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The relationship between tibial tunnel placement and graft intensity on MRI in anatomical double-bundle ACL reconstruction
Author(s):
Hashimoto Y. (Japan)
,
Hashimoto Y. (Japan)
Affiliations:
Teraoka T.
,
Teraoka T.
Affiliations:
Nishida Y.
,
Nishida Y.
Affiliations:
Takahashi S.
,
Takahashi S.
Affiliations:
Nakamura H.
Nakamura H.
Affiliations:
ESSKA Academy. Hashimoto Y. May 9, 2018; 209413; P05-957 Topic: Arthroscopic Surgery
Dr. Yusuke Hashimoto
Dr. Yusuke Hashimoto
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Abstract
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Objectives: The purpose of this study was to determine whether the graft signal intensity of the anteromedial bundle (AMB) on MRI was related to the tibial tunnel placement, anterior-posterior (A-P) stability and/or cyclops lesion formation following double-bundle (DB)-anterior cruciate ligament (ACL) reconstruction.

Methods: Between January 2010 and December 2014, 48 patients who underwent arthroscopic DB-ACL reconstruction and were followed up for a minimum of 2 year were retrospectively investigated. Follow-up included 1 week postoperative CT evaluation, 1 year postoperative MRI evaluation, and 1 year postoperative measurement of A-P instability using a KT-2000 arthrometer. Tibial tunnel placement and the location of Parson's knob were expressed as percentages. Patients were divided into two groups according to the graft intensity of the AMB on MRI: the high group (Grade 2 and 3) and the low group (Grade 1).
For all parameters (age, sex, height, weight, duration from injury to operation, and diameters and placement of the femoral and tibial tunnels of both the AMB and the PLB, the placement of Parson's knob, cyclops lesion and side-to-side difference with KT 2000) and clinical outcomes (Lysholm knee score and IKDC score), the Chi-squared test and Kruskal-Wallis tests were used to determine whether significant differences existed between two groups. Differences were considered significant if P values were < .05.

Results: There were 16 knees (26%) in Group H, and 32 knees in Group L. There was no difference between the two groups regarding the position of Parson's knob. The AMB placement in Group H was more anterior than that in Group L. The incidence of a cyclops lesion was significantly greater in Group H (seven cases (54%)) compared with Group L (8 cases (25.0%); P = .05). The arthrometric side-to-side difference was significantly greater in Group H (1.58 mm) than in Group L (0.83 mm; P = .019).

Conclusions: Group H had a more anterior AMB and significantly greater incidence of cyclops lesions than Group L. An increased signal intensity of the AMB may cause A-P instability.

Keywords:
Anterior cruciate ligament, Magnetic resonance imaging, Graft intensity, Tibial tunnel placement
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