nach oben

Knee Surgery, Sports Traumatology, Arthroscopy

Erschienen in:

18.08.2017 | Knee

The remnant preservation technique reduces the amount of bone tunnel enlargement following anterior cruciate ligament reconstruction

verfasst von: Shinya Yanagisawa, Masashi Kimura, Keiichi Hagiwara, Atsuko Ogoshi, Tomoyuki Nakagawa, Hiroyuki Shiozawa, Takashi Ohsawa, Hirotaka Chikuda

Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy | Ausgabe 2/2018

Einloggen, um Zugang zu erhalten

Abstract

Purpose

The aim of the present study was to investigate the correlation between postoperative tunnel enlargement after ACLR and remnant tissue preservation using the hamstring tendon.

Methods

One hundred and ninety-two subjects (male, n = 101; female, n = 91; mean age 27.1) who had undergone double-bundle ACL reconstruction were included in the present study. The patients were divided into two groups: the remnant tissue preservation group (Group R) and the non-remnant tissue preservation group (Group N). Computed tomographic scans of the operated knee were obtained at 2 weeks and 6 months after surgery. The area of the tunnel aperture for the anteromedial femoral tunnel (FAMT), posterolateral femoral tunnel (FPLT), anteromedial tibial tunnel (TAMT), and posterolateral tibial tunnel (TPLT) was measured. The area at 2 weeks after ACLR was subtracted from the area at 6 months after ACLR and then divided by the area at 2 weeks after ACLR. The differences in the outcomes and characteristics of the two groups were evaluated.

Results

Seventy-seven knees were classified into Group R, and 115 knees were classified into Group N. The age, gender, and body mass index did not differ to a statistically significant extent. The percentages of FAMT and TAMT enlargement in Group R were significantly smaller in comparison with Group N (P = 0.003 and P = 0.03, respectively). The percentage of FPLT and TPLT enlargement in the two groups did not differ to a statistically significant extent.

Conclusion

The remnant-preserving technique reduces the amount of bone tunnel enlargement. The present findings indicate the advantages of the remnant-preserving ACLR technique, and therefore the remnant-preserving technique should be recommended.

Level of evidence

II.

Adachi N, Ochi M, Uchino Y, Iwasa J, Ryoke K, Kuriwaka M (2002) Contribution of mechanoreceptors in the anterior cruciate ligament to the joint position sense knee. Acta Orthop Scand 73:330–334CrossRefPubMed

Aga C, Wilson KJ, Johansen S, Dornan G, La Prade RF, Engebretsen L (2016) Tunnel widening in single- versus double-bundle anterior cruciate ligament reconstructed knees. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-016-4204-0 PubMedPubMedCentral

Ahn JH, Lee YS, Ha HC (2009) Anterior cruciate ligament reconstruction with preservation of remnant bundle using hamstring autograft: technical note. Arch Orthop Trauma Surg 129:1011–1015CrossRefPubMed

Amiel D, Kleiner JB, Akeson WH (1986) The natural history of the anterior cruciate ligament autograft of patellar tendon origin. Am J Sports Med 14(6):449–462CrossRefPubMed

Berg EE (1993) Parsons’ knob (tuberculum intercondylare tertium): a guide to tibial anterior cruciate ligament insertion. Clin Orthop Relat Res 292:229–231

Clancy WG Jr, Narechania RG, Rosenberg TD, Gmeiner JG, Wisnefske DD, Lange TA (1981) Anterior and posterior cruciate ligament reconstruction in rhesus monkeys. J Bone Joint Surg Am 63(8):1270–1284CrossRefPubMed

Clatworthy MG, Annear P, Bulow JU, Bartlett RJ (1999) Tunnel widening in anterior cruciate ligament reconstruction: a prospective evaluation of hamstring and patella tendon grafts. Knee Surg Sports Traumatol Arthrosc 7(3):138–145CrossRefPubMed

Crain EH, Fithian DC, Paxton EW, Luetzow WF (2005) Variation in anterior cruciate ligament scar pattern: does the scar pattern affect anterior laxity in anterior cruciate ligament deficient knees? Arthroscopy 21:19–24CrossRefPubMed

Crespo B, Aga C, Wilson KJ, Pomeroy SM, LaPrade RF, Engebretsen L, Wijdicks CA (2014) Measurements of bone tunnel size in anterior cruciate ligament reconstruction: 2D versus 3D computed tomography model. J Exp Orthop 1(1):2CrossRefPubMedPubMedCentral

10.

Darabos N, Haspl M, Moser C et al (2011) Intraarticular application of autologous conditioned serum (ACS) reduces bone tunnel widening after ACL reconstructive surgery in a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 19:S36–S46CrossRefPubMed

11.

Fahey M, Indelicato PA (1994) Bone tunnel enlargement after anterior cruciate ligament replacement. Am J Sports Med 22(3):410–414CrossRefPubMed

12.

Faul F, Erdfelder E, Buchner A, Lang AG (2009) Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses. Behav Res Methods 41(4):1149–1160CrossRefPubMed

13.

Ferretti M, Ekdahl M, Shen W, Fu FH (2007) Osseous landmarks of the femoral attachment of the anterior cruciate ligament: an anatomic study. Arthroscopy 23(11):1218–1225CrossRefPubMed

14.

Fink C, Zapp M, Benedetto KP, Hackl W, Hoser C, Rieger M (2001) Tibial tunnel enlargement following anterior cruciate ligament reconstruction with patellar tendon autograft. Arthroscopy 17(2):138–143CrossRefPubMed

15.

Ge Y, Li H, Tao H, Hua Y, Chen J, Chen S (2015) Comparison of tendon-bone healing between autografts and allografts after anterior cruciate ligament reconstruction using magnetic resonance imaging. Knee Surg Sports Traumatol Arthrosc 23(4):954–960CrossRefPubMed

16.

Gohil S, Annear PO, Breidahl W (2007) Anterior cruciate ligament reconstruction using autologous double hamstrings: a comparison of standard versus minimal debridement techniques using MRI to assess revascularisation: a randomised prospective study with a one-year follow-up. J Bone Joint Surg Br 89:1165–1171CrossRefPubMed

17.

Grote S, Helfen T, Mück F, Regauer M, Prall WC (2015) Femoral marrow cavity bone harvesting used for arthroscopic refilling of misplaced or enlarged bone tunnels in revision ACL surgery: an arthroscopically supported technique with antegrade intramedullary bone harvesting by a reamer-irrigator-aspirator (RIA) system. Knee Surg Sports Traumatol Arthrosc 23(3):808–815CrossRefPubMed

18.

Hong L, Li X, Wang XS (2011) Arthroscopic anterior cruciate ligament reconstruction with remnant preservation: a prospective comparison study. Zhonghua Wai Ke Za Zhi 49:586–591PubMed

19.

Jacobs JJ, Roebuck KA, Archibeck M et al (2001) Osteolysis: basic science. Clin Orthop Relat Res 393:71–77CrossRef

20.

Junkin DM Jr, Johnson DL (2008) ACL tibial remnant, to save or not? Orthopedics 31:154–159CrossRefPubMed

21.

Kim SJ, Bae JH, Song SH, Lim HC (2013) Bone tunnel widening with autogenous bone plugs versus bioabsorbable interference screws for secondary fixation in ACL reconstruction. J Bone Joint Surg Am 95(2):103–108CrossRefPubMed

22.

Ko YW, Rhee SJ, Kim IW, Yoo JD (2015) The correlation of tunnel position, orientation and tunnel enlargement in outside-in single-bundle anterior cruciate ligament reconstruction. Knee Surg Relat Res 27(4):247–254CrossRefPubMedPubMedCentral

23.

Kobayashi M, Nakagawa Y, Suzuki T et al (2006) A retrospective review of bone tunnel enlargement after anterior cruciate ligament reconstruction with hamstring tendons fixed with a metal round cannulated interference screw in the femur. Arthroscopy 22:1093–1099CrossRefPubMed

24.

Koga H, Muneta T, Yagishita K, Watanabe T, Mochizuki T, Horie M, Nakamura T, Otabe K, Sekiya I (2015) Evaluation of a behind-remnant approach for femoral tunnel creation in remnant-preserving double-bundle anterior cruciate ligament reconstruction—comparison with a standard approach. Knee 22(3):249–255CrossRefPubMed

25.

Kondo E, Yasuda K, Onodera J, Kawaguchi Y, Kitamura N (2015) Effects of remnant tissue preservation on clinical and arthroscopic results after anatomic double-bundle anterior cruciate ligament reconstruction. Am J Sports Med 43(8):1882–1892CrossRefPubMed

26.

Lee BI, Min KD, Choi HS, Kim JB, Kim ST (2006) Arthroscopic anterior cruciate ligament reconstruction with the tibial-remnant preserving technique using a hamstring graft. Arthroscopy 22(340):e1–e340

27.

Lee YS, Lee SW, Nam SW, Oh WS, Sim JA, Kwak JH, Lee BK (2012) Analysis of tunnel widening after double-bundle ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 20(11):2243–2250CrossRefPubMed

28.

Lee YS, Lee BK, Oh WS, Cho YK (2014) Comparison of femoral tunnel widening between outside-in and trans-tibial double-bundle ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 22(9):2033–2039CrossRefPubMed

29.

Lertwanich P, Martins CA, Asai S, Ingham SJ, Smolinski P, Fu FH (2011) Anterior cruciate ligament tunnel position measurement reliability on 3-dimensional reconstructed computed tomography. Arthroscopy 27(3):339–391CrossRef

30.

L’Insalata JC, Klatt B, Fu FH, Harner CD (1997) Tunnel expansion following anterior cruciate ligament reconstruction: a comparison of hamstring and patellar tendon autografts. Knee Surg Sports Traumatol Arthrosc 5(4):234–238CrossRefPubMed

31.

Maeda S, Ishibashi Y, Tsuda E, Yamamoto Y, Toh S (2011) Intraoperative navigation evaluation of tibial translation after resection of anterior cruciate ligament remnants. Arthroscopy 27:1203–1210CrossRefPubMed

32.

Mouzopoulos G, Siebold R (2012) Why perform an ACL augmentation? Knee Surg Sports Traumatol Arthrosc 20(2):245–251CrossRefPubMed

33.

Muneta T, Koga H, Nakamura T, Horie M, Watanabe T, Yagishita K, Sekiya I (2015) A new behind-remnant approach for remnant-preserving double-bundle anterior cruciate ligament reconstruction compared with a standard approach. Knee Surg Sports Traumatol Arthrosc 23(12):245–251CrossRef

34.

Nakamae A, Ochi M, Deie M, Adachi N, Kanaya A, Nishimori M, Nakasa T (2010) Biomechanical function of anterior cruciate ligament remnants: how long do they contribute to knee stability after injury in patients with complete tears? Arthroscopy 26:1577–1585CrossRefPubMed

35.

Noh JH, Yang BG, Roh YH, Lee JS (2011) Synovialization on second-look arthroscopy after anterior cruciate ligament reconstruction using Achilles allograft in active young men. Knee Surg Sports Traumatol Arthrosc 19:1843–1850CrossRefPubMed

36.

Ohsawa T, Kimura M, Hagiwara K, Yorifuji H, Takagishi K (2012) Clinical and second-look arthroscopic study comparing 2 tibial landmarks for tunnel insertions during double-bundle ACL reconstruction with a minimum 2-year follow-up. Am J Sports Med 40(11):2479–2486CrossRefPubMed

37.

Peyrache MD, Djian P, Christel P, Witvoet J (1996) Tibial tunnel enlargement after anterior cruciate ligament reconstruction by autogenous bone-patellar tendon-bone graft. Knee Surg Sports Traumatol Arthrosc 4(1):2–8CrossRefPubMed

38.

Segawa H, Omori G, Tomita S, Koga Y (2001) Bone tunnel enlargement after anterior cruciate ligament reconstruction using hamstring tendons. Knee Surg Sports Traumatol Arthrosc 9(4):206–210CrossRefPubMed

39.

Segawa H, Koga Y, Omori G, Sakamoto M, Hara T (2003) Influence of the femoral tunnel location and angle on the contact pressure in the femoral tunnel in anterior cruciate ligament reconstruction. Am J Sports Med 31(3):444–448CrossRefPubMed

40.

Shino K, Suzuki T, Iwahashi T, Mae T, Nakamura N, Nakata K, Nakagawa S (2010) The resident’s ridge as an arthroscopic landmark for anatomical femoral tunnel drilling in ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 18(9):1164–1168CrossRefPubMed

41.

Siebold R, Cafaltzis K (2010) Differentiation between intraoperative and postoperative bone tunnel widening and communication in double-bundle anterior cruciate ligament reconstruction: a prospective study. Arthroscopy 26(8):1066–1073CrossRefPubMed

42.

Silva A, Sampaio R, Pinto E (2010) Femoral tunnel enlargement after anatomic ACL reconstruction: a biological problem? Knee Surg Sports Traumatol Arthrosc 18(9):1189–1194CrossRefPubMed

43.

Surer L, Yapici C, Guglielmino C, van Eck CF, Irrgang JJ, Fu FH (2016) Fibrin clot prevents bone tunnel enlargement after ACL reconstruction with allograft. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-016-4109-y

44.

Tachibana Y, Mae T, Shino K, Kanamoto T, Sugamoto K, Yoshikawa H, Nakata K (2015) Morphological changes in femoral tunnels after anatomic anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 23(12):3591–3600CrossRefPubMed

45.

Takahashi T, Kondo E, Yasuda K, Miyatake S, Kawaguchi Y, Onodera J, Kitamura N (2016) Effects of Remnant tissue preservation on the tendon graft in anterior cruciate ligament reconstruction: a biomechanical and histological study. Am J Sports Med 44(7):1708–1716CrossRefPubMed

46.

Takata Y, Nakase J, Numata H, Oshima T, Tsuchiya H (2016) Computed tomography value and tunnel enlargement of round and rounded rectangular femoral bone tunnel for anterior cruciate ligament reconstruction. Arch Orthop Trauma Surg 136:1587–1594CrossRefPubMed

47.

Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 198:43–49

48.

Vadalà A, Iorio R, De Carli A, Argento G, Di Sanzo V, Conteduca F, Ferretti A (2007) The effect of accelerated, brace free, rehabilitation on bone tunnel enlargement after ACL reconstruction using hamstring tendons: a CT study. Knee Surg Sports Traumatol Arthrosc 15(4):365–371CrossRefPubMed

49.

Vergis A, Gillquist J (1995) Graft failure in intra-articular anterior cruciate ligament reconstructions: a review of the literature. Arthroscopy 11(3):312–321CrossRefPubMed

50.

Weber AE, Delos D, Oltean HN, Vadasdi K, Cavanaugh J, Potter HG, Rodeo SA (2015) Tibial and femoral tunnel changes after acl reconstruction: a prospective 2-year longitudinal mri study. Am J Sports Med 43(5):1147–1156CrossRefPubMed

51.

Webster KE, Feller JA, Hameister KA (2001) Bone tunnel enlargement following anterior cruciate ligament reconstruction: a randomised comparison of hamstring and patellar tendon grafts with 2-year follow-up. Knee Surg Sports Traumatol Arthrosc 9(2):86–91CrossRefPubMed

52.

Wilson TC, Kantaras A, Atay A, Johnson D (2004) Tunnel enlargement after anterior cruciate ligament surgery. Am J Sports Med 32:543–549CrossRefPubMed

53.

Xie GM, Huang Fu XQ, Zhao JZ (2012) The effect of remnant preservation on patterns of gene expression in a rabbit model of anterior cruciate ligament reconstruction. J Surg Res 176:510–516CrossRefPubMed

54.

Yasuda K, Kondo E, Ichiyama H, Kitamura N, Tanabe Y, Tohyama H, Minami A (2004) Anatomic reconstruction of the anteromedial and posterolateral bundles of the anterior cruciate ligament using hamstring tendon grafts. Arthroscopy 20:1015–1102CrossRefPubMed

55.

Zhang Q, Zhang S, Cao X, Liu L, Liu Y, Li R (2014) The effect of remnant preservation on tibial tunnel enlargement in ACL reconstruction with hamstring autograft: a prospective randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 22(1):166–173CrossRefPubMed

56.

Zysk SP, Fraunberger P, Veihelmann A, Dörger M, Kalteis T, Maier M, Pellengahr C, Refior HJ (2004) Tunnel enlargement and changes in synovial fluid cytokine profile following anterior cruciate ligament reconstruction with patellar tendon and hamstring tendon autografts. Knee Surg Sports Traumatol Arthrosc 12(2):98–103CrossRefPubMed

Titel: The remnant preservation technique reduces the amount of bone tunnel enlargement following anterior cruciate ligament reconstruction
verfasst von: Shinya Yanagisawa
Masashi Kimura
Keiichi Hagiwara
Atsuko Ogoshi
Tomoyuki Nakagawa
Hiroyuki Shiozawa
Takashi Ohsawa
Hirotaka Chikuda
Publikationsdatum: 18.08.2017
Verlag: Springer Berlin Heidelberg
Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy / Ausgabe 2/2018
Print ISSN: 0942-2056
Elektronische ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-017-4679-3

Arthropedia

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

Neu im Fachgebiet Orthopädie und Unfallchirurgie

23.04.2024 | Leitsymptom Rückenschmerzen | Nachrichten

Update Orthopädie und Unfallchirurgie

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

Newsletter bestellen

Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Springer Medizin

The remnant preservation technique reduces the amount of bone tunnel enlargement following anterior cruciate ligament reconstruction

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

Arthropedia

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Ärztliche Empathie hilft gegen Rückenschmerzen

Stereotaktische Radiatio schlägt konventionelle Bestrahlung

Vorsicht mit hohen NSAR-Dosen bei ankylosierender Spondylitis!

Brustkrebs in der Vorgeschichte macht Gelenkersatz komplikationsträchtiger

Update Orthopädie und Unfallchirurgie

Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Springer Medizin

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

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

Weitere Artikel der Ausgabe 2/2018

Peak stresses shift from femoral tunnel aperture to tibial tunnel aperture in lateral tibial tunnel ACL reconstructions: a 3D graft-bending angle measurement and finite-element analysis

MRI-based tendon bone healing is related to the clinical functional scores at the first year after anterior cruciate ligament reconstruction with hamstring tendon autograft

Changes in gait pattern and early functional results after ACL repair are comparable to those of ACL reconstruction

Superior perioperative analgesia with combined femoral–obturator–sciatic nerve block in comparison with posterior lumbar plexus and sciatic nerve block for ACL reconstructive surgery

Young athletes after ACL reconstruction with quadriceps strength asymmetry at the time of return-to-sport demonstrate decreased knee function 1 year later

There is no difference between quadriceps- and hamstring tendon autografts in primary anterior cruciate ligament reconstruction: a 2-year patient-reported outcome study

Arthropedia

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Ärztliche Empathie hilft gegen Rückenschmerzen

Stereotaktische Radiatio schlägt konventionelle Bestrahlung

Vorsicht mit hohen NSAR-Dosen bei ankylosierender Spondylitis!

Brustkrebs in der Vorgeschichte macht Gelenkersatz komplikationsträchtiger

Update Orthopädie und Unfallchirurgie