Tunnel enlargement and changes in synovial fluid cytokine profile following anterior cruciate ligament reconstruction with patellar tendon and hamstring tendon autografts

Zysk, S.; Fraunberger, Peter; Veihelmann, A.; Dörger, Martina; Kalteis, T.; Maier, Markus; Pellengahr, Christoph von Schulze; Refior, H. J.

doi:10.1007/s00167-003-0426-z

Cited by 111 publications

(115 citation statements)

References 25 publications

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“…The biological theory states that release of TNF, interleukins, and nitric oxide present in the synovial fluid can cause osteolysis. The mechanical reasons for tunnel widening are graft tunnel micro motion in suspensory fixation, stress shielding proximal to the interference screw and nonantomical graft fixation [18,19,20] . As menisci along with cruciate ligaments also has important role in biomechanical stability, we have tried to evaluate incidence of tunnel widening and knee instability after ACL reconstruction and compare them in two groups: those with meniscal repair and those with without repair.…”

Section: Resultsmentioning

confidence: 99%

Influence of meniscal repair versus meniscectomy on ACL reconstruction in terms of knee stability and radiological imaging

Deore¹,

Patil²,

Kale³

et al. 2017

Int. J. Orthop. Sci.

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Objective: To compare effect of meniscus repair and meniscectomy in patients undergoing ACL reconstruction in terms of clinical instability and radiological tunnel widening 1 year after surgery. Introduction: Meniscectomy has been shown to have detrimental effects on knee in terms of increased contact pressure in femoral and tibial condyles, rotary instability and early changes of osteoarthritis. These changes are exaggerated in ACL deficient knees. Patients present to the surgeon at different times after injury ranging from 3 weeks to one year. Depending upon status of meniscal tears and its reparability at the time of surgery, surgeon has to choose between meniscectomy and meniscus repair during ACL reconstruction. We tried to compare meniscus repair and meniscectomy in terms of knee stability and radiological tunnel widening after ACL reconstruction in short term follow up. Methodology: 30 patients who underwent ACL reconstruction were selected after going through selection criteria, were divided between meniscus repair group and meniscus excision group. Meniscus tears, which were in the red red zone were repaired with inside out, all inside and outside in methods, depending upon their location from anterior to posterior zones. Those tears which presented late were irreducible, avascular and became loose body scuffing articular cartilage, were excised with shaver. All patients underwent standard ACL reconstruction with hamstring graft. Patients were evaluated clinically and radiologically at 3 months 6 months and 12 months. Results: Group 1 had 14 patients who underwent meniscus repair and group 2 had 16 patients who underwent meniscectomy during ACL reconstruction. Evaluation with Lachman's test showed that, 14% patients (2 out of 14) from Group 1 had grade 2 Lachman test. Thirty seven % of group 2 had grade 2 Lachman test though the difference was not significant (p = 0.151). Tibial tunnel diameter in meniscectomy group increased from 8 mm to 11.86mm (S.D= 1.11.) at 12 months. Tibial diameter in group 2 increased from 8 mm to 12.28 mm (S.D. = 1.52), (p= 0.394). Conclusion: Whenever ACL tear is associated with medial or lateral meniscal tears, meniscal repair is the preferred treatment over meniscectomy. The amount of tunnel widening is higher when meniscus is excised as compared to meniscal repair. The anterior tibial translation remains higher when meniscus is excised during ACL reconstruction, though short term functional results are same.

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Section: Resultsmentioning

confidence: 99%

Influence of meniscal repair versus meniscectomy on ACL reconstruction in terms of knee stability and radiological imaging

Deore¹,

Patil²,

Kale³

et al. 2017

Int. J. Orthop. Sci.

View full text Add to dashboard Cite

show abstract

“…Possible factors responsible for bone resorption include mechanical theory which states that there is a micromotion of the graft relative to the tunnel wall which causes synovial fluid bathing of the graft, leading to an inflammatory response in the tunnel. Also stress shielding of the tunnel wall proximal to the interference screw can cause weakening of the bone [6,20,21] Biological factors include nonspecific inflammatory response cells, heat necrosis due to drilling, cytokine response like TNF, interleukin-6, nitric oxide from the synovial fluid and foreign body response to allograft [22,23] There are different patterns of osteolysis at tibial tunnel described by Peyrache where patellar tendon bone graft was fixed with screw. These are cone type, cavity type and line type [7] We evaluated similar changes in our patients and tried to evaluate its clinical and functional correlation.…”

Section: Discussionmentioning

confidence: 99%

Radiological and clinical evaluation amongst types of tibial tunnel widening and choice of graft fixation implants in ACL reconstruction

Deore¹,

Patil²,

Samant³

et al. 2017

Int. J. Orthop. Sci.

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Objective: To study incidence of tibial tunnel widening and its functional correlation in patients operated with ACL reconstruction with four fold hamstring tendon autograft. To evaluate radiologically and clinically tunnel widening when tibial side of graft is fixed with suture disc or interference screw and to study type of tunnel widening (cavity type, cone type and line type) and its functional correlation. Introduction: Arthroscopic ACL reconstruction is most commonly done ligament reconstruction surgery in orthopaedic with gratifying results. However, it is also associated with complications. Tunnel widening (TW) as one of the complications has been topic of discussion in orthopaedic literature recently. Type of graft fixation in tibia has been considered as cause of tunnel widening. We compared TW in grafts fixed with suture disc and interference screw, evaluated type of tunnel widening in tibia and its correlation in terms of radiology and function. Methodology: A cohort of 30 patients operated with arthroscopic ACL reconstruction were evaluated over a period of three years. Patients were divided between suture disc group and interference screw group for tibial fixation and femoral fixation was kept same in both the groups i.e. suspensory. We assessed amount of tunnel widening in tibia with radiographs and CT scan at 3 months 6 months and 12 months, divided TW into cavity type, cone type and line type. We tried to correlate amount of TW with type of tibial fixation and its functional score. We also tried to correlate type of TW and functional score. Results: Amount of TTW was more with interference screw group than suture disc group at 12 months. Lysholm score was almost equal in both the groups. Type of tunnel widening: cavity type is more common 53 %, followed by cone type 26% and then line type 21 %. TTW was highest i.e. 12.11mm in cavity type, followed by 12.04 in cone type and 11.72 in line type. Functional score was almost similar in all types. Conclusion: Both the groups i.e. suture disc and interference group had considerable tunnel widening but the difference between them is negligible to conclude superiority of on over the other. Functional score is similar in both the groups. Regarding type of tibial tunnel widening, cavity type TTW is most common (53%), followed by cone type (26%) and least common is line type widening (21 %). Maximum tunnel widening is in cavity type and if it's less than 12 mm then functional score is good in those patients. There is no significant correlation between the type of TTW and clinical stability and functional scores. But it has surgical implications as more tunnel widening leaves lesser bone bed for revision ACL reconstruction.

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“…The concentration of IL-1β in the normal human synovial fluid is 10±4.3 pg/ml [4,5,10,18,25]. Several magnetic resonance imaging studies have shown synovial fluid tracking between the graft-bone tunnel interface [25].…”

Section: Discussionmentioning

confidence: 99%

“…Several magnetic resonance imaging studies have shown synovial fluid tracking between the graft-bone tunnel interface [25]. The bone tunnel is subsequently exposed to increased levels of cytokines within the synovial fluid possibly inducing osteolysis [3,13,15].…”

Section: Discussionmentioning

confidence: 99%

Correlation between synovial fluid and serum IL-1β levels after ACL surgery–preliminary report

Daraboš

Hundrić-Hašpl

Hašpl

et al. 2008

International Orthopaedics (SICOT)

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The possibility of controlling the harmful intraarticular influence of elevated interleukin (IL)-1β synovial fluid concentration after anterior cruciate ligament (ACL) surgery could be useful. We investigated the correlation between serum and synovial fluid IL-1β levels following ACL reconstruction. We measured IL-1β concentration periodically in three synovial fluid and four serum samples in each of 20 patients receiving either autologous conditioned serum (ACS) containing endogenous anti-inflammatory cytokines including IL-1Ra and several growth factors (group A) or placebo (group B). A decrease in IL-1β synovial fluid concentration appeared to be more pronounced in absolute terms in group A. In eight patients serum IL-1β was detected on the 6th postoperative day. In four of them whose synovial fluid levels were over 10 pg/ml on the 6th postoperative day, serum IL-1β was detected on the 10th postoperative day. The results were different in group B. Correlation between serum and synovial fluid IL-1β appearance persists in patients after ACL surgery and ACS application. This study is an example of ACS influence on the ACL healing process controlling the IL-1β levels on the basis of the serum IL-1β detection.

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Tunnel enlargement and changes in synovial fluid cytokine profile following anterior cruciate ligament reconstruction with patellar tendon and hamstring tendon autografts

Cited by 111 publications

References 25 publications

Influence of meniscal repair versus meniscectomy on ACL reconstruction in terms of knee stability and radiological imaging

Influence of meniscal repair versus meniscectomy on ACL reconstruction in terms of knee stability and radiological imaging

Radiological and clinical evaluation amongst types of tibial tunnel widening and choice of graft fixation implants in ACL reconstruction

Correlation between synovial fluid and serum IL-1β levels after ACL surgery–preliminary report

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