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1.
The effect of accelerated,brace free,rehabilitation on bone tunnel enlargement after ACL reconstruction using hamstring tendons: a CT study 总被引:2,自引:0,他引:2
Antonio Vadalà Raffaele Iorio Angelo De Carli Giuseppe Argento Vincenzo Di Sanzo Fabio Conteduca Andrea Ferretti 《Knee surgery, sports traumatology, arthroscopy》2007,15(4):365-371
The mechanism of bone tunnel enlargement following anterior cruciate ligament (ACL) reconstruction is not yet clearly understood.
Many authors hypothesized that aggressive rehabilitation protocols may be a potential factor for bone tunnel enlargement, especially in reconstructions performed with hamstrings autograft. The purpose of this study was to evaluate
the effect of a brace free rehabilitation on the tunnel enlargement after ACL reconstruction using doubled semitendinosus
and gracilis tendons (DGST): our hypothesis was that early post-operative knee motion increase the diameters of the tibial
and femoral bone tunnels. Forty-five consecutive patients undergoing ACL reconstruction for chronic ACL deficiency were selected.
All patients were operated by the same surgeon using autologous DGST and the same fixation devices. Patients with associated
ligaments injuries and or severe chondral damage were excluded. The patients were randomly assigned to enter the control group
(group A, standard post-operative rehabilitation) and the study group (group B, brace free accelerated rehabilitation). A
CT scan was used to exactly determine the diameters of both femoral and tibial tunnels at various levels of lateral femoral
condyle and proximal tibia, using a previously described method [17]. Measurements were done by an independent radiologist in a blinded fashion the day after the operation and at a mean follow-up
of 10 months (range 9–11). Statistical analysis was performed using paired t-test. The mean femoral tunnel diameter increased significantly from 9.04 ± 0.05 (post-operative) to 9.30 ± 0.8 mm (follow-up)
in group A and from 9.04 ± 0.03 to 9.94 ± 1.12 mm in group B. The mean tibial tunnel diameter increased significantly from
9.03 ± 0.04 to 10.01 ± 0.80 mm in group A and from 9.04 ± 0.03 to 10.60 ± 0.78 mm in group B. The increase in femoral and
tunnel diameters observed in the study group was significantly higher than that observed in the control group. Our results
suggest that bone tunnel enlargement after ACL reconstruction using hamstrings autograft can be increased by an accelerated,
brace free, rehabilitation protocol. 相似文献
2.
Nam-Hong Choi Jung-Hoon Lee Kyung-Mo Son Brian N. Victoroff 《Knee surgery, sports traumatology, arthroscopy》2010,18(1):92-97
The purpose of this study was to evaluate tibial tunnel widening prospectively after anterior cruciate ligament (ACL) reconstruction
with hamstring tendon grafts using Rigidfix (DePuy Mitek, Raynham, MA) femoral fixation and Intrafix (DePuy Mitek) tibial
fixation. Fifty-six consecutive patients who underwent ACL reconstruction with a minimum of 2 years’ postoperative evaluation
were reviewed. On the anterior–posterior (AP) and lateral radiographs, the diameter of the tibial tunnel was measured at proximal,
middle, and distal positions, and the shape of the tibial tunnels were classified. Tunnel widening was defined as widening
of greater than 2 mm. Group I was defined as cases with no tunnel widening, and group II was defined as cases with tunnel
widening. Postoperative laxity evaluations were performed using Lachman test, pivot-shift test, and instrumented laxity testing
using the KT-1000 arthrometer. On the AP radiographs, the average diameter of the tibial tunnel increased 8.8% at 6 months
and 8.5% at 12 months postoperatively compared to the immediate postoperative day. On the lateral radiographs, the average
diameter of the tibial tunnel increased 7.2% at 6 months and 8.1% at 12 months year postoperatively compared to the immediate
postoperative day. The tunnel shape evaluation revealed predominantly linear type in 53 patients (95%). Group I was 42 patients
(75%), and group II was 14 (25%). The average KT-1000 measurement was 1.0 ± 1.8 mm in group I and 2.1 ± 2.8 mm in group II
(n.s.). The Lachman and pivot-shift tests showed no significant differences between the two groups. In conclusion, hamstring
ACL reconstruction using Rigidfix and Intrafix fixation showed less widening of the tibial tunnels than observed in previously
published studies. 相似文献
3.
Joshua A. Baumfeld David R. Diduch L. Joseph Rubino Jennifer A. Hart Mark D. Miller Michelle S. Barr Joseph M. Hart 《Knee surgery, sports traumatology, arthroscopy》2008,16(12):1108-1113
Femoral and tibial tunnel widening following ACL reconstruction using hamstring autograft has been described. Greater tunnel
widening has been reported with suspensory fixation systems. We hypothesized that greater tunnel widening will be observed
in patients whose hamstring autograft was fixated using a cortical, suspensory system, compared to double cross-pin fixation
on the femur. We performed clinical and radiographic evaluation on 46 patients at minimum 2 years after primary ACL reconstruction.
We measured subjective and objective outcomes including KT-1000 and AP, lateral radiographs. A musculoskeletal radiologist,
independent of the surgical team, measured tunnel width, while correcting for magnification, at the widest point and at 1 cm
away from tibial and femoral tunnel apertures. Patients in the suspensory graft fixation group exhibited significantly greater
absolute change and greater percent change in femoral tunnel diameter compared to patients with double cross-pin fixation
(P ≤ 0.05). This difference was noted on both AP and lateral radiographs and at both measurement sites. There was no significant
difference between groups for tibial tunnel widening, IKDC subjective scores or KT-1000 side to side differences. There was
significantly more femoral tunnel widening associated with the use of the endobutton suspensory fixation system compared to
the use of double cross-pins for fixation within the tunnel. 相似文献
4.
Rachel M. Frank Shane T. Seroyer Paul B. Lewis Bernard R. Bach Jr. Nikhil N. Verma 《Knee surgery, sports traumatology, arthroscopy》2010,18(11):1607-1611
This study aimed to establish normal values for the position of the native anterior cruciate ligament (ACL) insertion on the
tibia to assist in the evaluation of tunnel placement after primary ACL reconstruction or prior to revision surgery. One hundred
consecutive MRI studies performed on patients with a mean age of 29 years (range 20–35) from a single MRI facility were reviewed.
Patients with prior surgery, significant osteoarthritis, acute ACL injury, or evidence of ACL reconstruction were excluded.
Using digital image software, measurements were taken of anterior-most and posterior-most portions of the ACL insertion on
the tibia. Depth of the tibia was also measured from the anterior edge of the tibial plateau to the posterior edge at the
origin of the posterior cruciate ligament. The anterior insertion of the native ACL was located at a mean of 14 ± 3 mm (28 ± 5%)
from the anterior tibial articular margin; the posterior portion of the ACL was located at a mean of 31 ± 4 mm (63 ± 6%).
The tibial insertion of the ACL is located between 28 and 63% of the total anterior–posterior depth of the tibia. The results
from this study are clinically relevant as they provide the clinician with baseline data to describe the position of the tibial
footprint of the native ACL on sagittal MR imaging. Further, this data can be used as a guide to evaluate tibial tunnel position
prior to primary ACL reconstruction, revision ACL surgery, or in ACL-reconstructed patients who continue to experience pain,
instability, or dysfunction postoperatively. 相似文献
5.
Anna-Stina Moisala Timo Järvelä Antti Paakkala Timo Paakkala Pekka Kannus Markku Järvinen 《Knee surgery, sports traumatology, arthroscopy》2008,16(12):1080-1086
There has never been an MRI study of tunnel widening comparing bioabsorbable to metal screw fixation in autologous hamstring
anterior cruciate ligament (ACL) reconstruction. We randomized 62 patients to hamstring ACL reconstruction with either a bioabsorbable
(n = 31) or metal screw (n = 31) fixation. The evaluation methods were clinical examination, KT-1000 arthrometric measurement, the International Knee
Documentation Committee and Lysholm scores, and MRI. There were no differences between the groups preoperatively. Fifty-five
patients (89%) were available at a minimum of 2-year follow-up (range 24–36 months). There was tunnel widening in both groups,
but the increase was significantly greater in the AP dimension of the femoral tunnel in the bioabsorbable screw group compared
to metal group (P = 0.01). The tibial tunnels showed no intergroup difference. Ninety-four percent of the knees were normal or nearly normal
according to the IKDC scores and the average Lysholm score was 91 with no intergroup difference. The follow-up AP tibial tunnel
diameter was smaller with normal knee laxity compared to abnormal knee laxity. The graft failure rate in the bioabsorbable
screw group was 23% (7/31 patients) and 6% (2/31 patients) in the metal screw group. The use of bioabsorbable screws resulted
in more femoral tunnel widening, and more graft failures compared to metal screws. The tunnel widening in the tibia was associated
with the knee laxity (P = 0.02). 相似文献
6.
Qiang Zhang Shu Zhang Xuecheng Cao Lifeng Liu Ya Liu Rui Li 《Knee surgery, sports traumatology, arthroscopy》2014,22(1):166-173
Purpose
To investigate the effect of remnant preservation on tibial tunnel enlargement in a single-bundle anterior cruciate ligament (ACL) reconstruction with a hamstring autograft.Methods
From 2006 to 2009, a total of 62 patients who underwent single-bundle ACL reconstruction with a quadrupled hamstring tendon autograft were enrolled in this study. The patients were randomly divided into two groups: the preserving-remnant group and the removing-remnant group. Plain radiographs were taken at 1 week, and 3, 6, and 24 months postoperatively, and tibial tunnel enlargement was evaluated. The postoperative clinical assessment included the Lysholm rating scale and KT-1000 measurement.Results
In total, 27 patients in the preserving-remnant group and 24 patients in the removing-remnant group were followed up and the median follow-up was 24.5 months (range 24–27 months). Tibial tunnel enlargement occurred within 6 months postoperatively. Positive enlargement was observed in 8 patients (29.6 %) in the preserving-remnant group and 14 patients (58.3 %) in the removing-remnant group (P = 0.0388). The percentage of tibial tunnel enlargement was 25.7 ± 6.7 and 34.0 ± 8.9 % in the preserving- and removing-remnant groups, respectively (P = 0.0004). In the preserving-remnant group, the average Lysholm score increased from 60.3 ± 5.3 (51–69) to 93.0 ± 3.5 (88–100), and the side-to-side difference of the KT-1000 changed from 6.3 ± 0.9 (5.1–8.0) to 1.4 ± 0.6 (0.5–2.4) mm. In the removing-remnant group, the average Lysholm score increased from 58.7 ± 6.5 (48–71) to 91.1 ± 3.9 (85–100), and the side-to-side difference of the KT-1000 changed from 6.5 ± 0.8 (5.4–8.2) to 1.7 ± 0.6 (0.6–2.8) mm.Conclusions
It is confirmed that remnant preservation in ACL reconstruction can resist tibial tunnel enlargement but that this technique does not affect the short-term clinical outcome of ACL reconstruction.Level of evidence
I. 相似文献7.
No bone tunnel enlargement in patients with open growth plates after transphyseal ACL reconstruction
S. Kopf J.-P. Schenkengel G. Wieners C. Stärke R. Becker 《Knee surgery, sports traumatology, arthroscopy》2010,18(11):1445-1451
Bone tunnel enlargement after ACL reconstruction has been described extensively in adults. However, little is known about
this phenomenon in patients with open growth plates. Thus, the goals of the current study were to evaluate changes in bone
tunnel size in patients with open growth plates after transphyseal ACL reconstruction with suspensory fixation and to correlate
tunnel size with clinical outcome after medium-term follow-up. Fourteen patients with open growth plates were included that
underwent primary transphyseal ACL reconstruction using hamstrings autografts and suspensory fixation. Mean follow-up time
was 7 years. At the time of follow-up, MRIs of the operated knee were performed, and outcome was assessed using KOS-ADLS,
Lysholm score, IKDC Subjective Knee Form score, Knee Examination Form score, and KT-1000 measurements. On MRI, the cross-sectional
area of the bone tunnels was assessed using special axial cuts perpendicular to the axes of the tunnels. Two orthopaedic surgeons
and two radiologists analysed the MRIs. Change in bone tunnel size from surgery to follow-up was calculated. No significant
changes in bone tunnel size from surgery to follow-up were found. Regarding outcome measures, KOS-ADLS averaged 95%, Lysholm
Score averaged 96 points, IKDC Subjective Knee Form averaged 95%, IKDC Knee Examination Form scores were 8A, 5B, 1C, and KT-1000
measurements averaged 1.8 ± 1.4 mm. No significant correlations were found between tunnel size at follow-up and outcome measures.
Based on our study, bone tunnel enlargement does not occur in patients who have open growth plates and undergo ACL reconstruction
using suspensory fixation. 相似文献
8.
Tunnel expansion following anterior cruciate ligament reconstruction: a comparison of hamstring and patellar tendon autografts 总被引:42,自引:19,他引:23
J. C. L’Insalata Brian Klatt Freddie H. Fu Christopher D. Harner 《Knee surgery, sports traumatology, arthroscopy》1997,5(4):234-238
Thirty patients having had anterior cruciate ligament (ACL) reconstruction with bone-patellar tendon-bone (BPTB) autograft
and thirty patients having had ACL reconstruction with hamstring (HS) autograft were enrolled. All procedures were performed
using an endoscopic technique with identical postoperative rehabilitation, such that the only variable was the type of graft
and its fixation. Lateral and 45° posteroanterior (PA) weightbearing radiographs were performed in each patient at 6–12 (mean
9) months postoperatively in the HS group and 9–22 (mean 13) months postoperatively in the PT group. The sclerotic margins
of the tunnel were measured at the widest dimension of the tunnel by a single observer and were compared with the initially
drilled tunnel size after correction for radiographic magnification. For the BPTB group, all bone plugs appeared to be incorporated
radiographically. On the femoral side, the bone plug was incorporated at the roof of the intercondylar notch, such that no
tunnel measurement could be made. Well-defined sclerotic margins were always present at the tibial and femoral tunnels for
the HS group and at the tibial tunnel for the BPTB group. The mean percentage increase in tunnel size in the PA view was 9.7%
± 14.7% for the BPTB tibial tunnel, 20.9% ± 13.4% for the HS tibial tunnel, and 30.2% ± 17.2% for the HS femoral tunnel. The
mean percentage increase in tunnel size in the lateral view was 14.4% ± 16.1% for the BPTB tibial tunnel, 25.5% ± 16.7% for
the HS tibial tunnel, and 28.1% ± 14.7% for the HS femoral tunnel. The difference in HS and BPTB tibial tunnel expansion on
both the PA and lateral views was statistically significant (P = 0.003 and P = 0.01, respectively). Inter-observer variability was excellent with an intra-class correlation coefficient of 0.92. Tunnel
expansion was significantly greater following ACL reconstruction using HS autografts than in those using BPTB autografts.
The points of fixation for the HS grafts are at a greater distance from the normal insertion site and biomechanical point
of action of the ACL than the points of fixation for BPTB grafts. We believe that this greater distance creates a potentially
larger force moment during graft cycling which may lead to greater expansion of bone tunnels.
Received: 17 March 1997 Accepted: 30 June 1997 相似文献
9.
Michael Elias Hantes Vasilios C. Zachos Athanasios Liantsis Aaron Venouziou Apostolos H. Karantanas Konstantinos N. Malizos 《Knee surgery, sports traumatology, arthroscopy》2009,17(8):880-886
The purpose of this study was to evaluate differences in graft orientation between transtibial (TT) and anteromedial (AM)
portal technique using magnetic resonance imaging (MRI) in anterior cruciate ligament (ACL) reconstruction. Fifty-six patients
who were undergoing ACL reconstruction underwent MRI of their healthy and reconstructed knee. Thirty patients had ACL reconstruction
using the TT (group A), while in the remaining 26 the AM (group B) was used. In the femoral part graft orientation was evaluated
in the coronal plane using the femoral graft angle (FGA). The FGA was defined as the angle between the axis of the femoral
tunnel and the joint line. In the tibial part graft orientation was evaluated in the sagittal plane using the tibial graft
angle (TGA). The TGA was defined as the angle between the axis of the tibial tunnel and a line perpendicular to the long axis
of the tibia. The ACL angle of the normal knee in the sagittal view was also calculated. The mean FGA for group A was 72°,
while for the group B was 53° and this was statistically significant (P < 0.001). The mean TGA for group A was 64°, while for the group B was 63° (P = 0.256). The mean intact ACL angle for group A was 52°, while for the group B was 51°. The difference between TGA and intact
ACL angle was statistically significant (P < 0.001) for both groups. Using the AM portal technique, the ACL graft is placed in a more oblique direction in comparison
with the TT technique in the femoral part. However, there are no differences between the two techniques in graft orientation
in the tibial part. Normal sagittal obliquity is not restored with both techniques.
Paper presented at the 6th Biennial ISAKOS Congress, Florence, ITALY, 2007 and 12th ESSKA 2000 Congress, Innsbruck, Austria
2006. 相似文献
10.
Jin Hwan Ahn Sang Hak Lee Jae Chul Yoo Hae Chan Ha 《Knee surgery, sports traumatology, arthroscopy》2007,15(11):1293-1300
The aims of this study were to quantify the angle and placement of an anterior cruciate ligament (ACL) grafted with a single
incision ACL reconstruction technique using postoperative magnetic resonance imaging (MRI), and to compare the results with
those with a native ACL. Between February 1996 and May 2004, 96 consecutive patients, who had undergone postoperative MRI
of the knee followed by an arthroscopically assisted ACL reconstruction with either a hamstring tendon or bone-patellar tendon-bone
(BTB) autograft, were enrolled in this study. The femoral tunnel was drilled using the transtibial technique. The patients
were divided into two groups; the hamstring tendon graft group (group H; 50 patients) and the BTB graft group (group B; 46
patients). All the patients including both groups in this study underwent postoperative MRI and were followed up for a minimum
of 2 years. The control group (group C) consisted of 50 patients whose meniscus tear had been operated on by arthroscopy and
whose ACL was intact. The orientation of the ACL ligament or graft was measured using three different methods: the sagittal
ACL angle, the ACL-Blumensaat line angle, and the coronal ACL angle. The mean sagittal ACL angle in group C (58.7 ± 3.8°)
was significantly lower than in groups H (64.6 ± 4.2°) and B (71.3 ± 6.0°). The mean ACL-Blumensaat line angle in group C
(8.6 ± 3.6°) was also significantly lower than in groups H (12.8 ± 5.2°) and B (18.0 ± 5.3°). The mean coronal ACL angle in
group C (65.9 ± 4.4°) was lower than that in groups H (73.5 ± 2.4°) and B (75.2 ± 2.9°). The grafted ACL of the hamstring
tendon and BTB grafts on the postoperative MRI showed a significant vertical angle in the coronal and sagittal plane compared
with the native ACL. In the sagittal plane, the hamstring tendon graft was positioned more obliquely than the BTB graft, which
had a larger angle of the tibial tunnel, in an attempt to prevent a graft-tunnel mismatch. The postoperative MRI study showed
that the more horizontally the angle of the tibial tunnel can be placed in a single incision ACL reconstruction, the more
efficiently it can produce a graft closer to the native ACL. 相似文献
11.
Magarelli N Carducci C Cannataro G Graziano G Leone A Palmieri D Barbato M Ciampa F Bonomo L 《La Radiologia medica》2011,116(7):1124-1133
Purpose
This study aimed to evaluate correlations between the position of the tibial tunnel, its alignment with the ligament-screw system, presence of intratunnel fluid, position of the tibial tunnel with respect to the Blumensaat line and clinical knee stability in patients who underwent arthroscopic reconstruction of the anterior cruciate ligament (ACL), by using magnetic resonance (MR) imaging.Materials and methods
Forty-eight patients (40 men, eight women; mean age, 31 years) underwent arthroscopic reconstruction of the ACL using double-strand semitendinosus and gracilis tendons. The new ACL was fixed to the tibial tunnel using Bio-Intrafix (Mitek). All patients underwent MR imaging 12 months after surgery and clinical evaluation at 6 and 12 months using the International Knee Documentation Committee (IKDC) scoring system. MR imaging and clinical features were correlated using the Mann-Whitney U test for continuous variables and Fisher??s exact test for categorical variables.Results
Forty-one patients were clinically stable (groups A and B according to the IKDC test) and seven were unstable (group C). Mean values of tibial tunnel position in clinically unstable vs stable patients were, respectively, ?3.6 ±3.8 mm vs. ?2.8±3.8 mm in relation to the Blumensaat line (p=0.5712) and 77.3°±11.3 vs. 72.5°±5.5 necesas concerned the angle measured on the coronal view of the new ACL (p=0.3248); fluid was present in the tibial tunnel in 42.9% and 9.8% of cases, respectively (p=0.2104). MR imaging showed misalignment of ligament screw and tibial tunnel in 57.1% of patients in group C and in 12.2% in groups A and B (p=0.017).Conclusions
Misalignment of the ligament-screw system and the tibial tunnel and the presence of fluid in the tibial tunnel appear to be directly correlated with clinical instability. 相似文献12.
Patrick Weninger Benno Zifko Michael Liska Ralf Spitaler Hartmut Pelinka Harald Hertz 《Knee surgery, sports traumatology, arthroscopy》2008,16(11):988-995
Double biodegradable cross-pins are increasingly used for femoral fixation in arthroscopically assisted reconstruction of
the anterior cruciate ligament (ACL). There are no studies combining functional outcome analysis, radiographs and magnetic
resonance images (MRI) to evaluate this technique. The authors examined 45 patients after ACL reconstruction using double
biodegradable femoral cross-pin fixation and biodegradable tibial interference screw fixation with a minimum follow-up of
24 months. Clinical evaluation included International Knee Documentation Committee (IKDC) and modified Lysholm score. Radiographic
analysis included standard X-rays in anterior–posterior and lateral views and Telos stress device measurements. MRI was analyzed
to obtain information about hardware, intra-articular graft, osseous graft-integration and cartilage. IKDC score revealed
28 (62.2%) patients with normal knee function (group A), 15 (33.3%) patients with nearly normal (group B) knee function and
2 (4.4%) patients with abnormal knee function (group C). The Lysholm score was 94.6 (±7.2) in the operated knee and 98.8 (±7.4)
in the non-operated knee. Mean Telos stress device values were +4.6 (±2.6) in the operated and +3.9 (±2.4) in the non-operated
knee. MRI showed an intact intra-articular graft in all but one patient. Complete femoral graft integration was seen in 88.9%
and complete tibial graft integration in 86.7%. Biodegradable cross-pins were partially or fully visible in all patients.
The biodegradable tibial interference screw was fully visible in 16 (35.6%) and partially visible in 20 (44.4%) patients.
Thirty-one (68.9%) patients showed signs of cartilage degeneration on MRI at follow-up. The graft fixation with double biodegradable
pin fixation appears to be a reliable technique for ACL reconstruction providing a stable close-to-joint graft fixation. 相似文献
13.
A prospective evaluation of tunnel enlargement in anterior cruciate ligament reconstruction with hamstrings: extracortical versus anatomical fixation 总被引:20,自引:9,他引:11
J.-U. Buelow R. Siebold A. Ellermann 《Knee surgery, sports traumatology, arthroscopy》2002,10(2):80-85
Changes in the femoral and tibial bone tunnel were studied prospectively after arthroscopic ACL reconstruction with quadruple hamstring autograft. To determine whether tunnel enlargement can be decreased by fixing the graft close to the joint line having a stiffer fixation construct we compared "anatomical" (one absorbable interference screw femorally, and bicortical fixation with two absorbable interference screws tibially) and extracortical fixation techniques (Endobutton femorally, and two no. 6 Ethibond sutures over a suture washer tibially). Over a 2-year period we evaluated 60 patients clinically (IKDC scale, Cincinnati Knee Score, KT-1000) and radiographically (confirmed by MRI). The operated knee was radiographed immediately postoperatively and 6 and 24 months postoperatively. The femoral and tibial bone tunnel diameter was measured on anteroposterior and lateral images, and the tunnel area was calculated and compared to the initial area calculated from the perioperative drill size. In the "anatomical" group the immediately postoperative bone tunnel area was 75% larger than the initial tunnel area, after 6 months it was increased another 31%, and between 6 and 24 months it remained basically unchanged. In the "extracortical" group there was no significant enlargement immediately postoperatively, but after 6 months it was 65% larger than the initial area of drill and graft size, and between 6 and 24 months it decreased to 47%. There was no correlation between the amount of tunnel enlargement and clinical scores or KT-1000 measurement. Arthroscopic ACL reconstruction with quadruple hamstring autograft is associated with bone tunnel enlargement. Using a purely extracortical fixation technique thus significantly increased the tibial and femoral tunnel area during the first 6 postoperative months, while it decreased slightly thereafter. The insertion of large interference screws apparently not only compresses the graft in the bone tunnel but also significantly enlarges the bone tunnel itself. The immediate enlargement at the time of the operation is followed by a reduced further enlargement at 6 months and then stabilization. Tunnel widening did not influence clinical outcome over a 2-year period. 相似文献
14.
Kawakami Y Hiranaka T Matsumoto T Hida Y Fukui T Uemoto H Doita M Tsuji M Kurosaka M Kuroda R 《Knee surgery, sports traumatology, arthroscopy》2012,20(8):1503-1510
Purpose
The first purpose of this study was to examine whether fluoroscopic-based navigation system contributes to the accuracy and reproducibility of the bone tunnel placements in single-bundle anterior cruciate ligament (ACL) reconstruction. The second purpose was to investigate the application of the navigation system for double-bundle ACL reconstruction.Methods
A hospital-based case–control study was conducted, including a consecutive series of 55 patients. In 37 patients who received single-bundle ACL reconstruction, surgeries were performed with this system for 19 knees (group 1) and without this system for 18 knees (group 2). The positioning of the femoral and tibial tunnels was evaluated by plain sagittal radiographs. In 18 patients who received double-bundle ACL reconstruction using the navigation system (group 3), the bone tunnel positions were assessed by three-dimensional computed tomography (3D-CT). Clinical assessment of all patients was followed with the use of Lysholm Knees Score and IKDC.Results
Taking 0% as the anterior and 100% as the posterior extent, the femoral tunnels were 74.9?±?3.0% in group 1 and 71.5?±?5.8% in group 2 along Blumensaat’s line, and the tibial tunnels were 42.3?±?1.4% in group 1 and 42.5?±?4.6% in group 2 along the tibia plateau. The bone tunnel positions in group 1 were located significantly closer to the position planned preoperatively and varied less in both femur and tibial side, compared with those without navigation (group 2). (Femur: P?0.05, Tibia: P?0.001) 3D-CT evaluation of double-bundle ACL reconstruction (group 3) also demonstrated that the bone tunnel positions of both anteromedial (AM) and posterolateral (PL) were placed as we expected.Conclusion
The fluoroscopic-based navigation system contributed to the more reproducible placement of the bone tunnel during single-bundle ACL reconstruction compared with conventional technique. Additionally, this device was also useful for double-bundle ACL reconstruction.Level of evidence
Case–control study, Therapeutic study, Level III. 相似文献15.
George Basdekis Pascal Christel François Anne 《Knee surgery, sports traumatology, arthroscopy》2009,17(9):1089-1094
This study compares the positioning of femoral AM and PL tunnels obtained with specific ancillary instruments during anatomic
double-bundle ACL reconstruction with the native ACL footprint using three-dimensional computed tomography (3-D CT). In 35
consecutive patients, anatomic double-bundle ACL reconstruction was performed with specific ancillary instruments. Three-dimensional
CT reconstruction of both knees was performed using the volume rendering technique. In the controls (contralateral knee, with
intact ACL), the angle between the longitudinal axis of the footprint and the axis of the femur, the “footprint angle” (FA)
was measured. On the involved side, using the axis passing through the tunnel centers, FA was also measured. In both the groups,
footprint’s length and width, and distances to cartilage margins were measured. FA was 28.1° ± 5.0° in the controls and 32.9° ± 15.8°
on the involved side (n.s.). There was no statistical difference between the two groups for the other morphometric parameters:
footprint’s length and width, and distances to cartilage margins. Using specific ancillary instruments the morphometric parameters
of the reconstructed femoral ACL footprint were similar to the native ACL. 相似文献
16.
Atsushi Kanaya Mitsuo Ochi Masataka Deie Nobuo Adachi Makoto Nishimori Atsuo Nakamae 《Knee surgery, sports traumatology, arthroscopy》2009,17(8):907-913
Twenty-six patients with anteroposterior (AP) laxity of the knee, associated with torn anterior cruciate ligament (ACL), were
prospectively randomized for arthroscopic lower femoral tunnel placed single- or double-bundle reconstruction using hamstring
tendons. We evaluated AP and rotational stabilities under regular loads (a 100-N anterior load and a 1.5-N m external–internal
load) before and after ACL reconstruction, comparing single- and double-bundle reconstruction with our original device for
applying quantitative tibial rotation and the navigation system intraoperatively. No significant differences were found between
the two groups in AP displacement and total range of tibial rotation at 30° and 60° of knee flexion. We found that a lower
femoral tunnel placed single-bundle reconstruction reproduced AP and rotational stability as well as double-bundle reconstruction
after reconstruction intraoperatively. 相似文献
17.
Kwang Am Jung Su Chan Lee Moon Bok Song Choon Key Lee 《Knee surgery, sports traumatology, arthroscopy》2008,16(4):382-385
The authors devised an alternative arthroscopic double bundle ACL reconstruction technique using a bone patellar tendon bone
(BPTB)–gracilis tendon composite autograft. One tibial and two femoral tunnels were used to reconstruct two bundles of anterior
cruciate ligaments (ACL) [an anteromedial bundle (AM) and a post-erolateral bundle (PL)]. BTBB was fixed in the tunnels produced
on the isometric points of the tibia and femur using the conventional technique. The gracilis tendon was then fixed in a PL
tunnel produced using the outside-in technique. The authors consider that the devised technique based on a combination of
autogenous bone patellar bone graft and gracilis tendon, can minimize tunnel widening post-operatively, allow easier revision
should the reconstructed ACL fail, and also provides an alternative means of restoring rotation stability. 相似文献
18.
Edoardo Monaco Luca Labianca Barbara Maestri Angelo De Carli Fabio Conteduca Andrea Ferretti 《Knee surgery, sports traumatology, arthroscopy》2009,17(6):617-621
The KT-1000 is widely accepted as a tool for the instrumented measurement of the antero-posterior (AP) tibial translation.
The aim of this study is to compare the data obtained with the KT-1000 in ACL deficient knees with the data obtained using
a navigation system during “in vivo” ACL reconstruction procedures and to validate the accuracy of the KT-1000. An ACL reconstruction
was performed using computer aided surgical navigation (Orthopilot, B-Braun, Aesculap, Tuttlingen, Germany) in 30 patients.
AP laxity measurements were obtained for all patients using KT-1000 arthrometer (in a conscious state and under general anaesthesia)
and during surgery using the navigation system, always at 30° of knee flexion. The mean AP translation was 14 ± 4 and 15.6 ± 3.8 mm
using the KT-1000 in conscious and under general anaesthesia, respectively (P = 0.02) and 16.1 ± 3.7 mm using navigation. Measurements obtained with the KT-1000 under general anaesthesia were no different
from those obtained “in vivo” with the navigation system (P = 0.37). In conclusion this study validates the accuracy of the KT-1000 to exactly calculate AP translation of the tibia,
in comparison with the more accurate measurements obtained using a navigation system. 相似文献
19.
Casper Foldager Bent W. Jakobsen Bent Lund Svend Erik Christiansen Lotte Kashi Lone R. Mikkelsen Martin Lind 《Knee surgery, sports traumatology, arthroscopy》2010,18(1):79-84
Developing bio-absorbable interference screws for anterior cruciate ligament (ACL) reconstruction has proven to be a challenging
task. The aim of this study was to investigate the osteogenetic response of poly-lactide carbonate (PLC) interference screws
in ACL reconstruction in humans. Ten patients (median age, 28 years) underwent arthroscopic ACL reconstruction with semitendinosus/gracilis
tendon graft and a PLC interference screw. The patients were scanned with a multi-slice CT scanner 2 weeks and 1 year postoperatively.
Fourteen days postoperatively a mean tunnel widening of 78% [52%; 110%] was observed. At 1-year follow-up, the mean tunnel
widening was 128% [84%; 180%]. No sign of bone replacement or bone ingrowth was observed. Factors such as accelerated rehabilitation,
micro-motions, and early screw degradation might be responsible for this large tunnel widening. Our results demonstrate the
difficulty in translation of preclinical data. This study illustrates the need for extensive preclinical investigation of
new materials for clinical purposes. 相似文献
20.
Amit Sahasrabudhe Pascal Christel Francois Anne David Appleby Georges Basdekis 《Knee surgery, sports traumatology, arthroscopy》2010,18(11):1599-1606
Following anatomic double-bundle anterior cruciate ligament (ACL) reconstruction with hamstring tendon autografts, 38 consecutive
patients were evaluated with high-speed three-dimensional computed tomography. Scans were performed within 3 days following
surgery. The length and width of the reconstructed ACL footprint were measured on axial images. Then, 3D images were converted
into 2D with radiologic density for measurement purposes. Tunnel orientation was measured on AP and lateral views. In the
sagittal plane, the center of the anteromedial (AMB) and posterolateral bundle (PLB) tibial attachment positions was calculated
as the ratio between the geometric insertion sites with respect to the sagittal diameter of the tibia. In addition, the length
from the anterior tibial plateau to the retro-eminence ridge was measured; the relationship of this line with the centers
of the AM and PL tunnels was then measured. The AP length of the reconstructed footprint was 17.1 mm ± 1.9 mm and the width
7.3 mm ± 1.2 m. The distance from retro-eminence ridge to center of AM tunnel was 18.8 mm ± 2.8 mm, and the distance from
RER to center of PL tunnel was 8.7 mm ± 2.6 mm. The distance between tunnels center was 10.1 mm ± 1.7 mm. There were no significant
differences between the intra- and inter-observer measurements. The bone bridge thickness was 2.1 mm ± 0.8 mm. In the sagittal
plane, the centers of the tunnel apertures were located at 35.7% ± 6.7% and 53.7% ± 6.8% of the tibia diameter for the AMB
and PLB, respectively. The surface areas of the tunnel apertures were 46.3 mm2 ± 4.4 mm2 and 36.3 mm2 ± 4.0 mm2 for the AM and PL tunnels, respectively. The total surface area occupied by both tunnels was 82.6 mm2 ± 7.0 mm2. In the coronal plane, tunnel orientation showed the AM tunnel was more vertical than the PL tunnel with a 10° divergence
(14.8° vs. 24.1°). In the sagittal plane, both tunnels were almost parallel (29.9° and 25.4° for the AM and PL tunnels, respectively).
When using anatomic aimers, the morphometric parameters of the reconstructed tibial footprint in terms of length and distances
to the surrounding bony landmarks were similar to the native ACL tibial footprint. However, the native footprint width was
not restored, and the surface area of the two tunnel apertures was in the lower range of the published values for the native
footprint area. 相似文献