Bone Tunnel Enlargement after ACL Reconstruction with Hamstring Autograft Is Dependent on Original Bone Tunnel Diameter

Abstract

Bone tunnel enlargement is a well-established phenomenon following anterior cruciate ligament (ACL) reconstruction, and is related to soft tissue grafts, suspension fixation devices, and absorbable implants. Severe tunnel enlargement can lead to reconstruction failure. The correlation between bone tunnel enlargement following ACL reconstruction and original bone tunnel diameter has not been elucidated. To determine whether bone tunnel enlargement after ACL reconstruction with hamstring autograft is dependent on original tunnel diameter established during primary ACL reconstruction. A retrospective review was conducted on 56 patients scheduled for ACL revision surgery who had undergone computed tomography (CT) scanning as part of their preoperative evaluation. All patients had undergone previous hamstring ACL reconstruction. Original femoral and tibial bone tunnel diameters were extracted from operative reports, and femoral and tibial bone tunnel enlargement was assessed on CT serial sections. The correlation between original tunnel diameter and bone tunnel enlargement was investigated using regression analysis. Mean tibial bone tunnel enlargement was significantly and inversely dependent on the original tibial bone tunnel diameter with a correlation coefficient of -0.55 per unit (7 mm = +1.93 mm, 8 mm = +1.43 mm, 9 mm = 0.83 mm, = 0.007). Thus, every additional increase (mm) in diameter of the original tibial bone tunnel reduces the extend of tunnel widening by 0.55 mm. The results of this study indicate that tibial bone tunnel enlargement following ACL reconstruction is dependent on original tibial bone tunnel diameter with smaller diameter tunnels developing more tunnel enlargement than larger tunnels. The contributing factors remain unclear and need to be further investigated.

Better outcome for suture button compared with single syndesmotic screw for syndesmosis injury: five-year results of a randomized controlled trial

“…The medial deltoid ligament is found to be the primary stabilizer of the ankle, preventing external rotation of the talus (88). In a recent ESSKA-AFAS consensus, Van Dijk et al proposes that isolated syndesmotic injuries with intact deltoid ligament can be managed conservatively (181). A new RCT is being planned as a multicenter study in Norway, where patients with a stable, isolated suprasyndesmotic (AO/OTA C) fracture, are randomized to surgical or non-operative intervention.…”

Effect of bone canal widening after anterior cruciate ligament reconstruction

“…Также можно сделать вывод, что рентгенологические данные расширения костных каналов не влияют на клинические субъективные и объективные результаты реконструкции ПКС. Наши данные согласуются с результатами исследований других авторов [19][20][21]23].…”

“…Большинство исследователей отрицают взаимосвязь между клиническими и функциональными результатами реконструкции ПКС и расширением костных каналов [17][18][19], однако некоторые авторы говорят о возникновении из-за этого повторной передней нестабильности и несостоятельности трансплантата ПКС [10,20]. Не следует отрицать и тот факт, что расширенные костные каналы чаще всего являются фактором риска двухэтапного устранения передней нестабильности [10].…”

Anterior cruciate ligament graft healing by peptide-based vascular endothelial growth factor and bone morphogenetic protein recruitment

“…Despite the long but often successful completion of graft integration, unfavorable variations exist, including graft necrosis 7 , bone tunnel enlargement 8 , poor graft osteointegration 9 , and low deposition and quality of new extracellular matrix 10 .…”