Bone tunnel enlargement on anterior cruciate ligament reconstruction

Abstract

Objective: To assess the presence of tibial bone tunnel enlargement after surgical reconstruction of the anterior cruciate ligament using quadruple graft of the flexor tendons and correlate the functional results in their presence. Methods: The studied lasted six months and included 25 patients, with ages ranging from 18 to 43 years old. Assessment was based on radiographs taken immediately postoperatively and at the third and sixth month of follow up in the anterior cruciate ligament reconstruction. Reconstruction of ligaments was performed with tendon grafts of the semitendinosus and gracilis muscle fixated in the femur with transverse metal screw and in the tibia with interference screws. Patients were evaluated objectively by tests ligament, graded from zero to four crosses and subjectively by the Lysholm method preoperative and after sixth month follow up. Results: Significant increase in the tunnels diameters were observed, 20.56% for radiographs in the anteroposterior view, 26.48% in profile view and 23.22% in computed tomography. Descriptive statistics showed significant improvement in subjective and objective clinical parameters. Conclusions: The bone tunnel enlargement is a phenomenon found in the first months after surgical reconstruction of the anterior cruciate ligament and it has no implications on clinical outcomes in the short term. Level of Evidence II, Prospective Study.

The past, present and future in scaffold-based tendon treatments

“…To this end, improvements in the fixation methods are at the forefront of clinical research to reduce the bone tunnel enlargement for tendon [337,338] and ligament [339,340]. Interferential screws, bioabsorbable or metalling in origin [341], are considered as the gold standard for tendon-to-bone fixation and for ligament reconstruction [342][343][344].…”

Relationship between bony tunnel and knee function in patients after patellar dislocation triple surgeries—a CT-based study

“…We surmised that the autograft might also had undergone such a process for one year after MPFL reconstruction and could not provide adequate force for preventing lateral patellar displacement as a native ligament, leading to micro-movement of the screw and secondary tunnel enlargement, particularly when patients undergo weight-bearing rehabilitation training that can overload the immature autograft. Several biological and mechanical factors also contribute to tunnel enlargement, such as synovial effusion including several toxic products, inflammatory response, absorbable screw and different characteristics of grafts2831323334. On the basis of our results, we regarded tunnel enlargement as a normal physiological response of the cortex around tunnel to grafts, the surrounding tissue inflammation and joint activity.…”

Radiological and clinical evaluation amongst types of tibial tunnel widening and choice of graft fixation implants in ACL reconstruction

“…Compression system also can have the tunnel widening if the graft is not fixed near the joint line leading to stress shielding of the unloaded proximal bone. Leonardi found up to 70% tunnel widening in cases where grafts were fixed distant from the articular surface when compared to 23% in anatomic fixation [15] . As we have used interference screw on tibial side fixing the graft rigidly, we expected these cases to have lesser amount of tunnel widening.…”