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Relationship between bone plug position and morphological changes of tunnel aperture in anatomic rectangular tunnel ACL reconstruction

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

In animal studies after ACL reconstruction (ACL-R) using the bone-patellar tendon-bone (BTB), the graft-healing pattern was found to depend on the relationship between bone plug and the tunnel wall. This difference of graft-healing pattern could influence the postoperative morphological changes of the tunnel. However, no study has assessed the relationship between bone plug position and the change of tunnel morphology. Therefore, the main purpose of this study was to investigate the relationship between the bone plug position within femoral or tibial tunnel and morphological changes of each tunnel aperture in ACL-R using computed tomography.

Methods

Subjects were 30 consecutive patients (six females and 24 males; mean age, 20.4 ± 5.4 years) who underwent primary ACL-R using BTB. The distance from the tunnel aperture to the tendon-bone junction (TBJ) at 2 weeks postoperatively, and tunnel aperture enlargement and tunnel wall migration from 2 weeks to 6 months postoperatively, were evaluated.

Results

The distance from the femoral tunnel aperture to the TBJ in most cases was less than 2 mm, whereas the TBJ was located within the tibial tunnel. Femoral tunnel aperture was significantly enlarged (17.0 ± 11.7%) distally, and the tibial tunnel aperture was significantly enlarged (19.6 ± 12.5%) posterolaterally. Only the position at distal portion of femoral bone plug was correlated with femoral tunnel aperture enlargement (r = 0.454, p = 0.0015).

Conclusion

Both femoral and tibial tunnel aperture were significantly enlarged distally and posterolaterally 6 months postoperatively. Only correlation between the position at distal portion of femoral bone plug and femoral tunnel enlargement were found, suggesting the deep plug position in the tunnel is a risk factor for femoral tunnel enlargement, highlighting the importance of accurately locating the TBJ just at the femoral tunnel aperture. Another option is to deviate the harvest site in the patellar tendon to match the shape of the TBJ and the tunnel aperture.

Level of evidence

4 (case series).

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Funding

No author or related institution has received any financial benefit from research in this study.

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Authors and Affiliations

  1. Department of Orthopedic Sports Medicine, Seifu Hospital, 5-1-3, Shinkanaoka-cho, Sakai, 591-8021, Japan

    Ryohei Uchida & Yoshiki Shiozaki

  2. Department of Orthopedic Sports Medicine, Osaka-Rousai Hospital, Sakai, Japan

    Yoshinari Tanaka, Keisuke Kita, Hiroshi Amano & Yuta Tachibana

  3. Department of Orthopedics, Hannan-Chuo Hospital, Matsubara, Japan

    Takashi Kanamoto

  4. Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, Suita, Japan

    Tatsuo Mae

  5. Faculty of Comprehensive Rehabilitation, Osaka Prefecture University, Habikino, Japan

    Rikio Takao & Shuji Horibe

Authors
  1. Ryohei Uchida
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  2. Yoshiki Shiozaki
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  3. Yoshinari Tanaka
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  4. Keisuke Kita
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  5. Hiroshi Amano
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  6. Takashi Kanamoto
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  7. Tatsuo Mae
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  8. Yuta Tachibana
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  9. Rikio Takao
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  10. Shuji Horibe
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Corresponding author

Correspondence to Ryohei Uchida.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

IRB approval was obtained (Seifu hospital, approval ID: 25-1).

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All patients gave informed consent for study inclusion.

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Cite this article

Uchida, R., Shiozaki, Y., Tanaka, Y. et al. Relationship between bone plug position and morphological changes of tunnel aperture in anatomic rectangular tunnel ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 27, 2417–2425 (2019). https://doi.org/10.1007/s00167-018-5224-8

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  • DOI: https://doi.org/10.1007/s00167-018-5224-8

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