The effect of accelerated, brace free, rehabilitation on bone tunnel enlargement after ACL reconstruction using hamstring tendons: a CT study

Abstract

The mechanism of bone tunnel enlargement following anterior cruciate ligament (ACL) reconstruction is not yet clearly understood. Many authors hypothesized that aggressive rehabilitation protocols may be a potential factor for bone tunnel enlargement, especially in reconstructions performed with hamstrings autograft. The purpose of this study was to evaluate the effect of a brace free rehabilitation on the tunnel enlargement after ACL reconstruction using doubled semitendinosus and gracilis tendons (DGST): our hypothesis was that early post-operative knee motion increase the diameters of the tibial and femoral bone tunnels. Forty-five consecutive patients undergoing ACL reconstruction for chronic ACL deficiency were selected. All patients were operated by the same surgeon using autologous DGST and the same fixation devices. Patients with associated ligaments injuries and or severe chondral damage were excluded. The patients were randomly assigned to enter the control group (group A, standard post-operative rehabilitation) and the study group (group B, brace free accelerated rehabilitation). A CT scan was used to exactly determine the diameters of both femoral and tibial tunnels at various levels of lateral femoral condyle and proximal tibia, using a previously described method [17]. Measurements were done by an independent radiologist in a blinded fashion the day after the operation and at a mean follow-up of 10 months (range 9-11). Statistical analysis was performed using paired t-test. The mean femoral tunnel diameter increased significantly from 9.04 +/- 0.05 (post-operative) to 9.30 +/- 0.8 mm (follow-up) in group A and from 9.04 +/- 0.03 to 9.94 +/- 1.12 mm in group B. The mean tibial tunnel diameter increased significantly from 9.03 +/- 0.04 to 10.01 +/- 0.80 mm in group A and from 9.04 +/- 0.03 to 10.60 +/- 0.78 mm in group B. The increase in femoral and tunnel diameters observed in the study group was significantly higher than that observed in the control group. Our results suggest that bone tunnel enlargement after ACL reconstruction using hamstrings autograft can be increased by an accelerated, brace free, rehabilitation protocol.

Cationised gelatin and hyaluronic acid coating enhances polyethylene terephthalate artificial ligament graft osseointegration in porcine bone tunnels

“…Vadalà et al [31] also used CT to exactly determine the diameters of both femoral and tibial tunnels at various levels of the lateral femoral condyle and proximal tibia and demonstrated that early post-operative knee motion increases the diameters of the tibial and femoral bone tunnels. Interestingly, in the proximal site of the femoral tunnel or the tibial tunnel in our study, we found no significant difference of the bone tunnel area between groups on the CT images.…”

Rehabilitation After Anterior Cruciate Ligament Reconstruction

“…Vadalà et al 11 randomized forty-five patients after ACL reconstruction with hamstring autograft to either accelerated brace-free rehabilitation (immediate knee motion, weightbearing as tolerated on postoperative day two, immediate isometric and isotonic exercises), or standard rehabilitation (two weeks of bracing and isometric exercises, then active knee motion until six weeks, when isotonic and isokinetic exercises were initiated). The authors used computed tomography to calculate tibial and femoral tunnel diameters immediately postoperatively and at ten months of follow-up.…”

“…Since 2005, numerous studies have evaluated the safety of accelerated and brace-free rehabilitation protocols that attempt to return athletes to sports more quickly [3][4][5][6][7][8][9][10][11] . Several studies investigated the use of bracing for additional benefits such as pain control [12][13][14] .…”

Tunnel enlargement after anterior cruciate ligament reconstruction in patients with post-operative septic arthritis

“…According to many other authors [11,16,23,25], this study suggests how, at a short term follow up, this phenomenon is not strictly correlated with unsatisfactory clinical outcomes; however, it could often represent a further concern for the surgeon, especially in the case of ACL revision. At the present time, several biological and Fig.…”