Top

Knee Surgery, Sports Traumatology, Arthroscopy

Published in:

01-03-2021 | Magnetic Resonance Imaging | KNEE

Combination of anterior tibial and femoral tunnels makes the signal intensity of antero-medial graft higher in double-bundle anterior cruciate ligament reconstruction

Authors: Daisuke Chiba, Yuji Yamamoto, Yuka Kimura, Shizuka Sasaki, Eiichi Tsuda, Yasuyuki Ishibashi

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 3/2021

Abstract

Purpose

To elucidate whether sagittal graft tunnel affects the signal intensity in anatomical ACL reconstruction (ACLR) and to clarify the prevalence of intercondylar roof impingement. It was hypothesized that if the tunnel apertures are located within the anatomical footprint of ACL, tunnel position would not affect the signal intensity.

Methods

A total of 132 patients who underwent anatomical double-bundle ACLR (DB-ACLR) using hamstring autograft were recruited. Tunnel position was determined by the quadrant method on three-dimensional computed tomography; the femoral tunnel position was defined as “high and low” or “deep and shallow”, while that of the tibial side was defined as “anterior and posterior” or “medial and lateral”. Subjects were divided into three groups according to the tertile of % deep–shallow. The signal intensity was evaluated by the region of interest value of the antero-medial bundle (AMB) and postero-lateral bundle on magnetic resonance imaging at 12 months after reconstruction. Linear regression analysis was conducted to elucidate the relationship between the percentage position of each tunnel and the graft signal intensity.

Results

In the shallow tertile group, AMB signal intensity increased in the anterior position of the tibial tunnel (β = − 0.34; P = 0.025). In the intermediate and deep tertile groups, the tunnel position did not correlate with the signal intensity.

Conclusions

A more anterior tibial tunnel position increases AMB signal intensity in shallower femoral tunnel. Conversely, this correlation is attenuated for deeper femoral tunnels. Surgeons should pay attention to sagittal femoral tunnel position to create a more anterior tibial tunnel position.

Level of evidence

Level III.

Available only for authorised users

Ahn JH, Kim JD, Kang HW et al (2015) Anatomic placement of the femoral tunnels in double-bundle anterior cruciate ligament reconstruction correlates with improved graft maturation and clinical outcomes. Arthroscopy 31:2152–2161PubMed

Araujo PH, Asai S, Pinto M et al (2015) ACL graft position affects in situ graft force following ACL reconstruction. J Bone Joint Surg Am 97:1767–1773PubMed

Bedi A, Maak T, Musahl V et al (2011) Effect of tunnel position and graft size in single-bundle anterior cruciate ligament reconstruction: An evaluation of time-zero knee stability. Arthroscopy 27:1543–1551PubMed

Bedi A, Maak T, Musahl V et al (2011) Effect of tibial tunnel position on stability of the knee after anterior cruciate ligament reconstruction: Is the tibial tunnel position most important? Am J Sports Med 39:366–373PubMed

Bernard M, Hertel P, Hornung H et al (1997) Femoral insertion of the ACL. Radiographic quadrant method. Am J Knee Surg 10:14–21PubMed

Bernhardson AS, Aman ZS, Dornan GJ et al (2019) Tibial slope and its effect on force in anterior cruciate ligament grafts: anterior cruciate ligament force increases linearly as posterior tibial slope increases. Am J Sports Med 47:296–302PubMed

Chen L, Wu Y, Lin G et al (2018) Graft bending angle affects allograft tendon maturity early after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 26:3048–3054PubMed

Chiba D, Tsuda E, Tsukada H et al (2017) Tunnel malpositions in anterior cruciate ligament risk cartilaginous changes and bucket-handle meniscal tear: arthroscopic survey in both primary and revision surgery. J Orthop Sci 22:892–897PubMed

Forsythe B, Kopf S, Wong AK et al (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 92:1418–1426PubMed

10.

George MS, Dunn WR, Spindler KP (2006) Current concepts review: revision anterior cruciate ligament reconstruction. Am J Sports Med 34:2026–2037PubMed

11.

Hatayama K, Terauchi M, Saito K et al (2013) The importance of tibial tunnel placement in anatomic double-bundle anterior cruciate ligament reconstruction. Arthroscopy 29:1072–1078PubMed

12.

Hakozaki A, Niki Y, Enomoto H et al (2015) Clinical significance of T2*-weighted gradient-echo MRI to monitor graft maturation over one year after anatomic double-bundle anterior cruciate ligament reconstruction: a comparative study with proton density-weighted MRI. Knee 22:4–10PubMed

13.

Hofbauer M, Soldati F, Szomolanyi P et al (2019) Hamstring tendon autografts do not show complete graft maturity 6 months postoperatively after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 27:130–136PubMed

14.

Howell SM, Clark JA, Farley TE et al (1991) A rationale for predicting anterior cruciate graft impingement by the intercondylar roof: a magnetic resonance imaging study. Am J Sports Med 19:276–282PubMed

15.

Howell SM, Berns GS, Farley TE (2009) Unimpinged and impinged anterior cruciate ligament grafts: MR signal intensity measurements. Radiology 179:639–643

16.

Howell SM (1992) Arthroscopic roofplasty: a method for correcting an extension deficit caused by roof impingement of an anterior cruciate ligament graft. Arthroscopy 8:375–379PubMed

17.

Howell SM, Clark JA (1992) Tibial tunnel placement in anterior cruciate ligament reconstructions and graft impingement. Clin Orthop Relat Res 283:187–195

18.

Hussein M, van Eck CF, Cretnik A et al (2012) Prospective randomized clinical evaluation of conventional single-bundle, anatomic single-bundle, and anatomic double-bundle anterior cruciate ligament reconstruction: 281 cases with 3- to 5-year follow-up. Am J Sports Med 40:512–520PubMed

19.

Iriuchishima T, Tajima G, Ingham SJ et al (2010) Impingement pressure in the anatomical and nonanatomical anterior cruciate ligament reconstruction: a cadaver study. Am J Sports Med 38:1611–1617PubMed

20.

Jagodzinski M, Leis A, Iselborn KW et al (2003) Impingement pressure and tension forces of the anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc 11:85–90PubMed

21.

Jepsen CF, Lundberg-Jensen AK, Faunoe P et al (2007) Does the position of the femoral tunnel affect the laxity or clinical outcome of the anterior cruciate ligament-reconstructed knee? a clinical, prospective, randomized, double-blind study. Arthroscopy 23:1326–1333PubMed

22.

Kellgren JH, Lawrence JS (1957) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16:494–502PubMedPubMedCentral

23.

Kopf S, Forsythe B, Wong AK et al (2012) Transtibial ACL reconstruction technique fails to position drill tunnels anatomically in vivo 3D CT study. Knee Surg Sports Traumatol Arthrosc 20:2200–2207PubMed

24.

Lee JK, Lee S, Seong SC et al (2015) Anatomy of the anterior cruciate ligament insertion sites: comparison of plain radiography and three-dimensional computed tomographic imaging to anatomic dissection. Knee Surg Sports Traumatol Arthrosc 23:2297–2305PubMed

25.

Lee MC, Seong SC, Lee S et al (2007) Vertical femoral tunnel placement results in rotational knee laxity after anterior cruciate ligament reconstruction. Arthroscopy 23:771–778PubMed

26.

Loh JC, Fukuda Y, Tsuda E et al (2003) Knee stability and graft function following anterior cruciate ligament reconstruction: comparison between 11 o'clock and 10 o'clock femoral tunnel placement. Arthroscopy 19:297–304PubMed

27.

Mochizuki Y, Kaneko T, Kawahara K et al (2018) The quadrant method measuring four points is as a reliable and accurate as the quadrant method in the evaluation after anatomical double-bundle ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 26:2389–2394PubMed

28.

Nagai K, Tashiro Y, Herbst E et al (2018) Steeper posterior tibial slope correlates with greater tibial tunnel widening after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 26:3717–3723PubMed

29.

Navacchia A, Bates NA, Schilaty ND et al (2019) Knee abduction and internal rotation moments increase ACL force during landing through the posterior slope of the Tibia. J Orthop Res 37:1730–1742PubMedPubMedCentral

30.

Nawabi DH, Tucker S, Schafer KA et al (2016) ACL fibers near the lateral intercondylar ridge are the most load bearing during stability examinations and isometric through passive flexion. Am J Sports Med 44:2563–2571PubMed

31.

Nohmi S, Ishibashi Y, Tsuda E et al (2012) Biomechanical comparison between single-bundle and double-bundle anterior cruciate ligament reconstruction with hamstring tendon under cyclic loading condition. Sports Med Arthrosc Rehabil Ther Technol 4:23PubMedPubMedCentral

32.

Ntoulia A, Papadopoulou F, Ristanis S et al (2011) Revascularization process of the bone-patellar tendon-bone autograft evaluated by contrast-enhanced magnetic resonance imaging 6 and 12 months after anterior cruciate ligament reconstruction. Am J Sports Med 39:1478–1486PubMed

33.

Ntoulia A, Papadopoulou F, Zampeli F et al (2013) Evaluation with contrast-enhanced magnetic resonance imaging of the anterior cruciate ligament graft during its healing process: a two-year prospective study. Skeletal Radiol 42:541–552PubMed

34.

Sadoghi P, Kröpfl A, Jansson V et al (2011) Impact of tibial and femoral tunnel position on clinical results after anterior cruciate ligament reconstruction. Arthroscopy 27:355–364PubMed

35.

Sasaki N, Ishibashi Y, Tsuda E et al (2012) The femoral insertion of the anterior cruciate ligament: discrepancy between macroscopic and histological observations. Arthroscopy 28:1135–1146PubMed

36.

Sasaki S, Tsuda E, Hiraga Y et al (2016) Prospective randomized study of objective and subjective clinical results between double-bundle and single-bundle anterior cruciate ligament reconstruction. Am J Sports Med 44:855–864PubMed

37.

Saupe N, White LM, Chiavaras MM et al (2008) Anterior cruciate ligament reconstruction grafts: MR imaging features at long-term follow-up—correlation with functional and clinical evaluation. Radiology 249:581–590PubMed

38.

Shino K, Nakata K, Nakamura N et al (2015) Anatomically oriented anterior cruciate ligament reconstruction with a bone-patellar tendon-bone graft via rectangular socket and tunnel: a snug-fit and impingement-free grafting technique. Arthroscopy 21:1402

39.

Sonoda M, Morikawa T, Tsuchiya K et al (2007) Correlation between knee laxity and graft appearance on magnetic resonance imaging after double-bundle hamstring graft anterior cruciate ligament reconstruction. Am J Sports Med 35:936–942PubMed

40.

Taketomi S, Inui H, Nakamura K et al (2014) Clinical outcome of anatomic double-bundle ACL reconstruction and 3D CT model-based validation of femoral socket aperture position. Knee Surg Sports Traumatol Arthrosc 22:2194–2201PubMed

41.

Tashiro Y, Gale T, Sundaram V et al (2017) The graft bending angle can affect early graft healing after anterior cruciate ligament reconstruction. In vivo analysis with 2 years’ follow-up. Am J Sports Med 45:1829–1836PubMed

42.

Tensho K, Shimodaira H, Aoki T et al (2014) Bony landmarks of the anterior cruciate ligament tibial footprint: a detailed analysis comparing 3-dimensional computed tomography images to visual and histological evaluations. Am J Sports Med 42:1433–1440PubMed

43.

Tsuda E, Ishibashi Y, Fukuda A et al (2010) Tunnel position and relationship to postoperative knee laxity after double-bundle anterior cruciate ligament reconstruction with a transtibial technique. Am J Sports Med 38:698–706PubMed

44.

Tsukada H, Ishibashi Y, Tsuda E et al (2008) Anatomical analysis of the anterior cruciate ligament femoral and tibial footprints. J Orthop Sci 13:122–129PubMed

45.

Tsukada S, Fujishiro H, Watanabe K et al (2014) Anatomic variations of the lateral intercondylar ridge: relationship to the anterior margin of the anterior cruciate ligament. Am J Sports Med 42:1110–1117PubMed

46.

van Diek FM, Wolf MR, Murawski CD et al (2014) Knee morphology and risk factors for developing an anterior cruciate ligament rupture: an MRI comparison between ACL-ruptured and non-injured knees. Knee Surg Sports Traumatol Arthrosc 22:987–994PubMed

47.

Vrooijink SH, Wolters F, van Eck CF et al (2011) Measurements of knee morphometrics using MRI and arthroscopy: a comparative study between ACL-injured and non-injured subjects. Knee Surg Sports Traumatol Arthrosc 19:S12–S16PubMed

48.

Zantop T, Diermann N, Schumacher T et al (2008) Anatomical and nonanatomical double-bundle anterior cruciate ligament reconstruction: importance of femoral tunnel location on knee kinematics. Am J Sports Med 36:678–685PubMed

Title: Combination of anterior tibial and femoral tunnels makes the signal intensity of antero-medial graft higher in double-bundle anterior cruciate ligament reconstruction
Authors: Daisuke Chiba
Yuji Yamamoto
Yuka Kimura
Shizuka Sasaki
Eiichi Tsuda
Yasuyuki Ishibashi
Publication date: 01-03-2021
Publisher: Springer Berlin Heidelberg
Keywords: Magnetic Resonance Imaging
Magnetic Resonance Imaging
Femuroacetabular Impingement
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 3/2021
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-020-06014-4

At a glance: The STEP trials

Springer Medicine

Combination of anterior tibial and femoral tunnels makes the signal intensity of antero-medial graft higher in double-bundle anterior cruciate ligament reconstruction

Abstract

Purpose

Methods

Results

Conclusions

Level of evidence

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Level of evidence

Please log in to get access to this content

Other articles of this Issue 3/2021

Evaluation of the “Minimal Clinically Important Difference” (MCID) of the KOOS, KSS and SF-12 scores after open-wedge high tibial osteotomy

Variations in medial and lateral slope and medial proximal tibial angle

Anterior root of lateral meniscus and medial tibial spine are reliable intraoperative landmarks for the tibial footprint of anterior cruciate ligament

No difference in patient satisfaction after mobile bearing or fixed bearing medial unicompartmental knee arthroplasty

Better accuracy and reproducibility of a new robotically-assisted system for total knee arthroplasty compared to conventional instrumentation: a cadaveric study

Effectiveness of thicker hamstring or patella tendon grafts to reduce graft failure rate in anterior cruciate ligament reconstruction in young patients