Tunnel widening prevention with the allo-Achilles tendon graft in anterior cruciate ligament reconstruction

Abstract

Background:Tunnel widening (TW) after anterior cruciate ligament (ACL) reconstruction can be a serious complication, and there is controversy over how to prevent it. This study aimed to suggest surgical approaches to prevent TW using an allo-Achilles tendon graft, and then to evaluate TW after these surgical tips were applied.Materials and Methods:Sixty two patients underwent ACL reconstruction with an allo-Achilles tendon graft. Four surgical approaches were used: Making a tibial tunnel by bone impaction, intraarticular reamer application, bone portion application for the femoral tunnel, and an additional bone plug application for the tibial tunnel. After more than 1-year, followup radiographs including anteroposterior and lateral views were taken in 29 patients encompassing thirty knees. The diameter of the tunnels at postoperation day 1 (POD1) and at followup was measured and compared.Results:In 18 knees (60%), there were no visible femoral tunnel margins on the radiographs at POD1 or followup. In the other 12 cases, which had visible femoral tunnel margins on followup radiographs, the mean femoral tunnel diameter was 8.6 mm. In the tibial tunnel, the mean diameters did not increase on all three levels (proximal, middle, and distal), and there was no statistically significant difference between the diameters at POD1 and followup.Conclusion:The suggested tips for surgery involving an allo-Achilles tendon graft can effectively prevent TW after ACL reconstruction according to this case series. These surgical tips can prevent TW.

Remnant preservation with tensioning can improve the clinical outcome after anterior cruciate ligament reconstruction

“…Using the transtibial technique and intra-articular reamer application method in our previous study, the tibial and femoral tunnels were reamed. 27 After reaming, the passed sutures were pulled through the tibial tunnel by a grasper (Figure 2(a) and (b)). After the guide pin was pulled down through the tibial tunnel, the two sutures were passed through the proximal end of soft part of the Allo-Achilles tendon from medial to lateral directions (Figure 2(c) and (d)).…”

“…ACL reconstruction was performed as described previously. 27 Briefly, the fresh frozen Allo-Achilles tendon was prepared to 10 mm in diameter. A femoral tunnel was made via the transtibial technique and the graft was fixed using a metal interference screw for the femoral side and a spike washer with screw plus a bioabsorbable interference screw for the tibial side.…”