Anterior Cruciate Ligament Reconstruction With Bone–Patellar Tendon–Bone Graft Through a Rectangular Bone Tunnel Made With a Rectangular Retro-dilator: An Operative Technique

Hayashi, Hironobu; Kurosaka, Daitaro; Saito, Mitsuru; Ikeda, Ryo; Kijima, Eiji; Yamashita, Yu; Marumo, Keishi

doi:10.1016/j.eats.2017.03.018

Cited by 8 publications

(11 citation statements)

References 12 publications

(20 reference statements)

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“…It is noteworthy that while there are limited comparative studies comparing tibial tunnel preparation technique, there are multiple studies comparing ED against SD in femoral tunnel preparation as well as those studies concerned with downstream consequences of tibial tunnel preparation (28–31). While the concept of ED against SD is not foreign to clinicians’ understanding of the femoral tunnel preparation, it is apparent that the body of literature regarding the preparation of the tibial tunnel is lacking.…”

Section: Discussionmentioning

confidence: 99%

“…While the concept of ED against SD is not foreign to clinicians’ understanding of the femoral tunnel preparation, it is apparent that the body of literature regarding the preparation of the tibial tunnel is lacking. It is important to note that SD of the femoral tunnel has been shown to be potentially advantageous in comparison to ED by reducing intraoperative complications and compacting cancellous bone resulting in a stronger graft fit (28). However, the tibia and femur differ in bone composition and strength and might respond differently to ED and SD (32).…”

Section: Discussionmentioning

confidence: 99%

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No difference between extraction drilling and serial dilation for tibial tunnel preparation in anterior cruciate ligament reconstruction: a systematic review

Crum

Ayeni

et al. 2018

Journal of ISAKOS

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Importance: This review highlights a lack of consensus and need for further study regarding optimal tibial tunnel preparation method in anterior cruciate ligament reconstruction (ACLR). Objective: This review examines existing clinical and biomechanical outcomes of both extraction drilling (ED) and serial dilation (SD) as a technique for tibial tunnel preparation in ACLR. Evidence Review: In accordance with PRISMA guidelines, three electronic databases (MEDLINE, EMBASE, and PubMed) were searched and systematically screened in duplicate from database inception to September 6, 2017 for English-language, human studies, of all levels of evidence that examined ED and/or SD for tibial tunnel preparation in ACLR. Data including patient demographics, tibial tunnel preparation techniques, biomechanical and clinical outcomes and complications were retrieved from eligible studies. Findings: ED was used in 71 patients, who were mean age 29.9 years (range: 17–50), 68% male, and followed for mean 16.5 months (range: 3.8–46). SD was used in 70 patients (70 knees), who were mean age 29.3 years (range: 18–50), 69% male, and followed for mean 14.1 months (range: 3.8–46). There were no statistically significant differences (mean preoperative; mean postoperative) for either tibial preparation technique for Lysholm (50.1; 92.5), Tegner (3.5; 6.1), International Knee Documentation Committee (IKDC) (48.8; 92.7), and Lachman or laxity scores. However, ED demonstrated statistically significant increased postoperative tibial tunnel expansion (1.8 mm versus 1.4 mm) and (at 12 weeks) graft migration at the tibial fixation site (1.3 mm versus 0.8 mm). Across biomechanical studies, there were no statistically significant differences (ED; SD) with forces required to initiate graft slippage (156 N; 174 N), graft stiffness (187 N; 186.5 N), and screw torque (1.6 N/m; 1.8 N/m). ED demonstrated a lower mean load to failure for the graft construct (433 N versus 631 N; p<0.05). Conclusions and Relevance: Though biomechanical data demonstrated lower mean load to failure for the graft using ED, clinical data suggest increased tibial tunnel expansion and post-operative graft migration at the tibial fixation site. Future studies with long-term follow-up data are required to ascertain the optimal technique for graft incorporation and postoperative success. Level of Evidence: IV:Systematic Review of Level I-IV studies.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

No difference between extraction drilling and serial dilation for tibial tunnel preparation in anterior cruciate ligament reconstruction: a systematic review

Crum

Ayeni

et al. 2018

Journal of ISAKOS

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“…Surgery was performed as described previously (Figs 1 and 2) [9]. Briefly, surgery was performed in the supine position under general anesthesia, and utilized a 30 ° oblique arthroscope with a diameter of 4.0 mm.…”

Section: Methodsmentioning

confidence: 99%

“…In BPTB ACLR incorporating the anatomical rectangular tunnel (ART BPTB ACLR) technique, the pattern of force sharing was similar to that in the normal ACL in response to anterior tibial load and during passive knee extension motion [8]. We previously reported a safe, minimally invasive method of ART BPTB ACLR technique by using a rectangular retro-dilator (RRD) (Ario Medical, Osaka, Japan) [9]. The RRD method enables easier bone socket and tunnel creation at the intended target positions whilst minimizing bone drilling.…”

Section: Introductionmentioning

confidence: 99%

Positioning the femoral bone socket and the tibial bone tunnel using a rectangular retro-dilator in anterior cruciate ligament reconstruction

et al. 2019

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Purpose The purpose of this study was to evaluate the positions of femoral bone sockets and tibial bone tunnels made with the rectangular retro-dilator (RRD), which we manufactured for anterior cruciate ligament reconstruction (ACLR) with a bone-patella tendon-bone (BPTB) graft which is fixed into the rectangular bone socket and tunnel made at anatomical ACL insertion sites. Methods 42 patients who had undergone ACLR with BPTB using the RRD were evaluated to assess bone socket and tunnel positions by the quadrant method and Magnussen classification using three-dimensional (3-D) CT. Intra-operative complications were also investigated in all patients. Results 3-D CT of the operated knee joints using the RRD showed that the bone socket and tunnel were placed in anatomical positions. In the quadrant method, the mean position of the femoral bone socket aperture was located at 22.0 ± 4.2% along the Blumensaat’s line, and 37.4 ± 7.2% across the posterior condylar rim. The mean positions of the tibial bone tunnel aperture were 37.7 ± 5.2% and 46.1 ± 2.2% antero-posteriorly and medio-laterally, respectively. In addition, according to the Magnussen classification, 39 cases were evaluated as type 1, and almost all were located behind the lateral intercondylar ridge (also known as the resident’s ridge). 3 cases were classified as type 2, which overlapped with the resident’s ridge. A partial fracture of BPTB bone fragment was observed in 2 patients, but no serious complications including neurovascular injury were observed. Conclusion The study indicates that the use of RRD achieves a safe anatomical reconstruction of the ACL.

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“…Rectangular bone tunnels have been described with patellar tendon (PT) graft by Hayashi et al. 3 and with quadriceps tendon (QT) graft by Fink and Hoser 4 (in German). Both PT and QT grafts are broader and flatter than HT grafts and hence morphologically more similar to the ribbon-like ACL.…”

mentioning

confidence: 99%

Minimally Invasive Quadriceps Tendon Single-Bundle, Arthroscopic, Anatomic Anterior Cruciate Ligament Reconstruction With Rectangular Bone Tunnels

Fink

Lawton

Förschner

et al. 2018

Arthroscopy Techniques

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Many surgeons use quadriceps tendon (QT) graft for anterior cruciate ligament (ACL) revision surgery; however, despite excellent clinical results, the QT has not achieved universal acceptance for primary ACL reconstruction. One of the reasons for this may be that the QT is technically demanding to harvest and the scar from open harvesting techniques is less cosmetically favorable than that from hamstring tendon techniques. Recent evidence has suggested that broad flat QT grafts may more closely mimic native ACL “ribbon-like” morphology than hamstring tendon grafts. Furthermore, rectangular bone tunnels may more accurately re-create native ACL attachments, allowing grafts to simulate native ACL rotation during knee flexion and potentially improving biomechanics. Rectangular tunnels have further advantages in revision cases, in which—in comparison with round tunnels—they have reduced overlap with pre-existing transtibial tunnels, increasing the chance of bypassing primary tunnels during revision surgery. Finally, instrumentation for minimally invasive QT harvesting has reduced technical difficulty and improved cosmetic results. Hence, technical and cosmetic concerns are no longer barriers to QT use. These anatomic and biomechanical advantages and technical developments make the QT an increasingly attractive option for both primary and revision ACL reconstruction.

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Anterior Cruciate Ligament Reconstruction With Bone–Patellar Tendon–Bone Graft Through a Rectangular Bone Tunnel Made With a Rectangular Retro-dilator: An Operative Technique

Cited by 8 publications

References 12 publications

No difference between extraction drilling and serial dilation for tibial tunnel preparation in anterior cruciate ligament reconstruction: a systematic review

No difference between extraction drilling and serial dilation for tibial tunnel preparation in anterior cruciate ligament reconstruction: a systematic review

Positioning the femoral bone socket and the tibial bone tunnel using a rectangular retro-dilator in anterior cruciate ligament reconstruction

Minimally Invasive Quadriceps Tendon Single-Bundle, Arthroscopic, Anatomic Anterior Cruciate Ligament Reconstruction With Rectangular Bone Tunnels

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