Morphological Changes in the Tibial Tunnel After ACL Reconstruction With the Outside-In Technique and Adjustable Suspensory Fixation

Orthopaedic Journal of Sports Medicine

卷:11

Ahmet Emin Okutan ; Enes Gürün ; Serkan Surucu ; Lokman Kehribar ; Mahir Mahiroğulları

[1] Department of Orthopaedics and Rehabilitation, Yale University, New Haven, Connecticut, USA.

[2] Department of Radiology, Faculty of Medicine, Samsun University, Samsun, Turkey.

[3] Department of Orthopedics and Traumatology, Memorial Sisli Hospital, Istanbul, Turkey.

[4] Department of Orthopedics and Traumatology, Faculty of Medicine, Samsun University, Samsun, Turkey.

关键词: ACL reconstruction;    tibial loop tunnel;    bone healing;    remnant preservation;   

DOI  :  10.1177/23259671231155153

 received in 2022-11-30, accepted in 2023-01-08,  发布年份 2023

来源: Sage Journals

【 摘 要 】

Background:Anterior cruciate ligament reconstruction (ACLR) using the complete tibial tunnel technique and adjustable-loop cortical suspensory fixation is known to leave a “dead space” that holds the loop device in the tibial tunnel. The consequence of the dead space and its effect on graft healing are still uncertain.Purpose:To investigate morphological changes in the tibial tunnel and their effect on graft healing, and to identify factors affecting bone healing in the tibial loop tunnel after ACLR with a quadrupled semitendinosus tendon autograft using adjustable suspensory fixation.Study Design:Case series; Level of evidence, 4.Methods:Included were 48 patients (34 male, 14 female; mean age, 25.2 ± 5.6 years) who underwent ACLR with a quadrupled semitendinosus tendon autograft using adjustable suspensory fixation. To evaluate tibial tunnel morphology, computed tomography was performed at 1 day and 6 months postoperatively. At 1 year postoperatively, graft healing was assessed on magnetic resonance imaging using the graft signal-to-noise quotient (SNQ). Multivariate regression and correlation analyses were performed to determine any associations between volumetric changes in bone healing and operative variables.Results:At 6 months after ACLR, a mean of 63.2% of the tibial loop tunnel was filled by bone. Multivariate regression analysis showed that remnant preservation was significantly associated with the loop tunnel filling rate (P < .001). At 1 year after ACLR, the tibial loop tunnel was almost completely closed (98.5%). There were no correlations between loop tunnel volume and graft integration or graft SNQ. A significant but weak correlation was found between graft tunnel volume and intratunnel graft SNQ (P = .10) as well as integration grade in the tibial tunnel (P = .30).Conclusion:Excellent bone filling in the tibial loop tunnel was seen at 1 year after ACLR. Remnant preservation was significantly associated with the loop tunnel filling rate. A weak correlation was found between graft tunnel volume and intratunnel graft SNQ as well as integration grade in the tibial tunnel.

【 授权许可】

CC BY-NC-ND   
© The Author(s) 2023

【 图 表 】

Fig. 6