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Journal of Peking University (Health Sciences) ›› 2021, Vol. 53 ›› Issue (5): 883-890. doi: 10.19723/j.issn.1671-167X.2021.05.012

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Lengths of the fixed loop and the adjustable loop in the coarse bone tunnel were compared to influence the widening of the femoral bone tunnel and the function of the knee joint

YIN Yu,MEI Yu,WANG Ze-gang,SONG Shou-yi,LIU Peng-fei,HE Peng-feng,WU Wen-jie(),XIE Xing()   

  1. Beijing Key Laboratory of Sports Injuries, Beijing 100191, China
  • Received:2021-05-31 Online:2021-10-18 Published:2021-10-11
  • Contact: Wen-jie WU,Xing XIE E-mail:wuwenjiew13058@sina.com
  • Supported by:
    National Natural Science Foundation of China(8140810)

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Abstract:

Objective: To evaluate the effects of two different femoral cortical suspension devices (fixation loop and adjustable loop) on tunnel widening and knee function in patients following anterior cruciate ligament reconstruction for 12 months. Methods: A total of 60 patients who had undergone anterior cruciate ligament reconstruction were included in this study. According to the length of the loop(n)[n= total length of loop-(total length of femoral tunnel-total length of coarse tunnel)] in the rough bone tunnel, the patients were divided into A (adjustable loop was 0 mm in the coarse bone tunnel), B (fixation loop was greater than 0 mm and less than or equal to 10 mm in the coarse bone tunnel) and C (fixation loop was greater than 10 mm in the coarse bone tunnel) groups, of which 11 cases were in group A, 27 cases in group B and 22 cases in group C. In the three-dimensional reconstruction of the knee joint with multi-slice spiral CT, the widening of the bone tunnel in the three groups was compared. At the same time, IKDC, Lysholm and Tegner scores of the patients in the three groups were compared. Results: There were differences in the widening degree of the femoral canal among groups A, B and C, and the median difference of the widening degree of the femoral tunnel 12 months and immediately after the surgery was AP<0.05).According to the linear regression the relationship between the difference of the width of the femoral canal and the change of the length (n) of the loop in the coarse canal, it was found that there was a linear relationship between the value of n and the difference of the width of the bone canal. With the increase of the value of n, the difference of the width of the bone canal gradually became larger. The median difference of the width of the middle and superior tunnel was negative, while the median difference of the width of the middle and inferior tunnel was positive. During the follow-up, we found that there were no statistical differences in IKDC, Lysholm and Tegner scores among the three groups one year after surgery (P>0.05). Conclusion: Twelve months after surgery, compared with group B (fixed loop group) and group C (fixed loop group), group A (adjustable loop group) had less bone tunnel widening.In groups A, B and C, as the length of the loop in coarse bone tunnel gradually increased, the width of bone tunnel became more significant. At the end of 12 months follow-up after anterior cruciate ligament reconstruction, the medial and inferior femoral tunnel was significantly wider than immediately after surgery, and the medial and superior femoral tunnel had gradually begun to undergo tendon-bone healing. There was no significant difference in knee function scores among groups A, B, and C in the follow-up 12 months after surgery.

Key words: Anterior cruciate ligament reconstruction, Fixation loops, Adjustable loops, Bone tunnel widening, Knee function

CLC Number: 

  • R686.5

Figure 1

Oblique sagittal view of the central axis of the femoral tunnel in a 3D reconstruction CT 1, superior femoral tunnel is 32.2 mm; 2, femoral coarse tunnel is 23.8 mm."

Figure 2

CT measurement of the width of the bony tunnel at each position A, oblique axial central section of the femoral tunnel in a 3D reconstruction, 3 of the superior femoral tunnel is 32.7 mm,4 of the femoral coarse tunnel is 23.6 mm; B, oblique coronal section perpendicular to the central axial section of the femoral tunnel in a 3D reconstruction CT; C, schematic view of oblique axial central section of the femoral tunnel in a 3D reconstruction CT,S is the length of the superior femoral tunnel, X is the length of the coarse femoral tunnel, M1 is the width of the internal opening (notch) of the femoral tunnel, M2 is the width of the lower 1/3 point of the femoral coarse femoral tunnel, M3 is the width of the 1/3 point of the femoral coarse femoral tunnel, and M4 is the width of the junction of the thick and thin femoral tunnel; D, schematic view of oblique coronal section perpendicular to the central axial section of the femoral tunnel in a 3D reconstruction CT, double arrows show the measured tunnel width."

Table 1

Results of variables in group A, B and C"

Items A B C
Age/year, M (Min, Max) 33 (25, 45) 31 (18, 58) 36 (24, 48)
BMI/(kg/m2), M (Min, Max) 25.7 (20.6, 28.7) 24.0 (18.2, 31.4) 24.1 (18.6, 29.7)
Lengths of the superior femoral
tunnel/mm, M (Min, Max)		 30.0 (29.0, 36.9) 34.2 (29.0, 43.0) 33.6 (25.8, 38.6)
Lengths of the coarse femoral
tunnel/mm, M (Min, Max)		 17.7 (15.5, 25.0) 25.2 (16.7, 29.4) 26.9 (22.0, 29.4)
T/mm, M (Min, Max) 8.000 (7.000, 9.000) 8.000 (7.000, 9.000) 8.000 (7.000, 9.000)
M1/mm, M (Min, Max) 9.300 (7.600, 11.800) 9.600 (7.900, 12.000) 10.950 (8.800, 15.100)
M2/mm M (Min, Max) 9.400 (7.200, 11.900) 9.500 (8.100, 13.000) 10.300 (8.400, 12.700)
M3/mm M (Min, Max) 7.600 (4.500, 9.900) 8.200 (6.000, 10.700) 7.700 (6.300, 12.200)
M4/mm M (Min, Max) 4.000 (1.600, 6.000) 5.100 (3.500, 8.000) 5.200 (4.200, 9.300)
M1-T/mm M (Min, Max) 1.000 (0.300, 3.800) 1.800 (0.700, 3.600) 3.100 (1.500, 7.100)
M2-T/mm M (Min, Max) 1.100 (-0.500, 3.900) 1.800 (0.300, 5.000) 2.300 (0.600, 5.200)
M3-T/mm M (Min, Max) -0.400 (-4.500, 1.900) 0.250 (-1.700, 2.700) 0.350 (-1.300, 3.800)
M4-T/mm M (Min, Max) -3.100 (-7.100, -2.100) -2.700 (-4.500, -1.000) -2.600 (-3.700, 1.300)
(M1-T)/T/% M (Min, Max) 0.125 (0.038, 0.475) 0.243 (0.088, 0.450) 0.401 (0.188, 0.888)
(M2-T)/T/% M (Min, Max) 0.157 (-0.056, 0.488) 0.238 (0.038, 0.625) 0.301 (0.075, 0.743)
(M3-T)/T/% M (Min, Max) -0.050 (-0.500, 0.238) 0.016 (-0.213, 0.338) 0.019 (-0.162, 0.529)
(M4-T)/T/% M (Min, Max) -0.443 (-0.800, -0.263) -0.348 (-0.563, -0.111) -0.346 (-0.463, 0.163)

Table 2

Analysis results of Wilcoxon rank sum test among groups A, B and C"

Items A vs.B B vs.C A vs.C
Age 0.420 0.243 0.863
BMI 0.910 0.185 0.073
Length of the superior femoral tunnel 0.022 0.278 0.089
Length of the coarse femoral tunnel 0.000 0.097 0.000
T 0.177 0.729 0.148
M1 0.375 0.003 0.003
M2 0.326 0.091 0.024
M3 0.097 0.960 0.187
M4 0.085 0.725 0.026
M1-T 0.005 0.000 0.000
M2-T 0.010 0.129 0.002
M3-T 0.031 0.936 0.037
M4-T 0.010 0.566 0.002
(M1-T)/T 0.004 0.000 0.000
(M2-T)/T 0.007 0.129 0.002
(M3-T)/T 0.031 0.912 0.041
(M4-T)/T 0.014 0.636 0.012

Table 3

Comparison of mean variance and P value of knee function score in group A, B and C at 12 months after surgery"

Items A B C P
A vs.B A vs.C B vs.C
Tegner score, x ?±s 4.18±0.75 4.44±0.75 4.54±1.01 0.341 0.394 0.973
Lysholm score, x ?±s 91.81±9.13 92.67±7.66 90.91±9.54 0.790 0.791 0.492
IKDC score, x ?±s 77.63±8.88 78.37±7.33 78.58±7.47 0.813 0.772 0.921

Figure 3

Schematic diagram of linear regression of the widening difference in each position of the femoral tunnel with the change of length of loop in the coarse tunnel value"

Figure 4

Boxplot of IKDC score in group A, B and C at 12 months after surgery A, adjustable loop is 0 mm in the coarse bone tunnel; B,fixation loop is greater than 0 mm and less than or equal to 10 mm in the coarse bone tunnel; C, fixation loop is greater than 10 mm in the coarse bone tunnel. IKDC, International Knee Documentation Committee."

Figure 5

Boxplot of Lysholm score in group A, B and C at 12 months after surgery A, adjustable loop is 0 mm in the coarse bone tunnel; B,fixation loop is greater than 0 mm and less than or equal to 10 mm in the coarse bone tunnel; C, fixation loop is greater than 10 mm in the coarse bone tunnel."

Figure 6

Boxplot of Tegner score in group A, B and C at 12 months after surgery A, adjustable loop is 0 mm in the coarse bone tunnel; B,fixation loop is greater than 0 mm and less than or equal to 10 mm in the coarse bone tunnel; C, fixation loop is greater than 10 mm in the coarse bone tunnel."

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