The predictive effect of anatomic femoral and tibial graft tunnel placement in posterior cruciate ligament reconstruction on functional and radiological outcome

Osti, Michael; Hierzer, Doris; Krawinkel, Alessa; Hoffelner, Thomas; Benedetto, K. P.

doi:10.1007/s00264-014-2565-x

Cited by 6 publications

(5 citation statements)

References 36 publications

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“…Several studies have evaluated graft tunnel angles using 3D CT. 15 , 18 , 20 , 27 , 28 , 34 However, those measurements considered the angles on only 2-dimensional planes (ie, sagittal or coronal projections) rather than in 3D space, and it is difficult to evaluate the true angle of the killer turn with such data. Our assessment method, by which we measured the killer turn in 3D space using 3D coordinates, provides a more reliable means of evaluating and comparing the angles created by different techniques.…”

Section: Discussionmentioning

confidence: 99%

“…However, to the best of our knowledge, the clinical outcomes of this technique using a lower tibial tunnel have not been reported. Furthermore, although quantitative radiological assessments of the killer turn 15 , 18 , 20 , 27 , 28 , 34 have been reported, the angles were measured on 2-dimensional coronal, sagittal, or axial projections, which yield different results from the true angles in 3-dimensional (3D) space.…”

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confidence: 99%

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Lower Tibial Tunnel Placement in Isolated Posterior Cruciate Ligament Reconstruction: Clinical Outcomes and Quantitative Radiological Analysis of the Killer Turn

Lin

Huang

Zhang

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: The “killer turn” effect after posterior cruciate ligament (PCL) reconstruction is a problem that can lead to graft laxity or failure. Solutions for this situation are currently lacking. Purpose: To evaluate the clinical outcomes of a modified procedure for PCL reconstruction and quantify the killer turn using 3-dimensional (3D) computed tomography (CT). Study design: Case series; Level of evidence, 4. Methods: A total of 15 patients underwent modified PCL reconstruction with the tibial aperture below the center of the PCL footprint. Next, 2 virtual tibial tunnels with anatomic and proximal tibial apertures were created on 3D CT. All patients were assessed according to the Lysholm score, International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, Tegner score, side-to-side difference (SSD) in tibial posterior translation using stress radiography, and 3D gait analysis. Results: The modified tibial tunnel showed 2 significantly gentler turns (superior, 109.87° ± 10.12°; inferior, 151.25° ± 9.07°) compared with those reconstructed with anatomic (91.33° ± 7.28°; P < .001 for both comparisons) and proximal (99° ± 7.92°; P = .023 and P < .001, respectively) tibial apertures. The distance from the footprint to the tibial aperture was 16.49 ± 3.73 mm. All patient-reported outcome scores (mean ± SD) improved from pre- to postoperatively: Lysholm score, from 46.4 ± 18.87 to 83.47 ± 10.54 ( P < .001); Tegner score, from 2.47 ± 1.85 to 6.07 ± 1.58 ( P < .001); IKDC sports activities score, from 19 ± 9.90 to 33.07 ± 5.35 ( P < .001); and IKDC knee symptoms score, from 17.87 ± 6.31 to 25.67 ± 3.66 ( P < .001). The mean SSD improved from 9.15 ± 2.27 mm preoperatively to 4.20 ± 2.31 mm postoperatively ( P < .001). The reconstructed knee showed significantly more adduction (by 1.642°), less flexion (by 1.285°), and more lateral translation (by 0.279 mm) than that of the intact knee ( P < .001 for all). Conclusion: Lowering the tibial aperture during PCL reconstruction reduced the killer turn, and the clinical outcomes remained satisfactory. However, SSD and clinical outcomes were similar to those of previously described techniques using an anatomic tibial tunnel.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Lower Tibial Tunnel Placement in Isolated Posterior Cruciate Ligament Reconstruction: Clinical Outcomes and Quantitative Radiological Analysis of the Killer Turn

Lin

Huang

Zhang

et al. 2020

Orthopaedic Journal of Sports Medicine

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“…Effective PCL reconstruction can restore knee stability and even delay the progress of osteoarthritis so that patients can achieve better results after rehabilitation. [16] Therefore, it is imperative to choose the appropriate graft for PCL reconstruction. This article focuses on the clinical efficacy of PCL reconstructions using autograft versus allograft tendons.…”

Section: Discussionmentioning

confidence: 99%

Comparison of autograft and allograft tendons in posterior cruciate ligament reconstruction

Tian

Hu²,

et al. 2017

Medicine

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Background:The purpose of this meta-analysis of randomized controlled trials (RCTs) and non-RCTs was to compare the clinical outcomes of autograft versus allograft tendons in patients who underwent posterior cruciate ligament (PCL) reconstruction.Methods:We conducted a search of PubMed, EMBASE, The Cochrane Library, and Web of Science databases for RCTs and non-RCTs comparing autograft and allograft tendons in PCL reconstruction up to August 2016. The outcomes were Lysholm knee function score, postoperative objective and subjective International Knee Documentation Committee Score (IKDCS), Tegner activity scale, and knee posterior stability. Data analysis was performed using RevMan 5.3 software.Results:One RCT and 4 non-RCTs met the inclusion criteria. The current meta-analysis indicated that there were no significant differences in the Lysholm knee function score (mean difference [MD] = −0.99, 95% confidence interval [CI]: −5.51 to 3.54, P = .67), Tegner activity scale (MD = 0.46, 95% CI: 0.03 to 0.90, P = .04), postoperative objective IKDCS (odds ratio [OR] = 1.66, 95% CI: 0.77 to 3.58, P = .20), postoperative subjective IKDCS (MD = 3.00, 95% CI: −0.29 to 6.29, P = .07), or knee posterior stability (MD = −0.45, 95% CI: −1.28 to 0.38, P = .29) between patients who received autograft tendons and those who received allograft tendons. The patients with autograft tendons had a higher Tegner activity scale (MD = 0.46, 95% CI: 0.03 to 0.90, P = .04) than those with allograft tendons.Conclusions:The present meta-analysis shows that there was insufficient evidence to indicate that allograft tendons were significantly better than autograft tendons for PCL reconstruction. Due to the limited quality and data in the studies currently available, in the future, more high-quality RCTs are required to answer this question more definitively.

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“…Actually, we could clearly identify the tibial PCL attachment after manually adjusting the grayscale value of the CT image. Besides, the digital definition of center of the PCL anterolateral and postmedial bundles’ tibial insertion by Osti et al ( 34 ) was referred by us to ensure the accuracy of the tibial PCL attachment. (III) In this study, all the measurements were drawn from the knee extended position.…”

Section: Discussionmentioning

confidence: 99%

The optimal tibial tunnel placement to maximize the graft bending angle in the transtibial posterior cruciate ligament reconstruction: a quantitative assessment in three-dimensional computed tomography model

Jia¹,

Guo²,

Peng³

et al. 2023

Quant Imaging Med Surg

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Background The graft bending angle created by the graft and the tibial tunnel has inevitably occurred during the transtibial posterior cruciate ligament (PCL) reconstruction. However, few studies quantitively analyzed this angle. This study aimed to (I) explore the optimal tibial tunnel placement to maximize the graft bending angle in the PCL reconstruction; (II) reveal the effect of the tibial tunnel placement on the graft bending angle. Methods This was an in-vitro surgical simulation study based on the three-dimensional (3D) computed tomography (CT). A total of 55 patients who took CT scanning for knee injuries were selected (April 2020 to January 2022) from the local hospital database for review. The 3D knee models were established on the Mimics software based on the knees’ CT data. Using the Rhinoceros software to simulate the transtibial PCL reconstruction on the 3D CT knee model. The anteromedial and anterolateral tibial tunnel approaches were simulated with different tibial tunnel angle. The graft bending angle and tibial tunnel length (TTL) with different tibial tunnel angles were quantitively analyzed. Results The graft bending angle in anterolateral approach with a 50° tibial tunnel angle was significantly greater than it in anteromedial approach with a 60° tibial tunnel angle (P<0.001). There was no difference of the graft bending angle between the anterolateral approach with a 40° tibial tunnel angle and the anteromedial approach with a 60° tibial tunnel angle (P>0.05). The graft bending angle showed a strong correlation with the tibial tunnel angle (for anteromedial approach: r=0.759, P<0.001; for anterolateral approach: r=0.702, P<0.001). The best-fit equation to calculate the graft bending angle based on the tibial tunnel angle was Y = 0.89*X + 59.05 in anteromedial tibial tunnel approach (r 2 =0.576), and was Y = 0.78*X + 80.21 anterolateral tibial tunnel approach (r 2 =0.493). Conclusions The graft bending angle and TTL will significantly increase as the tibial tunnel angle becomes greater. Maximizing the tibial tunnel angle (50° tibial tunnel angle) in the anterolateral approach could provide the greatest graft bending angle in the PCL reconstruction. No matter how the tibial tunnel angle is changed in the anteromedial approach, using anterolateral approach might reduce the killer turn effect more effectively than using anteromedial approach.

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The predictive effect of anatomic femoral and tibial graft tunnel placement in posterior cruciate ligament reconstruction on functional and radiological outcome

Abstract: Despite a small sample size and subject to the threshold values we used, our data indicate a potentially minor effect of anatomic tunnel placement on midterm functional outcome following PCL reconstruction.

Cited by 6 publications

References 36 publications

Lower Tibial Tunnel Placement in Isolated Posterior Cruciate Ligament Reconstruction: Clinical Outcomes and Quantitative Radiological Analysis of the Killer Turn

Lower Tibial Tunnel Placement in Isolated Posterior Cruciate Ligament Reconstruction: Clinical Outcomes and Quantitative Radiological Analysis of the Killer Turn

Comparison of autograft and allograft tendons in posterior cruciate ligament reconstruction

The optimal tibial tunnel placement to maximize the graft bending angle in the transtibial posterior cruciate ligament reconstruction: a quantitative assessment in three-dimensional computed tomography model

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