Comparison of the aperture and midportion femoral tunnel widening after anterior cruciate ligament reconstruction

Abstract

Background: To identify whether the aperture or the midportion of the femoral tunnel had a larger tunnel widening in patients who undergo ACL reconstruction. Methods: PubMed, EMBASE and Cochrane Library were searched for relative studies that evaluated tunnel widening in patients underwent arthroscopic ACL reconstruction. Two reviewers independently recorded data from each study, including the sample size and magnitude of tunnel widening. Random-effects meta-analyses were performed to pool the outcomes of tunnel widening by estimating the standardized mean differences in tunnel widening and their 95% confidence intervals (CIs), Publication bias was assessed using funnel plots and Egger test when the number of included studies was >10. Results: Eleven included studies compared tunnel widening between the aperture and the midportion. In these studies, 372 and 92 patients underwent single- and double-bundle ACL reconstructions, respectively. Subgroup analyses in terms of evaluation imaging tool for tunnel widening showed no significant differences in tunnel widening between the aperture and the midportion of the femoral tunnel regardless of plain radiograph (mean difference, 0.02 mm; P = .97), computed tomography (mean difference 0.08 mm; P = .55), and magnetic resonance imaging (mean difference, 0.13 mm; P = .78). Likewise, no significant difference in femoral tunnel widening was found between the aperture and the midportion, irrespective of transtibial (mean difference, 0.18 mm; P = .57), anteromedial (mean difference, 0.02 mm; P = .90), and outside-in techniques (mean difference, 0.01 mm; P = .98). Conclusion: No significant difference in femoral tunnel widening was found between the aperture and the midportion in the patients who underwent ACL reconstruction.

Effect of Demineralized Bone Matrix, Bone Marrow Mesenchymal Stromal Cells, and Platelet-Rich Plasma on Bone Tunnel Healing After Anterior Cruciate Ligament Reconstruction: A Comparative Micro-Computed Tomography Study in a Tendon Allograft Sheep Model

“…10 In humans, MRI shows that tunnel widening occurs in the first 6 to 24 weeks, 44 but despite conflicting reports, a systematic review showed no significant difference in femoral tunnel widening between the aperture and midportion in humans. 5 Possible reasons why widening would be greater at the aperture compared with midportion include biological factors such as synovial fluid influx containing osteolytic cytokines 36 and increased graft tunnel motion. 31 In this study, the control group showed greater tunnel widening at the femoral aperture compared with the femoral midportion.…”

How the Aperture of Femoral Tunnel Affected in ACL Reconstruction Performed with AM Portal Technique?

“…6 ORIGINAL PAPER PŮVODNÍ PRÁCE intra-articular orientation of the intact ACL with proper coronal and sagittal obliquity, it might result in a possible increased edge pressure at the FT aperture related to the acute angle between the ACL graft and the FT compared to the transtibial technique. Celik and Lee reported in the meta-analyses that there was no significant difference in FT widening between the aperture and the mid-portion in patients who underwent ACL reconstruction (5). In the biomechanical study, which anatomic double bundle technique through far AM portal was used, Nishimato et al found that, the stress on the FT aperture in the AM portal technique, was not increased as much as transtibial technique (18).…”

Lateral posterior tibial slope does not affect femoral but does affect tibial tunnel widening following anatomic anterior cruciate ligament reconstruction using a Bone–Patellar Tendon–Bone graft

“…A recent systematic review concluded that no significant difference in TW was found between the aperture and the midportion in patients who underwent ACL reconstruction. 36 Second, in the present study, none of the factors that might affect TW, such as graft-bending angle, position of the bone plug in the tunnel, and tunnel location, were evaluated. Thus, further investigations in larger cohorts using multivariate regression analyses of such factors must be performed in the future.…”