Graft bending angle is correlated with femoral intraosseous graft signal intensity in anterior cruciate ligament reconstruction using the outside-in technique

Ahn, Jin Hwan; Jeong, Han Eol; Lee, Yong Seuk; Park, Jai Hyung; Lee, Jin Ho; Ko, Taeg Su

doi:10.1016/j.knee.2015.10.006

Cited by 30 publications

(49 citation statements)

References 58 publications

(76 reference statements)

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“…The most important finding of the present study was that if the coronal GBA of the FPLT was steep, the percentage of FPLT enlargement was large. Previous studies have reported that the GBA is significantly correlated with the femoral intraosseous graft maturation after ACLR using the outside-in technique 2 and that a steep GBA may negatively affect proximal graft healing after ACLR. 25 Bone tunnel enlargement after ACLR is a recognized complication; however, the mechanism of bone tunnel enlargement is not fully understood.…”

Section: Discussionmentioning

confidence: 96%

“…1 A steep graft bending angle (GBA) has been recently proposed as a biomechanical factor that could contribute to poor graft healing or graft damage. 2 This may be particularly important in ACLR via the outside-in technique, as the intra-articular aperture is more acute in the outside-in technique compared with the transportal technique. 3 A common complication after ACLR with hamstring autografts is bone tunnel enlargement.…”

Section: Introductionmentioning

confidence: 99%

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A steep coronal graft bending angle is associated with bone tunnel enlargement of the posterolateral bundle after anterior cruciate ligament reconstruction

Kimura¹,

Hagiwara²,

Ogoshi³

et al. 2019

J Orthop Surg (Hong Kong)

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Purpose: The correlation between the graft bending angle (GBA) of the anteromedial bundle and posterolateral bundle after anterior cruciate ligament reconstruction (ACLR) and postoperative tunnel enlargement was evaluated. Methods: Two hundred fifty-eight patients (137 males, 121 females; mean age 27.3 years) who had undergone doublebundle ACLR were included. Computed tomographic scans of the operated knee were obtained at 2 weeks and 6 months postoperatively. The area of the tunnel aperture for femoral anteromedial tunnel (FAMT) and femoral posterolateral tunnel (FPLT) was measured; the area at 2 weeks after ACLR was subtracted from the area at 6 months after ACLR and then divided by the area at 2 weeks after ACLR. The femoral tunnel angles were obtained with Cobb angle measurements. The femoral tunnel angle in the coronal plane was measured relative to the tibial plateau (coronal GBA). On the median value, the patients were divided into two groups in each of FAMT and FPLT; those with a coronal GBA of FAMT of !27 were classified as group A, while those with a coronal GBA of <27 were classified as group B, those with a coronal GBA of FPLT of !23 were classified as group C, while those with a coronal GBA of<23 were classified as group D. Results: Group A included 129 knees, while group B included 129 knees. Groups A and B did not significantly differ regarding FAMT enlargement. Group C included 133 knees, while group D included 125 knees. The percentage of FPLT enlargement in group C was significantly smaller than that in group D (p ¼ 0.001). Conclusions: A steep coronal GBA of the FPLT after ACLR results in greater FPLT enlargement. The present findings suggest that surgeons should avoid creating a steep GBA of the FPLT in the outside-in technique.

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Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

A steep coronal graft bending angle is associated with bone tunnel enlargement of the posterolateral bundle after anterior cruciate ligament reconstruction

Kimura¹,

Hagiwara²,

Ogoshi³

et al. 2019

J Orthop Surg (Hong Kong)

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“…As knee flexion angle increased, graft bending angle also increased. The increased acuity of the graft bending angle at the femoral tunnel aperture was reported to cause increased bending stress on the graft, leading to injury of the graft and tunnel widening [ 20 , 21 ]. A previous study [ 16 ] dealing with effect of only flexion angle presented the results of two-dimensional measurement on X-ray using eight cadaveric specimens.…”

Section: Discussionmentioning

confidence: 99%

“…A previous study demonstrated that the increased acuity of the graft bending angle at the femoral tunnel aperture led to increased bending stress on the graft [ 20 ]. Repetitive motion of the reconstructed graft at the sharp edge due to the acute femoral tunnel angle could result in injury of graft and tunnel widening [ 20 , 21 ]. It was noted that femoral graft bending angle in ACL reconstruction with transportal technique was more acute than angle in ACL reconstruction with transtibial technique [ 22 ].…”

Section: Introductionmentioning

confidence: 99%

Optimal Condition to Create Femoral Tunnel Considering Combined Influence of Knee Flexion and Transverse Drill Angle in Anatomical Single-Bundle ACL Reconstruction Using Medial Portal Technique: 3D Simulation Study

Kim

Choi

Kim

et al. 2018

BioMed Research International

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There has been no previous study using three-dimensional (3D) measurement on femoral tunnel characteristics according to the combined influence of various flexion angles of knee and transverse drill angles in single-bundle ACL reconstruction with transportal technique. The purpose of this study was to determine optimal condition of knee flexion angle and transverse drill angle to create secure femoral tunnel in single-bundle ACL reconstruction with transportal technique considering tunnel length, tunnel wall breakage, and graft bending angle. This study was conducted using simulation of 3D computed tomography of thirty subjects. Three variables of femoral tunnel changed according to combined influence of four flexion angles of knee and three transverse drill angles were measured: tunnel length, wall breakage, and graft bending angle. There was no case of short femoral tunnel less than 25 mm at 120° and 130° of flexion. There was no case of breakage of femoral tunnel at 120° of flexion with maximum transverse drill angle (MTA) and MTA-10° and at 130° of flexion. Considering effect on graft bending angle, decrease of flexion angle and transverse drill angle could be appropriate in creating femoral tunnel. Increased flexion angle and transverse drill angle secured femoral tunnel having sufficiently long length without wall breakage. However, avoiding excessive flexion angle and maximum transverse drill angle could be recommended because they tended to cause more acute graft bending angle.

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“…Not surprisingly, the modified transtibial technique yielded longer, more vertical tunnels, and the postoperative magnetic resonance imaging results recapitulated previously reported data suggesting that the decreased graft bending angles associated with transtibial drilling resulted in a lower signal-to-noise quotient, which has previously been described as a surrogate for graft maturation. 6,7 It is interesting to note that an analysis of postoperative computed tomography scans showed no significant differences between the 2 techniques in femoral tunnel position as described by the quadrant method proposed by Bernard et al 8 The study by Lee et al 1 has several strengths. First, the authors should be commended for obtaining 100% follow-up among 100 patients at 36 months.…”

Section: See Related Article On Page 2857mentioning

confidence: 98%

Editorial Commentary: Does “No Difference” Really Mean “No Difference”? Not All Anterior Cruciate Ligament Transtibial Drilling Techniques Are Created Equal

Sheean

Musahl

2018

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Despite the preponderance of biomechanical data suggesting that independent femoral tunnel drilling results in more favorable knee kinematics and superior anterior cruciate ligament footprint restoration when compared with transtibial tunnel drilling, equivalent clinical outcomes associated with both techniques continue to be reported. However, readers could contemplate the meaning of "clinical equivalence" and, perhaps, find themselves wanting better ways to detect differences between surgical techniques.

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Graft bending angle is correlated with femoral intraosseous graft signal intensity in anterior cruciate ligament reconstruction using the outside-in technique

Cited by 30 publications

References 58 publications

A steep coronal graft bending angle is associated with bone tunnel enlargement of the posterolateral bundle after anterior cruciate ligament reconstruction

A steep coronal graft bending angle is associated with bone tunnel enlargement of the posterolateral bundle after anterior cruciate ligament reconstruction

Optimal Condition to Create Femoral Tunnel Considering Combined Influence of Knee Flexion and Transverse Drill Angle in Anatomical Single-Bundle ACL Reconstruction Using Medial Portal Technique: 3D Simulation Study

Editorial Commentary: Does “No Difference” Really Mean “No Difference”? Not All Anterior Cruciate Ligament Transtibial Drilling Techniques Are Created Equal

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