps tendon autograft: clinical outcome in 4–7 years. Knee Surg Sports Traumatol Arthrosc. 2006;14(11):1077–85. doi:10.1007/s00167-006-0111-0.CrossRefPubMed

39.

Geib TM, Shelton WR, Phelps RA, Clark L. Anterior cruciate ligament reconstruction using quadriceps tendon autograft: intermediate-term outcome. Arthroscopy. 2009;25(12):1408–14. doi:S0749-8063(09)00516-7 [pii] doi:10.1016/j.arthro.2009.06.004.

40.

Lund B, Nielsen T, Fauno P, Christiansen SE, Lind M. Is Quadriceps Tendon a Better Graft Choice Than Patellar Tendon? A Prospective Randomized Study. Arthroscopy J Arthroscopic Relat Sur. 2014;30(5):593–8. doi:10.1016/J.Arthro.2014.01.012.

41.

Webster KE, Feller JA, Elliott J, Hutchison A, Payne R. A comparison of bone tunnel measurements made using computed tomography and digital plain radiography after anterior cruciate ligament reconstruction. Arthroscopy. 2004;20(9):946–50. doi:10.1016/j.arthro.2004.06.037.CrossRefPubMed

42.

Kopf S, Schenkengel JP, Wieners G, Starke C, Becker R. No bone tunnel enlargement in patients with open growth plates after transphyseal ACL reconstruction. Knee Surg Sports Traumatol Arthrosc. 2010;18(11):1445–51. doi:10.1007/s00167-009-1041-4.CrossRefPubMed

43.

Kobayashi M, Nakagawa Y, Suzuki T, Okudaira S, Nakamura T. A retrospective review of bone tunnel enlargement after anterior cruciate ligament reconstruction with hamstring tendons fixed with a metal round cannulated interference screw in the femur. Arthroscopy. 2006;22(10):1093–9. doi:10.1016/j.arthro.2006.05.017.CrossRefPubMed

44.

Iorio R, Vadala A, Argento G, Di Sanzo V, Ferretti A. Bone tunnel enlargement after ACL reconstruction using autologous hamstring tendons: a CT study. Int Orthop. 2007;31(1):49–55. doi:10.1007/s00264-006-0118-7.CrossRefPubMed

Title: Press-fit fixation using autologous bone in the tibial canal causes less enlargement of bone tunnel diameter in ACL reconstruction - a CT scan analysis three months postoperatively
Authors: Ralph Akoto
Jonas Müller-Hübenthal
Maurice Balke
Malte Albers
Bertil Bouillon
Philip Helm
Marc Banerjee
Jürgen Höher
Publication date: 01-12-2015
Publisher: BioMed Central
Published in: BMC Musculoskeletal Disorders / Issue 1/2015
Electronic ISSN: 1471-2474
DOI: https://doi.org/10.1186/s12891-015-0656-5

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Press-fit fixation using autologous bone in the tibial canal causes less enlargement of bone tunnel diameter in ACL reconstruction - a CT scan analysis three months postoperatively

Abstract

Background

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2015

Genome-wide DNA methylation study of hip and knee cartilage reveals embryonic organ and skeletal system morphogenesis as major pathways involved in osteoarthritis

Relationship between developmental canal stenosis and surgical results of anterior decompression and fusion in patients with cervical spondylotic myelopathy

Productivity at work and quality of life in patients with rheumatoid arthritis

Effectiveness of intra-articular injections of sodium bicarbonate and calcium gluconate in the treatment of osteoarthritis of the knee: a randomized double-blind clinical trial

The Brazilian Portuguese version of the revised Maastricht Upper Extremity Questionnaire (MUEQ-Br revised): translation, cross-cultural adaptation, reliability, and structural validation

Frequency of sarcopenia and associated factors among hospitalized elderly patients