Skip to main content
SpringerLink
Log in

Tibial tunnel widening after anterior cruciate ligament reconstructions with hamstring tendons using Rigidfix femoral fixation and Intrafix tibial fixation

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Charlton WP, Randolph DA Jr, Lemos S, Shields CL Jr (2003) Clinical outcome of anterior cruciate ligament reconstruction with quadrupled hamstring tendon graft and bioabsorbable interference screw fixation. Am J Sports Med 31:518–521

    PubMed  Google Scholar 

  2. Yasuda K, Tsujino J, Ohkoshi Y, Tanabe Y, Kaneda K (1995) Graft site morbidity with autogenous semitendinosus and gracilis tendons. Am J Sports Med 23:706–714

    Article  CAS  PubMed  Google Scholar 

  3. Clatworthy MG, Annear P, Buelow JU, Bartlett RJ (1997) Tunnel widening in anterior cruciate ligament reconstruction: a prospective evaluation of hamstring and patella tendon grafts. Knee Surg Sports Traumatol Arthrosc 7:138–145

    Article  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  5. 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 5:234–238

    Article  PubMed  Google Scholar 

  6. 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 4:2–8

    Article  CAS  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  8. Zantop T, Weimann A, Rummler M, Hassenpflug J, Petersen W (2004) Initial fixation strength of two bioabsorbable pins for the fixation of hamstring grafts compared to interference screw fixation: single cycle and cyclic loading. Am J Sports Med 32:641–649

    Article  PubMed  Google Scholar 

  9. Kousa P, Järvinen TLN, Vihavainen M, Kannus P, Järvinen M (2003) The fixation strength of six hamstring graft fixation devices in anterior cruciate ligament reconstruction. Part II: Tibial site. Am J Sports Med 31:182–188

    PubMed  Google Scholar 

  10. Fauno P, Kaalund S (2005) Tunnel widening after hamstring anterior cruciate ligament reconstruction is influenced by the type of graft fixation used: a prospective randomized study. Arthroscopy 21:1337–1341

    PubMed  Google Scholar 

  11. Kobayashi M, Nakagawa Y, Suzuki T, Okudaira S, Nakamura T (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 22:1093–1099

    Article  PubMed  Google Scholar 

  12. Nebelung W, Becker R, Merkel M, Röpke M (1998) Bone tunnel enlargement after anterior cruciate ligament reconstruction with semitendinosus tendon using Endobutton fixation on the femoral side. Arthroscopy 14:810–815

    Article  CAS  PubMed  Google Scholar 

  13. Höher J, Livesay GA, Ma CB, Withrow JD, Fu FH, Woo SL-Y (1999) Hamstring graft motion in the femoral bone tunnel when titanium/polyester tape fixation. Knee Surg Sports Traumatol Arthrosc 7:215–219

    Article  PubMed  Google Scholar 

  14. Ma CB, Francis K, Towers J, Irrgang J, Fu FH, Harner CH (2004) Hamstring anterior cruciate ligament reconstruction: a comparison of bioabsorbable interference screw and endobutton-post fixation. Arthroscopy 20:122–128

    PubMed  Google Scholar 

  15. Buck DC, Simonian PT, Larson RV, Borrow J, Nathanson DA (2000) Timeline of tibial tunnel expansion after sing-incision hamstring anterior cruciate ligament reconstruction. Arthroscopy 20:34–36

    Article  Google Scholar 

  16. Kousa P, Järvinen TL, Pohjonen T, Kannus P, Kotikoski M, Järvinen M (1995) Fixation strength of a biodegradable screw in anterior cruciate ligament reconstruction. J Bone Joint Surg Br 77:901–905

    CAS  PubMed  Google Scholar 

  17. Kurosaka M, Yoshiya S, Andrish JT (1987) A biomechanical comparison of different surgical techniques of graft fixation in anterior cruciate ligament reconstruction. Am J Sports Med 15:225–229

    Article  CAS  PubMed  Google Scholar 

  18. Tsuda E, Fukuda Y, Loh JC, Debski RE, Fu FH, Woo SL-Y (2002) The effect of soft-tissue graft fixation in anterior cruciate ligament reconstruction on graft-tunnel motion under anterior tibial loading. Arthroskopie 18:960–967

    Google Scholar 

  19. Buelow J-U, Siebold R, Ellermann A (2002) A prospective evaluation of tunnel enlargement in anterior cruciate ligament reconstruction with hamstrings: extracortical versus anatomical fixation. Knee Surg Sports Traumatol Arthrosc 10:80–85

    Article  PubMed  Google Scholar 

  20. Ahn JH, Park JS, Lee YS, Cho YJ (2007) Femoral bioabsorbable cross-pin fixation in anterior cruciate ligament reconstruction. Arthroscopy 23:1093–1099

    PubMed  Google Scholar 

  21. Baumfeld JA, Diduch DR, Rubino LJ, Hart JA, Miller MD, Barr MS, Hart JM (2008) Tunnel widening following anterior cruciate ligament reconstruction using hamstring autograft: a comparison between double cross-pin and suspensory graft fixation. Knee Surg Sports Traumatol Arthrosc 16:1108–1113

    Article  PubMed  Google Scholar 

  22. Brand J Jr, Weiler A, Caborn DNM, Brown CH Jr, Johnson DL (2000) Graft fixation in cruciate ligament reconstruction. Am J Sports Med 28:761–774

    PubMed  Google Scholar 

  23. Brand JC Jr, Pienkowski D, Steenlage E, Hamilton D, Johnson DL, Caborn DNM (2000) Interference screw fixation strength of a quadrupled hamstring tendon graft is directly related to bone mineral density and insertion torque. Am J Sports Med 28:705–710

    PubMed  Google Scholar 

  24. Järvelä T, Moisala AS, Paakkala T, Paakkala A (2008) Tunnel enlargement after double-bundle anterior cruciate ligament reconstruction: a prospective, randomized study. Arthroscopy 24:1349–1357

    Article  PubMed  Google Scholar 

  25. Moisala AS, Järvelä T, Paakkala A, Paakkala T, Kannus P, Järvinen M (2008) Comparison of the bioabsorbable and metal screw fixation after ACL reconstruction with a hamstring autograft in MRI and clinical outcome: a prospective randomized study. Knee Surg Sports Traumatol Arthrosc 16:1080–1086

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Eulji Medical Center, 280-1, Hagye-1-dong, Nowon-gu, Seoul, 139-231, Korea

    Nam-Hong Choi

  2. Department of Orthopaedic Surgery, United Hospital, 957-14, Dogok-dong, Gangnam-gu, Seoul, 135-270, Korea

    Jung-Hoon Lee & Kyung-Mo Son

  3. Department of Orthopaedic Surgery, Case Western Reserve University College of Medicine, 11100 Euclid Avenue, Cleveland, OH, 44106, USA

    Brian N. Victoroff

Authors
  1. Nam-Hong Choi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jung-Hoon Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kyung-Mo Son
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Brian N. Victoroff
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nam-Hong Choi.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Choi, NH., Lee, JH., Son, KM. et al. Tibial tunnel widening after anterior cruciate ligament reconstructions with hamstring tendons using Rigidfix femoral fixation and Intrafix tibial fixation. Knee Surg Sports Traumatol Arthrosc 18, 92–97 (2010). https://doi.org/10.1007/s00167-009-0951-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-009-0951-5

Keywords

Search

Navigation