Grafted Tendon Healing in Femoral and Tibial Tunnels after Anterior Cruciate Ligament Reconstruction

Nakase, Junsuke; Kitaoka, Katsuhiko; Toratani, Tatsuhiro; Kosaka, Masahiro; Ohashi, Yoshinori; Tsuchiya, Hiroyuki

doi:10.1177/230949901402200117

Cited by 15 publications

(19 citation statements)

References 20 publications

(17 reference statements)

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“…In the current study, the center of the femoral tunnel was located at 25.3% from the deepest subchondral contour of the lateral femoral condyle and at 31.8% from Blumensaat's line. This result indicates that our femoral tunnels were located slightly posterior and shallower, compared the placement that was reported by Piefer et al However, this result appears to be reasonable for tendon-bone healing, as the tendon-bone junction is revitalized on the anterior side of the femoral bone tunnel [24] .…”

Section: Discussioncontrasting

confidence: 33%

Technique of anatomical single bundle ACL reconstruction with rounded rectangle femoral dilator

et al. 2016

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Section: Discussioncontrasting

confidence: 33%

Technique of anatomical single bundle ACL reconstruction with rounded rectangle femoral dilator

et al. 2016

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“…In our study, grafts gradually remodeled within 2 years after ACLR, shown by the SNQs of intra-articular and intraosseous grafts peaking at 6 months postoperatively and then gradually decreasing at 12 and 24 months. To eliminate the influence of background noise, the SNQ 12,30,44,49 has been adopted as a more precise parameter than signal intensity to measure graft quality using MRI in which a lower SNQ reflects better graft maturity. 44 Increases in femoral graft SNQs at 6 months postoperatively and decreases at 2 years have been previously found in both human and animal studies.…”

Section: Discussionmentioning

confidence: 99%

“…Intraobserver and interobserver reliability values for the SNQ were 0.876 and 0.935, respectively. The SNQ 12,30,44,49 has been adopted as a measurement for analyzing graft quality in which a lower SNQ reflects better graft maturity. 44 At 1 day postoperatively, the mean SNQ of the femoral intraosseous graft was 3.476 6 0.344, and that of the intra-articular graft was 3.375 6 0.763.…”

Section: Graft Snq Measurementsmentioning

confidence: 99%

“…41 Moreover, it has been found that firm incorporation of the tendon graft within the tunnel enables the graft to mature into a structure similar to the native ACL. 30 However, tunnel widening and poor intraosseous graft incorporation are often reported, especially after ACLR using a cortical suspension device. 17,33,48 This could cause knee instability and compromise graft maturation within the tunnel.…”

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confidence: 99%

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Morphological Changes of the Femoral Tunnel and Their Correlation With Hamstring Tendon Autograft Maturation up to 2 Years After Anterior Cruciate Ligament Reconstruction Using Femoral Cortical Suspension

et al. 2020

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Background: Graft healing within the femoral tunnel after anterior cruciate ligament reconstruction (ACLR) using suspensory fixation could be reflected in graft maturation and tunnel morphological changes. However, the correlation between graft maturation and femoral tunnel changes remains unclear. Purpose: To quantitatively evaluate femoral tunnel morphological changes and graft maturation and to analyze their correlation after ACLR using femoral cortical suspension. Study Design: Case series; Level of evidence, 4. Methods: Patients who underwent single-bundle ACLR with a hamstring tendon autograft using femoral cortical suspension were included. Preoperative and postoperative (at 6, 12, and 24 months) knee function were evaluated using KT-1000 arthrometer testing, the Lysholm knee scoring scale, and the International Knee Documentation Committee (IKDC) questionnaire. At 1 day, 6 months, 12 months, and 24 months after ACLR, 3-dimensional magnetic resonance imaging was performed to observe the morphology of the femoral tunnel and to evaluate graft maturation using the graft signal/noise quotient (SNQ). The Pearson product moment correlation coefficients ( r) of femoral tunnel radii versus clinical outcomes and graft SNQs at last follow-up were analyzed. Results: A total of 22 patients completed full follow-up. KT-1000 arthrometer, Lysholm, and IKDC scores improved over time postoperatively, but no significant improvement was seen after 12 months ( P < .05). The radius of the tunnel containing the graft and the SNQs of the femoral intraosseous graft and intra-articular graft were the highest at 6 months, and they decreased by 24 months but remained higher than their 1-day postoperative values ( P < .05). Expansion mainly occurred at the anteroinferior wall of the femoral tunnel. The tunnel aperture radius was positively correlated with SNQs of the intraosseous graft ( r = 0.591; P < .05) and intra-articular graft ( r = 0.359; P < .05) but not with clinical outcomes. Conclusion: After ACLR using suspensory fixation, morphological changes of the femoral tunnel were mainly observed in the part of the tunnel containing the graft, which expanded at 6 months and reduced by 24 months. Expansion mainly occurred at the anteroinferior wall of the femoral tunnel. Femoral tunnel expansion was correlated with inferior graft maturation but not with clinical outcomes.

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“…4 Rodeo et al 18 used animal experiments to prove the existence of GTM, reporting that the amplitude of GTM had a positive correlation with the width of graft-bone interface and a negative correlation with the healing progress. Nakase et al, 16 using magnetic resonance imaging (MRI) for follow-up of patients who received ACL reconstruction, found differences in healing for different portions of the graft not only longitudinally but also transversally. These investigators suggested that the windshield wiper effect caused anterior-posterior GTM that impaired the healing process.…”

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confidence: 99%

Effect of Nearly Isometric ACL Reconstruction on Graft-Tunnel Motion: A Quantitative Clinical Study

Wan

Chen

et al. 2019

Orthopaedic Journal of Sports Medicine

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Background: In anterior cruciate ligament (ACL) reconstruction, minimizing the graft-tunnel motion (GTM) will promote graft-to-bone healing and avoid graft loosening or tearing as well as potential bone tunnel enlargement. A nearly isometric state of the graft can be achieved by placing the tunnel properly to theoretically gain better graft-to-bone healing. However, little clinical evidence is available to quantify the relation between GTM and tunnel position. Purpose: To find the proper zones for the femoral and tibial tunnel apertures that minimize the GTM, referred to as the “nearly isometric zone,” through use of intraoperative GTM measurement and 3-dimensional computed tomography (3D-CT). Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 100 patients were enrolled in this study. Nearly isometric ACL reconstruction was performed, and an intra-articular GTM measuring device was designed to measure and record the amplitude of GTM while the knee was flexed from 0° to 120°. Postoperatively, the patients underwent multislice CT, and the images were used to create 3D-CT models. After tibial aperture examination, 5 patients were excluded due to the divergence of tibial aperture, and therefore 95 patients remained in the study. Patients were divided into 2 groups according to whether the lateral intercondylar ridge was absent or present. The Bernard-Hertel grid coordinates ( h, t) of the femoral tunnel were then quantified. Results: The maximal GTM (mGTM) was a mean ± SD of 1.06 ± 0.66 mm (range, 0.0-3.0 mm). The mGTM in patients with a lateral intercondylar ridge was significantly lower than that in patients without a lateral intercondylar ridge (0.81 ± 0.39 vs 1.59 ± 0.73 mm, respectively; P < .0001). The average h and t were 0.227 ± 0.079 and 0.429 ± 0.770, respectively. Notably, in 1 patient, the mGTM was 0 mm whereas the coordinates ( h, t) of the femoral tunnel were 0.250 and 0.255. The overall GTM slowly increased before 90° but increased significantly after the knee was bent 105° ( P = .010). Correlation analysis showed that the t coordiinate had significant correlation with mGTM ( R = 0.581; P < .001). A gradient pattern was created to show the nearly isometric blue zone (mGTM <0.5 mm), which was found to overlap with the IDEAL (isometric, direct insertion, eccentric, anatomic, low tension-flexion pattern) position. Conclusion: A method of measuring intraoperative GTM and quantifying femoral tunnel position on postoperative 3D-CT was successfully developed. The presence of a lateral condylar ridge can significantly reduce mGTM. A nearly isometric zone was described that was consistent with the IDEAL concept.

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Grafted Tendon Healing in Femoral and Tibial Tunnels after Anterior Cruciate Ligament Reconstruction

Abstract: After ACL reconstruction, the tendon-to- bone healing in the FIZ of the tibial tunnel was faster than that of the femoral tunnel.

Cited by 15 publications

References 20 publications

Technique of anatomical single bundle ACL reconstruction with rounded rectangle femoral dilator

Technique of anatomical single bundle ACL reconstruction with rounded rectangle femoral dilator

Morphological Changes of the Femoral Tunnel and Their Correlation With Hamstring Tendon Autograft Maturation up to 2 Years After Anterior Cruciate Ligament Reconstruction Using Femoral Cortical Suspension

Effect of Nearly Isometric ACL Reconstruction on Graft-Tunnel Motion: A Quantitative Clinical Study

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