Comparison of Tunnel Enlargement and Clinical Outcome Between Bioabsorbable Interference Screws and Cortical Button-Post Fixation in Arthroscopic Double-Bundle Anterior Cruciate Ligament Reconstruction: A Prospective, Randomized Study With a Minimum Follow-Up of 2 Years

Chiang, En Rung; Chen, Kun Hui; Lin, Aaron; Wang, Shih Tien; Wu, Hsiang Ling; Li, Hsiao; Chang, Ming Chau; Liu, Chien Lin; Chen, Tain Hsiung

doi:10.1016/j.arthro.2018.08.039

Cited by 31 publications

(35 citation statements)

References 30 publications

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“…(ACL, anterior cruciate ligament.) e248 enlargement, which could be shown by Chiang et al 20 in the setting of double-bundle reconstruction. Hence, there were multiple aims for developing an ACL reconstruction technique with special features, as outlined in the 2 sections to follow.…”

mentioning

confidence: 81%

Anterior Cruciate Ligament Reconstruction Using a Ribbon-Like Graft With a C-Shaped Tibial Bone Tunnel

Fink

Śmigıelski²,

Siebold³

et al. 2020

Arthroscopy Techniques

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According to recent anatomic studies, the anterior cruciate ligament (ACL) appears to be a flat, "ribbon-like" structure, with a thin, oval-shaped insertion on the femur and a C-shaped tibial insertion. According to this anatomy, we describe an ACL-reconstruction technique that aims to approximate this natural anatomy. The basic principle of this technique is not to use conventional round tunnels but create tunnel shapes that resemble more closely the original ACL insertion sites. Using either a rectangular quadriceps tendon graft or a "flat" hamstring graft may not only provide a biomechanical advantage with increased rotational stability but also improve boneetendon healing due to increased boneetendon contact and decreased diffusion length. Creating a C-shaped tibial tunnel also avoids laceration of the anterior horn of the lateral meniscus, which is frequently harmed during conventional tibial tunnel drilling.

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mentioning

confidence: 81%

Anterior Cruciate Ligament Reconstruction Using a Ribbon-Like Graft With a C-Shaped Tibial Bone Tunnel

Fink

Śmigıelski²,

Siebold³

et al. 2020

Arthroscopy Techniques

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“…What is especially alarming is that, unlike a single-bundle technique, the "anatomically" placed grafts in a double-bundle ACL also result in tunnel expansion (with potentially twice as many tunnels involved), thus introducing the possibility of tunnel convergence, creating an even more challenging problem with revision ACL surgery. Importantly, in their article, Chiang et al 3 point out that the clinical outcomes were not significantly different between the 2 fixation groups (despite less expansion on the cortical fixation group, contrary to their hypothesis). The paradox of increased tunnel expansion with nonsignificant differences in clinical outcomes corroborates the findings described by numerous other investigators around the world.…”

mentioning

confidence: 85%

“…Despite more than 20 years of publications, in 2018, tunnel expansion after ACL reconstruction remains a challenging problem and is especially an issue with double-bundle (4 tunnels) reconstruction. The article in this issue of Arthroscopy (Level II evidence), "Comparison of Tunnel Enlargement and Clinical Outcome Between Bioabsorbable Interference Screws and Cortical Button-Post Fixation in Arthroscopic Double-Bundle Anterior Cruciate Ligament Reconstruction: A Prospective, Randomized Study With a Minimal Follow-Up of 2 Years," authored by Chiang, Chen, Lin, Wang, Wu, Ma, Chang, Liu, and Chen, 3 showed that, despite anatomically placed tunnels and 2 different fixation types, tunnel expansion (ranging from 40%-60%) occurred in most of the tunnels. One of the first articles published was more than 21 years ago, 4 and while it still remains a mystery, the problem of tunnel expansion likely represents a combination of biomechanical and biological processes that should become clearer as our knowledge of tissue engineering evolves.…”

mentioning

confidence: 99%

Editorial Commentary: Déjà Vu: Double-Bundle Anterior Cruciate Ligament Reconstruction Revisited

Harner¹,

Warth²,

Poehling³

2019

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Regardless of the technique utilized, tunnel expansion following anterior cruciate ligament reconstruction remains a mystery and a clinical challenge. No procedure seems to be immune to this, even anatomic double-bundle reconstruction. This technique was introduced more than 20 years ago and showed great promise while also contributing significantly to our current knowledge of anterior cruciate ligament anatomy and biomechanics. However, we must remember that new techniques do carry with them new side effects that we must document and acknowledge if we hope to improve our surgical outcomes.

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“…As a result of widening, the tunnels are often enlarged to greater than 10 mm, making a primary fixation of the graft either impossible or at least very difficult. [10][11][12] In addition, the initial tunnels are often poorly positioned, increasing the risk of tunnel confluence when new tunnels are placed correctly. It should be noted that nonanatomic tunnel placement represents the most common etiology, occurring in 22% to 79% of cases.…”

mentioning

confidence: 99%

Autologous Bone Graft Versus Silicate-Substituted Calcium Phosphate in the Treatment of Tunnel Defects in 2-Stage Revision Anterior Cruciate Ligament Reconstruction: A Prospective, Randomized Controlled Study With a Minimum Follow-up of 2 Years

Recum

Gehm

Guehring³

et al. 2020

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Purpose: To compare and evaluate knee laxity and functional outcomes between autologous bone graft and silicatesubstituted calcium phosphate (Si-CaP) in the treatment of tunnel defects in 2-stage revision anterior cruciate ligament reconstruction (ACLR). Methods: This prospective, randomized controlled trial was conducted between 2012 and 2015 with a total of 40 patients who underwent 2-stage revision ACLR. The tunnels were filled with autologous iliac crest cancellous bone graft in 20 patients (control group) and with Si-CaP in the other 20 patients (intervention group). After a minimum follow-up period of 2 years, functional outcomes were assessed by KT-1000 arthrometry (side-to-side [STS] difference), the Tegner score, the Lysholm score, and the International Knee Documentation Committee score. Results: A total of 37 patients (follow-up rate, 92.5%) with an average age of 31 years were followed up for 3.4 years (range, 2.2-5.5 years). The KT-1000 measurement did not show any STS difference between the bone graft group (0.9 AE 1.5 mm) and the Si-CaP group (0.7 AE 2.0 mm) (P ¼ .731). One patient in the intervention group (5%) had an STS difference greater than 5 mm. Both groups showed significant improvements in the Tegner score, Lysholm score, and International Knee Documentation Committee score from preoperative assessment to final follow-up (P .002), without any difference between the 2 groups (P ! .396). Complications requiring revision occurred in 4 control patients (22%) and in 2 patients in the intervention group (11%) (P ¼ .660). No complications in relation to Si-CaP were observed. Conclusions: Equivalent knee laxity and clinical function outcomes were noted 3 years after surgery in both groups of patients. Si-CaP bone substitute is therefore a safe alternative to autologous bone graft for 2-stage ACLR. Level of Evidence: Level I, prospective, randomized controlled clinical trial. See commentary on page 186 R upture of the anterior cruciate ligament (ACL) is one of the most common knee injuries, and a marked increase in anterior cruciate ligament reconstructions (ACLRs) has occurred over the past 20 years. 1,2 Because of the rise in operations, the number of revision procedures is also increasing

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Comparison of Tunnel Enlargement and Clinical Outcome Between Bioabsorbable Interference Screws and Cortical Button-Post Fixation in Arthroscopic Double-Bundle Anterior Cruciate Ligament Reconstruction: A Prospective, Randomized Study With a Minimum Follow-Up of 2 Years

Cited by 31 publications

References 30 publications

Anterior Cruciate Ligament Reconstruction Using a Ribbon-Like Graft With a C-Shaped Tibial Bone Tunnel

Anterior Cruciate Ligament Reconstruction Using a Ribbon-Like Graft With a C-Shaped Tibial Bone Tunnel

Editorial Commentary: Déjà Vu: Double-Bundle Anterior Cruciate Ligament Reconstruction Revisited

Autologous Bone Graft Versus Silicate-Substituted Calcium Phosphate in the Treatment of Tunnel Defects in 2-Stage Revision Anterior Cruciate Ligament Reconstruction: A Prospective, Randomized Controlled Study With a Minimum Follow-up of 2 Years

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