Postoperative Evaluation after Anterior Cruciate Ligament Reconstruction: Measurements and Abnormalities on Radiographic and CT Imaging

Abstract

Reconstruction of a ruptured anterior cruciate ligament (ACL) is a well-established procedure for repair of ACL injury. Despite improvement of surgical and rehabilitation techniques over the past decades, up to 25% of patients still fail to regain satisfactory function after an ACL reconstruction. With development of CT imaging techniques for reducing metal artifacts, multi-planar reconstruction, and three-dimensional reconstruction, early post-operative imaging is increasingly being used to provide immediate feedback to surgeons regarding tunnel positioning, fixation, and device placement. Early post-operative radiography and CT imaging are easy to perform and serve as the baseline examinations for future reference.

All-Inside Single-Bundle Reconstruction of the Anterior Cruciate Ligament with the Anterior Half of the Peroneus Longus Tendon Compared to the Semitendinosus Tendon: A Two-Year Follow-Up Study

“…Based on the development of radiography techniques and anatomical studies, 3D CT scans were widely used to assess the tunnel position after ACL reconstruction. [29][30][31]49 These techniques can generate a stereo perspective of bony morphology and tunnel aperture, which makes tunnel evaluation more reliable and precise, especially for measuring the femoral tunnel with the quadrant method. Lertwanich et al 30 performed a 3D reconstructed CT measur-ing study of 31 cadavers to evaluate the reliability of the ACL tunnel location measurement by using three methods of 3D reconstructed CT.…”

“…In SB anatomical reconstruction, the optimal placement of the tunnel position has been evaluated. 29,42 On the femoral side, the center of the tunnel was optimally located at 24 to 27% from the proximal condylar surface (parallel to the Blumensaat line), at 28 to 34% from the notch roof (perpendicular to the Blumensaat line). 29,50 On the tibial tunnel, the optimal anterior-posterior placement of the bone tunnel was proposed around 43%, ranging from 27 to 60% according to the Amis and Jakob line.…”

“…29,42 On the femoral side, the center of the tunnel was optimally located at 24 to 27% from the proximal condylar surface (parallel to the Blumensaat line), at 28 to 34% from the notch roof (perpendicular to the Blumensaat line). 29,50 On the tibial tunnel, the optimal anterior-posterior placement of the bone tunnel was proposed around 43%, ranging from 27 to 60% according to the Amis and Jakob line. 29,42 In our study, on average, the femoral tunnel's center was placed at 30.0% from the femoral length and at 33.8% from the femoral height.…”

“…29,50 On the tibial tunnel, the optimal anterior-posterior placement of the bone tunnel was proposed around 43%, ranging from 27 to 60% according to the Amis and Jakob line. 29,42 In our study, on average, the femoral tunnel's center was placed at 30.0% from the femoral length and at 33.8% from the femoral height. The anterior-posterior placement of the tibial tunnel was placed at 36.0% along the Amis and Jacob line, which was quiet consistent with other studies of anatomical reconstruction.…”

“…Standard plain films and threedimensional (3D) computed tomography (CT) were taken for all of the patients after surgery to evaluate the tunnel placement. [29][30][31][32][33] Instability alone and instability with pain were the two main symptoms. There were no demographic differences between the AHPLT group and the semitendinosus group (►Table 1).…”