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

  • Yu YIN ,
  • Yu MEI ,
  • Ze-gang WANG ,
  • Shou-yi SONG ,
  • Peng-fei LIU ,
  • Peng-feng HE ,
  • Wen-jie WU ,
  • Xing XIE
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  • Beijing Key Laboratory of Sports Injuries, Beijing 100191, China

Received date: 2021-05-31

  Online published: 2021-10-11

Supported by

National Natural Science Foundation of China(8140810)

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.

Cite this article

Yu YIN , Yu MEI , Ze-gang WANG , Shou-yi SONG , Peng-fei LIU , Peng-feng HE , Wen-jie WU , Xing XIE . 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[J]. Journal of Peking University(Health Sciences), 2021 , 53(5) : 883 -890 . DOI: 10.19723/j.issn.1671-167X.2021.05.012

References

[1] Saccomanno MF, Shin JJ, Mascarenhas R, et al. Clinical and functional outcomes after anterior cruciate ligament reconstruction using cortical button fifixation versus transfemoral suspensory fixation: A systematic review of randomized controlled trials [J]. Arthroscopy, 2014, 30(11):1491-1498.
[2] Han DL, Nyland J, Kendzior M, et al. Intratunnel versus extratunnel fixation of hamstring autograft for anterior cruciate ligament reconstruction [J]. Arthroscopy, 2012, 28(12):1555-1566.
[3] Jansson KA, Harilainen A, Sandelin J, et al. Bone tunnel enlargement after anterior cruciate ligament reconstruction with the hamstring autograft and endobutton fifixation technique A clinical, radiographic and magnetic resonance imaging study with 2 years follow-up [J]. Knee Surg Sports Traumatol Arthroscopy, 1999, 7(5):290-295.
[4] Choi NH, Yang BS, Victoroff BN. Clinical and radiological outcomes after hamstring anterior cruciate ligament reconstructions: Comparison between fifixed-loop and adjustable-loop cortical suspension devices [J]. Am J Sports Med, 2017, 45(4):826-831.
[5] Clatworthy MG, Annear P, Bulow JU, et al. Tunnel widening in anterior cruciate ligament reconstruction: A prospective evaluation of hamstring and patella tendon grafts [J]. Knee Surg Sports Traumatol Arthrosc, 1999, 7(3):138-145.
[6] Fauno P, Kaalund S. Tunnel widening after hamstring anterior cruciate ligament reconstruction is influenced by the type of graft fixation used: A prospective randomized study [J]. Arthroscopy, 2005, 21(11):1337-1341.
[7] Buelow JU, Siebold R, Ellermann A. A prospective evaluation of tunnel enlargement in anterior cruciate ligament reconstruction with hamstrings: Extracortical versus anatomical fixation [J]. Knee Surg Sports Traumatol Arthrosc, 2002, 10(2):80-85.
[8] Wilson TC, Kantaras A, Atay A, et al. Tunnel enlargement after anterior cruciate ligament surgery [J]. Am J Sports Med, 2004, 32(2):543-549.
[9] Fahey M, Indelicato PA. Bone tunnel enlargement after anterior cruciate ligament replacement [J]. Am J Sports Med, 1994, 22(3):410-414.
[10] Schulte K, Majewski M, Irrgang JJ, et al. Radiographic tunnel changes following arthroscopic ACL reconstruction: Autograft versus allograft [J]. Arthroscopy, 1996, 11(6):372-373.
[11] Hoher J, Moller HD, Fu FH. Bone tunnel enlargement after anterior cruciate ligament reconstruction: Fact or fiction? [J]. Knee Surg Sports Traumatol Arthrosc, 1998, 6(4):231-240.
[12] Buelow JU, Siebold R, Ellermann A. A new bicortical tibial fixation technique in anterior cruciate ligament reconstruction with quadruple hamstring graft [J]. Knee Surg Sports Traumatol Arthrosc, 2000, 8(4):218-225.
[13] Fink C, Zapp M, Benedetto KP, et al. Tibial tunnel enlargement following anterior cruciate ligament reconstruction with patellar tendon autograft [J]. Arthroscopy, 2001, 17(2):138-143.
[14] Webster KE, Feller JA, Hameister KA. Bone tunnel enlargement following anterior cruciate ligament reconstruction: A randomised comparison of hamstring and patellar tendon grafts with 2-year follow-up [J]. Knee Surg Sports Traumatol Arthrosc, 2001, 9(2):86-91.
[15] Morgan CD, Stein DA, Leitman EH, et al. Anatomic tibial graft fixation using a retrograde bio-interference screw for endoscopic anterior cruciate ligament reconstruction [J]. Arthroscopy, 2002, 18(7):1-8.
[16] Jackson DW, Windler GE, Simon TM. Intraarticular reaction associated with the use of freeze-dried, ethylene oxide-sterilized bone-patella tendon-bone allografts in the reconstructuion of the anterior cruciate ligament [J]. Am J Sports Med, 1990, 18(1):1-11.
[17] Zijl JA, Kleipool AE, Willems WJ. Comparison of tibial tunnel enlargement after anterior cruciate ligament reconstruction using patellar tendon autograft or allograft [J]. Am J Sports Med, 2000, 28(4):547-551.
[18] Cameron ML, Buchgraber A, Passler HH, et al. The natural hisroty of the anterior cruciate ligament-deficient knee. Changes in synovial fluid cytokine and keratan sulfate concentrations [J]. Am J Sports Med, 1997, 25(6):751-754.
[19] Schamalzried TP, Akizuki KH, Fedenko AN, et al. The role of access of joint fluid to bone in periarticular osteolysis: A report of four cases [J]. J Bone Joint Surg, 1997, 79(3):447-452.
[20] Beyaz S, Güler Üö, Demir S, et al. Tunnel widening after single versus doublebundle anterior cruciate ligament reconstruction: A randomized 8year followup study [J]. Arch Orthop Trauma Surg, 2017, 137(11):1547-1555.
[21] Flanigan DC, Everhart JS, DiBartola A, et al. Bacterial DNA is associated with tunnel widening in failed ACL reconstructions [J]. Knee Surg Sports Traumatol Arthrosc, 2019, 27(11):3490-3497.
[22] Bjarnsholt T, Tolker-Nielsen T, Givskov M, et al. Detection of bacteria by fluorescence in situ hybridization in culture-negative soft tissue filler lesions [J]. Dermatol Surg, 2009, 35(2):1620-1624.
[23] Everhart JS, DiBartola AC, Dusane DH, et al. Bacterial deoxyribonucleic acid is often present in failed revision anterior cruciate ligament reconstructions [J]. Arthroscopy, 2018, 34(11):3046-3052.
[24] Wise BT, Patel NN, Wier G, et al. Outcomes of ACL reconstruction with fixed versus variable loop button fixation [J]. Orthopedics, 2017, 40(2):e275-e280.
[25] Petre BM, Smith SD, Jansson KS, et al. Femoral cortical suspension devices for soft tissue anterior cruciate ligament reconstruction: A comparative biomechanical study [J]. Am J Sports Med, 2013, 41(2):416-422.
[26] Barrow AE, Pilia M, Guda T, et al. Femoral suspension devices for anterior cruciate ligament reconstruction: Do adjustable loops lengthen? [J]. Am J Sports Med, 2014, 42(2):343-349.
[27] Johnson JS, Smith SD, LaPrade CM, et al. A biomechanical comparison of femoral cortical suspension devices for soft tissue anterior cruciate ligament reconstruction under high loads [J]. Am J Sports Med, 2015, 43(1):154-160.
[28] Ahn HW, SeonJK , Song EK, et al. Comparison of clinical and radiologic outcomes and second-look arthroscopic findings after anterior cruciate ligament reconstruction using fixed and adjustable loop cortical suspension devices [J]. Arthroscopy, 2019, 35(6):1736-1742.
[29] Iorio R, Di Sanzo V, Vadalà A, et al. ACL reconstruction with hamstrings: How different technique and fifixation devices influence bone tunnel enlargement [J]. Eur Rev Med Pharmacol Sci, 2013, 17(21):2956-2961.
[30] Lanzetti RM, Monaco E, de Carli A, et al. Can an adjustable-loop length suspensory fifixation device reduce femoral tunnel enlargement in anterior cruciate ligament reconstruction? A prospective computer tomography study [J]. Knee, 2016, 23(5):837-841.
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