nach oben

Archives of Orthopaedic and Trauma Surgery

Erschienen in:

28.01.2017 | Arthroscopy and Sports Medicine

Comparison of transtibial and retrograde outside-in techniques of anterior cruciate ligament reconstruction in terms of graft nature and clinical outcomes: a case control study using 3T MRI

verfasst von: Jin Hwan Ahn, Yong Seuk Lee, Hwa Jae Jeong, Jai Hyung Park, Yohan Cho, Kwang-Jeong Kim, Taeg Su Ko

Erschienen in: Archives of Orthopaedic and Trauma Surgery | Ausgabe 3/2017

Einloggen, um Zugang zu erhalten

Abstract

Introduction

This study was performed to compare ACL graft maturation and morphologies using MRI between trans-tibial (TT) and retrograde outside-in (OI) techniques, and to compare clinical outcomes between the two groups.

Materials and methods

Patients underwent single-tunnel ACL reconstruction using quadrupled hamstring autografts, with the TT technique used on 42 patients (TT group) and the retrograde OI technique used on 39 patients (OI group). All patients were examined with 3 T MRI at 6 months (between 5 and 7 months) after surgery. The signal intensity of the reconstructed graft was analyzed and compared between the two groups, using the signal/noise quotient (SNQ), the orientation of the ACL graft and the tibial tunnel location of the graft. The SNQ value is indicative of graft maturation, and the orientation of the graft and the tibial tunnel location of the graft represent graft morphology. Clinical evaluation was performed before the surgery and 2 years or more after the surgery.

Results

The mean SNQ value of the TT group was significantly (P = 0.030) lower than that of the OI group. The mean sagittal ACL angle (P < 0.001) and the mean coronal ACL angle (P < 0.001) were more vertical in the TT group. The tibial tunnel aperture was located at a significantly (P < 0.001) more posterior position in the TT group. There was no statistically significant difference in the clinical results between the two groups.

Conclusions

The OI technique showed a more anteriorly positioned tibial tunnel and a more oblique graft orientation in both sagittal and coronal planes. However, in comparison with the TT group, a significantly higher SNQ value was noticed in the follow-up MRI of the OI group at 6 months, although clinical results of the two groups were not significantly different during at least the 2-year follow-up.

Bedi A, Musahl V, Steuber V, Kendoff D, Choi D, Allen AA, Pearle AD, Altchek DW (2011) Transtibial versus anteromedial portal reaming in anterior cruciate ligament reconstruction: an anatomic and biomechanical evaluation of surgical technique. Arthroscopy 27:380–390. doi:10.1016/j.arthro.2010.07.018 CrossRefPubMed

Yagi M, Wong EK, Kanamori A, Debski RE, Fu FH, Woo SL (2002) Biomechanical analysis of an anatomic anterior cruciate ligament reconstruction. Am J Sports Med 30:660–666PubMed

Panni AS, Milano G, Tartarone M, Demontis A, Fabbriciani C (2001) Clinical and radiographic results of ACL reconstruction: a 5- to 7-year follow-up study of outside-in versus inside-out reconstruction techniques. Knee Surg Sports Traumatol Arthrosc 9:77–85CrossRefPubMed

Loh JC, Fukuda Y, Tsuda E, Steadman RJ, Fu FH, Woo SL (2003) Knee stability and graft function following anterior cruciate ligament reconstruction: comparison between 11 o’clock and 10 o’clock femoral tunnel placement. 2002 Richard O’Connor Award paper. Arthroscopy 19:297–304. doi:10.1053/jars.2003.50084 CrossRefPubMed

Sommer C, Friederich NF, Muller W (2000) Improperly placed anterior cruciate ligament grafts: correlation between radiological parameters and clinical results. Knee Surg Sports Traumatol Arthrosc 8:207–213. doi:10.1007/s001670000125 CrossRefPubMed

Saupe N, White LM, Chiavaras MM, Essue J, Weller I, Kunz M, Hurtig M, Marks P (2008) Anterior cruciate ligament reconstruction grafts: MR imaging features at long-term follow-up–correlation with functional and clinical evaluation. Radiology 249:581–590. doi:10.1148/radiol.2492071651 CrossRefPubMed

Biercevicz AM, Akelman MR, Fadale PD, Hulstyn MJ, Shalvoy RM, Badger GJ, Tung GA, Oksendahl HL, Fleming BC (2015) MRI volume and signal intensity of ACL graft predict clinical, functional, and patient-oriented outcome measures after ACL reconstruction. Am J Sports Med 43:693–699. doi:10.1177/0363546514561435 CrossRefPubMed

Weiler A, Peters G, Maurer J, Unterhauser FN, Sudkamp NP (2001) Biomechanical properties and vascularity of an anterior cruciate ligament graft can be predicted by contrast-enhanced magnetic resonance imaging. A two-year study in sheep. Am J Sports Med 29:751–761PubMed

Figueroa D, Melean P, Calvo R, Vaisman A, Zilleruelo N, Figueroa F, Villalon I (2010) Magnetic resonance imaging evaluation of the integration and maturation of semitendinosus-gracilis graft in anterior cruciate ligament reconstruction using autologous platelet concentrate. Arthroscopy 26:1318–1325. doi:10.1016/j.arthro.2010.02.010 CrossRefPubMed

10.

Biercevicz AM, Miranda DL, Machan JT, Murray MM, Fleming BC (2013) In situ, noninvasive, T2*-weighted MRI-derived parameters predict ex vivo structural properties of an anterior cruciate ligament reconstruction or bioenhanced primary repair in a porcine model. Am J Sports Med 41:560–566. doi:10.1177/0363546512472978 CrossRefPubMedPubMedCentral

11.

Ahn JH, Lee YS, Lee SH (2014) Creation of an anatomic femoral tunnel with minimal damage to the remnant bundle in remnant-preserving anterior cruciate ligament reconstruction using an outside-in technique. Arthrosc Tech 3:e175–e179. doi:10.1016/j.eats.2013.09.012 CrossRefPubMedPubMedCentral

12.

Zantop T, Ferretti M, Bell KM, Brucker PU, Gilbertson L, Fu FH (2008) Effect of tunnel-graft length on the biomechanics of anterior cruciate ligament-reconstructed knees: intra-articular study in a goat model. Am J Sports Med 36:2158–2166. doi:10.1177/0363546508320572 CrossRefPubMed

13.

Greis PE, Burks RT, Bachus K, Luker MG (2001) The influence of tendon length and fit on the strength of a tendon-bone tunnel complex. A biomechanical and histologic study in the dog. Am J Sports Med 29:493–497PubMed

14.

Vogl TJ, Schmitt J, Lubrich J, Hochmuth K, Diebold T, Del Tredici K, Sudkamp N (2001) Reconstructed anterior cruciate ligaments using patellar tendon ligament grafts: diagnostic value of contrast-enhanced MRI in a 2-year follow-up regimen. Eur Radiol 11:1450–1456. doi:10.1007/s003300100870 CrossRefPubMed

15.

Ahn JH, Lee SH, Choi SH, Lim TK (2010) Magnetic resonance imaging evaluation of anterior cruciate ligament reconstruction using quadrupled hamstring tendon autografts: comparison of remnant bundle preservation and standard technique. Am J Sports Med 38:1768–1777. doi:10.1177/0363546510368132 CrossRefPubMed

16.

Ahn JH, Lee SH, Yoo JC, Ha HC (2007) Measurement of the graft angles for the anterior cruciate ligament reconstruction with transtibial technique using postoperative magnetic resonance imaging in comparative study. Knee Surg Sports Traumatol Arthrosc 15:1293–1300. doi:10.1007/s00167-007-0389-6 CrossRefPubMed

17.

Odensten M, Gillquist J (1985) Functional anatomy of the anterior cruciate ligament and a rationale for reconstruction. J Bone Joint Surg Am 67:257–262CrossRefPubMed

18.

Unterhauser FN, Bail HJ, Hoher J, Haas NP, Weiler A (2003) Endoligamentous revascularization of an anterior cruciate ligament graft. Clin Orthop Relat Res 414:276–288. doi:10.1097/01.blo.0000079442.64912.51 CrossRef

19.

Rougraff BT, Shelbourne KD (1999) Early histologic appearance of human patellar tendon autografts used for anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 7:9–14. doi:10.1007/s001670050113 CrossRefPubMed

20.

Arai Y, Hara K, Takahashi T, Urade H, Minami G, Takamiya H, Kubo T (2008) Evaluation of the vascular status of autogenous hamstring tendon grafts after anterior cruciate ligament reconstruction in humans using magnetic resonance angiography. Knee Surg Sports Traumatol Arthrosc 16:342–347. doi:10.1007/s00167-007-0478-6 CrossRefPubMed

21.

Ntoulia A, Papadopoulou F, Ristanis S, Argyropoulou M, Georgoulis AD (2011) Revascularization process of the bone–patellar tendon–bone autograft evaluated by contrast-enhanced magnetic resonance imaging 6 and 12 months after anterior cruciate ligament reconstruction. Am J Sports Med 39:1478–1486. doi:10.1177/0363546511398039 CrossRefPubMed

22.

Segawa H, Koga Y, Omori G, Sakamoto M, Hara T (2005) Contact pressure in anterior cruciate ligament bone tunnels: comparison of endoscopic and two-incision technique. Arthroscopy 21:439–444. doi:10.1016/j.arthro.2004.12.007 CrossRefPubMed

23.

Nishimoto K, Kuroda R, Mizuno K, Hoshino Y, Nagamune K, Kubo S, Yagi M, Yamaguchi M, Yoshiya S, Kurosaka M (2009) Analysis of the graft bending angle at the femoral tunnel aperture in anatomic double bundle anterior cruciate ligament reconstruction: a comparison of the transtibial and the far anteromedial portal technique. Knee Surg Sports Traumatol Arthrosc 17:270–276. doi:10.1007/s00167-008-0680-1 CrossRefPubMed

24.

Jackson DW, Gasser SI (1994) Tibial tunnel placement in ACL reconstruction. Arthroscopy 10:124–131CrossRefPubMed

25.

Scanlan SF, Lai J, Donahue JP, Andriacchi TP (2012) Variations in the three-dimensional location and orientation of the ACL in healthy subjects relative to patients after transtibial ACL reconstruction. J Orthop Res 30:910–918. doi:10.1002/jor.22011 CrossRefPubMed

26.

Moisala AS, Jarvela T, Harilainen A, Sandelin J, Kannus P, Jarvinen M (2007) The effect of graft placement on the clinical outcome of the anterior cruciate ligament reconstruction: a prospective study. Knee Surg Sports Traumatol Arthrosc 15:879–887. doi:10.1007/s00167-007-0295-y CrossRefPubMed

27.

Scopp JM, Jasper LE, Belkoff SM, Moorman CT 3rd (2004) The effect of oblique femoral tunnel placement on rotational constraint of the knee reconstructed using patellar tendon autografts. Arthroscopy 20:294–299. doi:10.1016/j.arthro.2004.01.001 CrossRefPubMed

28.

Kopf S, Forsythe B, Wong AK, Tashman S, Anderst W, Irrgang JJ, Fu FH (2010) Nonanatomic tunnel position in traditional transtibial single-bundle anterior cruciate ligament reconstruction evaluated by three-dimensional computed tomography. J Bone Joint Surg Am 92:1427–1431. doi:10.2106/JBJS.I.00655 CrossRefPubMedPubMedCentral

29.

Silva A, Sampaio R, Pinto E (2012) ACL reconstruction: comparison between transtibial and anteromedial portal techniques. Knee Surg Sports Traumatol Arthrosc 20:896–903. doi:10.1007/s00167-011-1645-3 CrossRefPubMed

30.

Bowers AL, Bedi A, Lipman JD, Potter HG, Rodeo SA, Pearle AD, Warren RF, Altchek DW (2011) Comparison of anterior cruciate ligament tunnel position and graft obliquity with transtibial and anteromedial portal femoral tunnel reaming techniques using high-resolution magnetic resonance imaging. Arthroscopy 27:1511–1522. doi:10.1016/j.arthro.2011.07.007 CrossRefPubMed

Titel: Comparison of transtibial and retrograde outside-in techniques of anterior cruciate ligament reconstruction in terms of graft nature and clinical outcomes: a case control study using 3T MRI
verfasst von: Jin Hwan Ahn
Yong Seuk Lee
Hwa Jae Jeong
Jai Hyung Park
Yohan Cho
Kwang-Jeong Kim
Taeg Su Ko
Publikationsdatum: 28.01.2017
Verlag: Springer Berlin Heidelberg
Erschienen in: Archives of Orthopaedic and Trauma Surgery / Ausgabe 3/2017
Print ISSN: 0936-8051
Elektronische ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-016-2606-6

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen.
» Jetzt entdecken

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Ein Drittel der jungen Ärztinnen und Ärzte erwägt abzuwandern

07.05.2024 Medizinstudium Nachrichten

Extreme Arbeitsverdichtung und kaum Supervision: Dr. Andrea Martini, Sprecherin des Bündnisses Junge Ärztinnen und Ärzte (BJÄ) über den Frust des ärztlichen Nachwuchses und die Vorteile des Rucksack-Modells.

Aquatherapie bei Fibromyalgie wirksamer als Trockenübungen

03.05.2024 Fibromyalgiesyndrom Nachrichten

Bewegungs-, Dehnungs- und Entspannungsübungen im Wasser lindern die Beschwerden von Patientinnen mit Fibromyalgie besser als das Üben auf trockenem Land. Das geht aus einer spanisch-brasilianischen Vergleichsstudie hervor.

Endlich: Zi zeigt, mit welchen PVS Praxen zufrieden sind

IT für Ärzte Nachrichten

Darauf haben viele Praxen gewartet: Das Zi hat eine Liste von Praxisverwaltungssystemen veröffentlicht, die von Nutzern positiv bewertet werden. Eine gute Grundlage für wechselwillige Ärztinnen und Psychotherapeuten.

Proximale Humerusfraktur: Auch 100-Jährige operieren?

01.05.2024 DCK 2024 Kongressbericht

Mit dem demographischen Wandel versorgt auch die Chirurgie immer mehr betagte Menschen. Von Entwicklungen wie Fast-Track können auch ältere Menschen profitieren und bei proximaler Humerusfraktur können selbst manche 100-Jährige noch sicher operiert werden.

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Abstract

Introduction

Materials and methods

Results

Conclusions

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 3/2017

Minimal effect of patella eversion on ligament balancing in cruciate-retaining total knee arthroplasty

Outcome of extensive varus and valgus stem alignment in short-stem THA: clinical and radiological analysis using EBRA-FCA

Does a third condyle TKA restore normal gait kinematics in varus knees? In vivo knee kinematic analysis

Towards standardised definitions of shoulder arthroplasty complications: a systematic review of terms and definitions

Isolated acetabular revision with femoral stem retention after bipolar hip arthroplasty