The Comparison of Postoperative Bone Tunnel Enlargement between Single-Bundle Anterior Cruciate Ligament Reconstruction and Remnant-Preserving Augmentation
Author(s):
Sumida Y. (Japan)
,
Sumida Y. (Japan)
Affiliations:
Nakamae A.
,
Nakamae A.
Affiliations:
Ishikawa M.
,
Ishikawa M.
Affiliations:
Nakasa T.
,
Nakasa T.
Affiliations:
Suga N.
,
Suga N.
Affiliations:
Hayashi S.
,
Hayashi S.
Affiliations:
Ochi M.
,
Ochi M.
Affiliations:
Adachi N.
Adachi N.
Affiliations:
ESSKA Academy. Sumida Y. 05/09/18; 209527; P07-822 Topic: A1 - Anterior cruciate ligament (ACL) reconstruction
Yoshikazu Sumida
Yoshikazu Sumida
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Abstract
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Objectives: There are various procedures of anterior cruciate ligament (ACL) reconstruction for treatment of ACL injury. ACL augmentation is a procedure which preserves ACL remnant and may be beneficial not only for biomechanical function but also for proprioception and vascularization of the graft. Bone tunnel enlargement after ACL reconstruction is well-known phenomenon caused by micro-motion and biological factors. On the other hand, one tunnel enlargement after ACL augmentation is still unknown. Therefore, the purpose of this study is to reveal it comparing with ACL single-bundle reconstruction.

Methods: All the patients in this study were able to be followed up for at least one year after single-bundle ACL reconstruction or augmentation using semitendinosus tendon in our hospital from January 2013 to August 2016. There were 21 patients, 21 knees in augmentation (AUG) group and 14 patients, 14 knees in single-bundle (SB) group, respectively. The patients underwent computed tomography (CT) scans 2 days, 2 weeks, 3 months, 6 months and 1 year postoperatively. The cross sections were perpendicular to each tunnel axis and picked up at 4 points including intraarticular aperture in both femoral and tibial tunnel. Each cross-sectional area was measured by the digital caliper. We set data at day 2 as reference and the ratio of enlargement was calculated at each time point postoperatively. Anterior stability was measured by Kneelax, and clinical outcome was evaluated by Lysholm knee score.

Results: Bone tunnel enlargement was observed in both groups at each time point. The ratio of enlargement at intraarticular aperture in femoral tunnel at week 2 tended to be smaller in AUG group (1.2 ± 0.22 v.s. 1.3 ± 0.23, p=0.058), however there was no significant difference at each time point. The mean side-to-side difference of anterior displacement was 3.8 ± 1.7 mm in AUG group and 4.3 ± 2.1 mm in SB group (p>0.05) preoperatively, and 0.97 ± 1.6 mm in AUG group and 1.3 ± 1.5 mm in SB group (p>0.05) 1 year postoperatively. Lysholm knee score was 73.5 ± 13.4 in AUG group and 74.4 ± 16.7 in SB group (p>0.05) preoperatively, and 91.1 ± 10.1 in AUG group and 94.2 ± 9.24 in SB group (p>0.05) 1 year after surgery.

Conclusions: There were no significant differences on the ratio of bone tunnel enlargement, anterior stability and clinical outcome between the two groups.

Keywords:
ACL augmentation, bone tunnel enlargement
Objectives: There are various procedures of anterior cruciate ligament (ACL) reconstruction for treatment of ACL injury. ACL augmentation is a procedure which preserves ACL remnant and may be beneficial not only for biomechanical function but also for proprioception and vascularization of the graft. Bone tunnel enlargement after ACL reconstruction is well-known phenomenon caused by micro-motion and biological factors. On the other hand, one tunnel enlargement after ACL augmentation is still unknown. Therefore, the purpose of this study is to reveal it comparing with ACL single-bundle reconstruction.

Methods: All the patients in this study were able to be followed up for at least one year after single-bundle ACL reconstruction or augmentation using semitendinosus tendon in our hospital from January 2013 to August 2016. There were 21 patients, 21 knees in augmentation (AUG) group and 14 patients, 14 knees in single-bundle (SB) group, respectively. The patients underwent computed tomography (CT) scans 2 days, 2 weeks, 3 months, 6 months and 1 year postoperatively. The cross sections were perpendicular to each tunnel axis and picked up at 4 points including intraarticular aperture in both femoral and tibial tunnel. Each cross-sectional area was measured by the digital caliper. We set data at day 2 as reference and the ratio of enlargement was calculated at each time point postoperatively. Anterior stability was measured by Kneelax, and clinical outcome was evaluated by Lysholm knee score.

Results: Bone tunnel enlargement was observed in both groups at each time point. The ratio of enlargement at intraarticular aperture in femoral tunnel at week 2 tended to be smaller in AUG group (1.2 ± 0.22 v.s. 1.3 ± 0.23, p=0.058), however there was no significant difference at each time point. The mean side-to-side difference of anterior displacement was 3.8 ± 1.7 mm in AUG group and 4.3 ± 2.1 mm in SB group (p>0.05) preoperatively, and 0.97 ± 1.6 mm in AUG group and 1.3 ± 1.5 mm in SB group (p>0.05) 1 year postoperatively. Lysholm knee score was 73.5 ± 13.4 in AUG group and 74.4 ± 16.7 in SB group (p>0.05) preoperatively, and 91.1 ± 10.1 in AUG group and 94.2 ± 9.24 in SB group (p>0.05) 1 year after surgery.

Conclusions: There were no significant differences on the ratio of bone tunnel enlargement, anterior stability and clinical outcome between the two groups.

Keywords:
ACL augmentation, bone tunnel enlargement
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