ACL surgery: reasons for failure and management

Diquattro, Emanuele; Jahnke, Sonja; Traina, Francesco; Perdisa, Francesco; Becker, Roland; Kopf, Sebastian

doi:10.1530/eor-23-0085

Cited by 7 publications

(1 citation statement)

References 137 publications

(164 reference statements)

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“…After the failure of ACL initial reconstruction, it was di cult to identify and determine the appropriate location of femoral tunnel during the revision process [7][8][9]. If the tunnel position was improper, it was necessary to choose another tunnel or ll original tunnel for a second stage operation [10].…”

Section: Introductionmentioning

confidence: 99%

The significance of guiding anterior cruciate ligament revision: a modified femoral tunnel classification

Niu,

Chen,

Jin

et al. 2024

Preprint

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Background The positioning error of femoral tunnel was the key factor leading to the failure of anterior cruciate ligament (ACL) reconstruction. This study aimed to propose a new femoral tunnel classification to guide ACL revision process. Methods Totals of 150 patients with ACL reconstruction failure from 2016 and 2023 were enrolled in this retrospective study. According to the tunnel diameter, shape, back wall and the positioning relationship with the Lateral Intercondylar Ridge on the three-dimensional CT imaging, we divided the femoral tunnels into four types: Type I off-target type, Type Ⅱ straddled type, Type Ⅲ anatomical type, and Type IV irregular type. Finally, explored the inter-observer reliability within two groups of doctors (Group A, 12 high seniorities; Group B, 12 low seniorities), and evaluated the intra-observer reliability within 6 doctors after two months. Results Among 150 cases of femoral tunnel three-dimensional CT reconstructed imaging, 144 cases were successfully included in the classification system, and 6 cases were confirmed as uncertain type. We measured the Kappa (κ) coefficient of group A was significantly higher than that of group B (κ 0.72 VS 0.68), and the κ coefficient of group A was still higher than group B (κ 0.69 VS 0.62) after further dividing Type Ⅲ anatomical type into three subtypes. In addition, the κ coefficients of intra-observer reliability were all exceeded 0.73. Conclusion The new femoral tunnel classification was reliable and had clinical guiding significance based on three-dimensional CT imaging. Level of evidence Level Ⅲ

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Section: Introductionmentioning

confidence: 99%

The significance of guiding anterior cruciate ligament revision: a modified femoral tunnel classification

Niu,

Chen,

Jin

et al. 2024

Preprint

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Gradual stabilization and narrowing of bone tunnels following primary anterior cruciate ligament reconstruction

Liu,

Lu,

Vithran

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeThe purpose of this study is to dynamically assess variations in tunnel diameters following anterior cruciate ligament reconstruction (ACLR) and investigate correlations with patient‐reported outcomes (PROs) and graft maturity based on signal‐to‐noise quotient (SNQ).MethodsTunnel diameter and tunnel position were measured using three‐dimensional models derived from computed tomography (CT) data. Postoperative graft maturity and integration were evaluated using magnetic resonance imaging (MRI). Clinical outcomes were assessed through PROs, which included the International Knee Documentation Committee Subjective Knee Evaluation Form, Knee Injury and Osteoarthritis Outcome Scores and Lysholm scores. The correlation between tunnel enlargement extent, PROs and SNQ values, as well as correlations between confounding factors, tunnel diameter differences and SNQ were analyzed.ResultsA total of 73 participants underwent primary ACLR and scheduled follow‐ups. At the segment of the articular aperture, the femoral tunnel was enlarged by 32.3% to 10.4 ± 1.6 mm (p < 0.05), and the tibial tunnel was widened by 17.2% to 9.6 ± 1.2 mm (p < 0.05) at the 6‐month follow‐up. At 1 year postoperatively, diameters at the articular aperture were not further increased on the femoral (n.s.) and tibial (n.s.) sides. In early postoperative follow‐up, the femoral tunnel was anteriorly and distally shifted, coupled with posterior and lateral deviation involving the tibial side, exhibiting minimal migration at 1‐year follow‐up. The degree of tunnel widening was not correlated with PROs and SNQ values. Age, gender, body mass index (BMI), time from surgery to follow‐up, concomitant injuries and autograft type were not correlated with tunnel diameter differences and SNQ.ConclusionsThe femoral and tibial bone tunnels exhibited eccentrical widening and gradually stabilized at 1 year following ACLR. Furthermore, the enlarged bone tunnels were not correlated with unsatisfied PROs and inferior graft maturity.Level of evidenceLevel IV.

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Physeal-Sparing, All-Inside Anterior Cruciate Ligament Reconstruction Using Quadrupled Semitendinosus Autograft and Suture Tape Augmentation for Skeletally Immature Patients

Tang,

Xiao,

et al. 2024

Arthroscopy Techniques

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ACL surgery: reasons for failure and management

Cited by 7 publications

References 137 publications

The significance of guiding anterior cruciate ligament revision: a modified femoral tunnel classification

The significance of guiding anterior cruciate ligament revision: a modified femoral tunnel classification

Gradual stabilization and narrowing of bone tunnels following primary anterior cruciate ligament reconstruction

Physeal-Sparing, All-Inside Anterior Cruciate Ligament Reconstruction Using Quadrupled Semitendinosus Autograft and Suture Tape Augmentation for Skeletally Immature Patients

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