Predicting failure rates of autograft/allograft single-bundle transtibial anterior cruciate ligament reconstruction: a simple 3D CT radiographic evaluation for the
ESSKA Academy. Briggs K. 11/08/19; 285254; epESMA-63 Topic: Arthroscopic Surgery
Karen Briggs
Karen Briggs
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Abstract
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Background: Anatomic reconstruction of the anterior cruciate ligament (ACL) has been suggested to lead to superior outcomes by restoring knee kinematics, reestablishing anterior and rotatory stability, minimizing the risk of new injuries, and preventing degenerative changes. Surgical technique may play a role in the development and progression of knee osteoarthritis (OA); the anteromedial (AM) portal has been associated with critically short tunnels and an increased risk of posterior wall blowout, while the transtibial (TT) tunnel technique has been criticized for resulting in too vertical tunnel placement and failing to restore native anatomy which may predispose patients to the development of early knee OA. The footprint position of the ACL graft was evaluated in patients following autograft/allograft, single-bundle, transtibial ACLR to determine whether this technique can restore the native ACL footprint.
Methods: Fifty-seven patients with 59 ACL injuries that underwent either autograft or allograft, single-bundle, transtibial ACLR between 1999-2014 by a single surgeon were included. All patients underwent radiographic evaluation at a minimum of 12 months following ACLR. CT scan was performed using a GE Light Speed 64-slice scanner with a slice thickness of 0.625 mm. CT images underwent 3D reconstruction using OsiriX program (Pixmeo, Geneva, Switzerland) to assess ACL footprint. The ratio of the postero-anterior (PA) and proximal-distal (PD) position for the femoral footprint and medial-lateral (ML) and anteroposterior (AP) position for the tibial tunnel were calculated. Values will be compared to the previously reported data.
Results: Average footprint position of femoral PA and PD position were 37.6±3.42 and 44.6±4.44, respectively. Average footprint position of tibial ML and AP position were 47.7±3.5% and 44±6.3% respectively.
Conclusions: The trans-tibial single bundle ACL reconstruction technique appears to yield a central tunnel between the anteromedial and posterolateral bundles on the tibial side in both planes including medial-lateral and anterior-posterior. On the femoral side, the tunnel appears closer to posterolateral bundle tunnel on the proximal-distal and central in posterior-anterior axis between the anteromedial and posterolateral bundles. This simple, easy to use program can aid all physicians in determining whether their anteromedial or transtibial technique successfully restores the anatomic ACL footprint.
Background: Anatomic reconstruction of the anterior cruciate ligament (ACL) has been suggested to lead to superior outcomes by restoring knee kinematics, reestablishing anterior and rotatory stability, minimizing the risk of new injuries, and preventing degenerative changes. Surgical technique may play a role in the development and progression of knee osteoarthritis (OA); the anteromedial (AM) portal has been associated with critically short tunnels and an increased risk of posterior wall blowout, while the transtibial (TT) tunnel technique has been criticized for resulting in too vertical tunnel placement and failing to restore native anatomy which may predispose patients to the development of early knee OA. The footprint position of the ACL graft was evaluated in patients following autograft/allograft, single-bundle, transtibial ACLR to determine whether this technique can restore the native ACL footprint.
Methods: Fifty-seven patients with 59 ACL injuries that underwent either autograft or allograft, single-bundle, transtibial ACLR between 1999-2014 by a single surgeon were included. All patients underwent radiographic evaluation at a minimum of 12 months following ACLR. CT scan was performed using a GE Light Speed 64-slice scanner with a slice thickness of 0.625 mm. CT images underwent 3D reconstruction using OsiriX program (Pixmeo, Geneva, Switzerland) to assess ACL footprint. The ratio of the postero-anterior (PA) and proximal-distal (PD) position for the femoral footprint and medial-lateral (ML) and anteroposterior (AP) position for the tibial tunnel were calculated. Values will be compared to the previously reported data.
Results: Average footprint position of femoral PA and PD position were 37.6±3.42 and 44.6±4.44, respectively. Average footprint position of tibial ML and AP position were 47.7±3.5% and 44±6.3% respectively.
Conclusions: The trans-tibial single bundle ACL reconstruction technique appears to yield a central tunnel between the anteromedial and posterolateral bundles on the tibial side in both planes including medial-lateral and anterior-posterior. On the femoral side, the tunnel appears closer to posterolateral bundle tunnel on the proximal-distal and central in posterior-anterior axis between the anteromedial and posterolateral bundles. This simple, easy to use program can aid all physicians in determining whether their anteromedial or transtibial technique successfully restores the anatomic ACL footprint.
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