EFFECT OF BONE TUNNELS POSITIONING ON OUTCOMES OF TRANSTIBIAL ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

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Abstract

Purpose of the study — to evaluate position of bone tunnels after transtibial anterior cruciate ligament reconstruction (ACLR) and to determine the relationship of outcomes on their localization.

Material and methods. 54 patients in follow up from 25 to 57 months after transtibial ACLR with hamstring tendons. In all patients was performed magnetic resonance imaging (MRI) to evaluate structure of graft. Bone tunnels localization was determined by computed tomography with three-dimensional reconstruction. Subjective score evaluation was performing by scales IKDC-2000, KOOS, Lysholm. Knee laxity was measured by anterior drawer, Lachman, pivot-shift tests and with arthrometr. Patient was separated in groups depending on the localization of the femoral tunnel for lateral intercondylar ridge (1 group — center of femoral tunnel in front of the LIR, 2 group — in zone of the LIR).

Results. Tibial tunnel position in both groups of patients was the same and localized in central or back third of the footprint. The center of femoral tunnel in 32 patients (59%) was localized in front of the LIR (1 group), in other 22 (41%) — in proximal part of LIR (2 group). Clinical results show statistically significant differences between groups in knee stability and IKDC-2000. In 1 group 78% patients have knee instability grade 1 or 2, while in 2 group similar symptoms was in 32% patients. IKDC-2000 grade A were attributed 19% patients from 1 group and 64% from 2 group, rest of them was grade B or C.

Conclusions. Transtibial anterior cruciate ligament reconstruction with hamstring tendons in most patients did not allow anatomical femoral tunnel placement. Clinical outcomes were much affected by the localization of bone tunnels.

About the authors

S. A. Bantser

Vreden Russian Research Institute of Traumatology and Orthopedics

Author for correspondence.
Email: sergeibantser@gmail.com

Банцер Сергей Александрович — аспирант 

Ул. Акад. Байкова, д. 8, Санкт-Петербург, 195427

Russian Federation

A. P. Trachuk

Vreden Russian Research Institute of Traumatology and Orthopedics

Email: fake@neicon.ru

Alexandr P. Trachuk — Cand. Sci. (Med.) Senior Researcher, the Departament of Sports Traumatology and Rehabilitation 

8, ul. Akad. Baykova, St. Petersburg, 195427

Russian Federation

O. E. Bogopol’sky

Vreden Russian Research Institute of Traumatology and Orthopedics

Email: fake@neicon.ru

Oleg E. Bogopol’sky — Orthopedic surgeon matology and Rehabilitation

8, ul. Akad. Baykova, St. Petersburg, 195427

Russian Federation

R. M. Tikhilov

Vreden Russian Research Institute of Traumatology and Orthopedics;
Mechnikov North-Western State Medical University

Email: fake@neicon.ru

Rashid M. Tikhilov — Dr. Sci. (Med.) Professor Director of Vreden Russian Research Institute of Traumatology and Orthopedics; Professor of Mechnikov North-Western State Medical University 

8, ul. Akad. Baykova, St. Petersburg, 195427

Russian Federation

I. V. Sushkov

Vreden Russian Research Institute of Traumatology and Orthopedics

Email: fake@neicon.ru

Ivan V. Sushkov — Head of the Department of X-ray Diagnostics 

8, ul. Akad. Baykova, St. Petersburg, 195427

Russian Federation

E. A. Murga

Vreden Russian Research Institute of Traumatology and Orthopedics

Email: fake@neicon.ru

Evgeny Ya. Murga — Radiologist 

8, ul. Akad. Baykova, St. Petersburg, 195427

Russian Federation

References

  1. Хоминец В.В., Рикун О.В., Шаповалов В.М., Абрамов Г.Г., Гамолин С.В., Гладков Р.В., Федоров Р.А., Шкарупа А.В. Ревизионные реконструкции передней крестообразной связки при переднелатеральной ротационной нестабильности коленного сустава у военнослужащих. Военно-медицинский журнал. 2016;(6):24-29. Khominets V.V., Rikun O.V., Shapovalov V.M., Abramov G.G., Gamolin S.V., Gladkov R.V., Fedorov R.A., Shkarupa A.V. [Revision anterior cruciate ligament of knee reconstruction in case of anterolateral rotation knee instability in servicemen]. Voenno-meditsinskiy zhurnal [Military Medical Journal]. 2016;(6):24-29.
  2. Fu F.H., van Eck C.F., Tashman S., Irrgang J.J., Moreland M.S. Anatomic anterior cruciate ligament reconstruction: a changing paradigm. Knee Surg Sports Traumatol Arthrosc. 2015;23(3):640-648. doi: 10.1007/s00167-014-3209-9.
  3. Martins C.A.Q., Kropf E.J., Shen W., van Eck C.F., Fu F.H. The concept of anatomic anterior cruciate ligament reconstruction. Oper Tech Sports Med. 2008;16(3):104-115. doi: 10.1053/j.otsm.2008.10.008.
  4. Muller B., Duerr E.R.H., van Dijk C.N., Fu F.H. Anatomic anterior cruciate ligament reconstruction reducing anterior tibial subluxation. Knee Surg Sports Traumatol Arthrosc. 2016;24(9):3005-3010. doi: 10.1007/s00167-015-3612-x.
  5. Altertorn-Geli E., Lajara F., Samitier G., Cugat R. The transtibial versus the anteromedial portal technique in the arthroscopic bone-patellar tendon-bone anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2010;18(8):1013-1037. doi: 10.1007/s00167-009-0964-0.
  6. Chechik O., Amar E., Khashan M., Lador N., Eyal G., Gold A. An international survey on anterior cruciate ligament reconstruction practices. Int Orthop. 2013;37(2):201-207. doi: 10.1007/s00264-012-1611-9.
  7. Diquin T.R., Wind M.W., Finesberg M.S., Smolinski R.J., Buyea C.M. Current trends in anterior cruciate ligament reconstruction. J Knee Surg. 2009;22(1):7-12.
  8. Bhatia S., Korth K., van Thiel G.S., Frank R.M., Gupta D., Cole B.J., Bach B.R., Verma N.N. Effect of tibial tunnel diameter on femoral tunnel placement in transtibial single-bundle ACL reconstruction. Knee Surg Sports Traumatol Arthrosc. 2016;24(1):51-57. doi: 10.1007/s00167-014-3307-8
  9. Gadikota H.R., Sim J.A., Hosseini A., Gill T.J., Li G. The relationship between femoral tunnels created by the transtibial, anteromedial portal, and outside-in techniques and the anterior cruciate ligament footprint. Am J Sports Med. 2012;40(4):882-888. doi: 10.1177/0363546511434276.
  10. Kopf S., Forsythe B., Wong A.K., Tashman S., Andrest W., Irrgang J.J., Fu F.H. Nonanatomic tunnel position in traditional transtibial single-bundle anterior cruciate ligament reconstruction evaluated by threedimensional computed tomography. J Bone Joint Surg Am. 2010;92(6):1427-1431. doi: 10.2106/JBJS.I.00655.
  11. Ahn J.H., Lee S.H., Yoo J.C., Ha H.C. Measurement of the graft angles for the anterior cruciate ligament reconstruction with transtibial technique using postoperative magnetic resonance imaging in comparative study. Knee Surg Sports Traumatol Arthrosc. 2007;(15):1293-1300. doi: 10.1007/s00167-007-0389-6.
  12. Khalfayan E.E., Sharkey P.F., Alexander A.H., Bruckner J.D., Bynum E.D. The relationship between tunnel placement and clinical results after anterior cruciate ligament reconstruction. Am J Sports Med. 1996;24(3):335-341.
  13. Lee M.C., Seong S.C., Lee S., Chang C.B., Park Y.K., Jo H., Kim C.H. Vertical femoral tunnel placement results in rotational knee laxity after anterior cruciate ligament reconstruction. Arthroscopy. 2007;23(7):771-778. doi: 10.1016/j.arthro.2007.04.016.
  14. Strauss E.J., Barker J.U., McGill K., Cole B.J., Bach B.R., Verma N.N. Can anatomic femoral tunnel placement be achieved using a transtibial technique for hamstring anterior cruciate ligament reconstruction. Am J Sports Med. 2011;39(6):1263-1269. doi: 10.1177/0363546510395488.
  15. Gougoulias N., Khanna A., Griffiths D., Maffulli N. ACL reconstruction: can the transtibial technique achieve optimal tunnel positioning? A radiographic study. Knee. 2008;15(6):486-490. doi: 10.1016/j.knee.2008.07.006.
  16. Lee J.K., Lee S., Seong S.C., Lee M.C. Anatomic singlebundle ACL reconstruction is possible with use of the modified transtibial technique. J Bone Joint Surg Am. 2014;96(8):664-672. doi: 10.2106/JBJS.M.00088.
  17. Rue J.P.H., Ghodadra N., Bach B.R. Femoral tunnel placement in single-bundle anterior cruciate ligament reconstruction. Am J Sports Med. 2008;36(1):73-79. doi: 10.1177/0363546507311093.
  18. Sim J.A., Gadikota H.R, Li J.S. Biomechanical evaluation of knee joint laxities and graft forces after anterior cruciate ligament reconstruction by anteromedial portal, outside-in, and transtibial techniques. Am J Sports Med. 2011;39(12):2604-2610. doi: 10.1177/0363546511420810.
  19. Youm Y.S., Cho S.D., Lee S.H., Youn C.H. Modified transtibial versus anteromedial portal technique in anatomic single-bundle anterior cruciate ligament reconstruction: comparison of femoral tunnel position and clinical results. Am J Sports Med. 2014;42(12):2941-2948. doi: 10.1177/0363546514551922.
  20. Shea K.G., Carey J.L., Richmond J., Sandmeier R., Pitts R.T., Polousky J.D., Chu C., Shultz S.J., Ellen M., Smith A., LaBella C.R., Anderson A.F., Musahl V., Myer G.D., Jevsevar D., Bozic K.J., Shaffer W., Cummins D., Murray J.N., Patel N., Shores P., Woznica A., Martinez Y., Gross L., Sevarino K. Management of anterior cruciate ligament injuries. J Bone Joint Surg Am. 2015;97(8):672-676. doi: 10.2106/JBJS.N.01257.
  21. Tsukada H., Ishibashi Y., Tsuda E., Fukuda A., Toh S. Anatomical analysis of the anterior cruciate ligament femoral and tibial footprints. J Orthop Sci. 2008;13(2): 122-129. doi: 10.1007/s00776-007-1203-5.
  22. Feretti M., Ekdahl M., Shen W., Fu F.H. Osseous landmarks of the femoral attachment of the anterior cruciate ligament: an anatomic study. Arthroscopy. 2007;23(11):1218-1225. doi: 10.1016/j.arthro.2007.09.008.
  23. Сучилин И.А., Маланин Д.А., Краюшкин А.И., Черезов Л.Л., Грунин С.В. Анатомические ориентиры межмыщелковой ямки бедренной кости при пластике передней крестообразной связки. Вестник ВолгГМУ. 2012;42(2):63-65. Suchilin I.A., Malanin D.A., Krayushkin A.I., Cherezov L.L., Grunin S.V. [Anatomical landmarks of the femoral intercondylar space in anterior cruciate ligament reconstruction]. Vestnik VolgGMU [Journal of VolgSMU]. 2012;42(2):63-65.
  24. Iwahashi T., Shino K., Nakata K., Otsubo H., Suzuki T., Amano H., Nakamura N. Direct anterior cruciate ligament insertion to the femur assessed by histology and 3-dimensional volume-rendered computed tomography. Arthroscopy. 2010;26(9):13-20. doi: 10.1016/j.arthro.2010.01.023.
  25. Bernard M., Hertel P., Hornung H., Cierpinski T. Femoral insertion of the ACL. Radiographic quadrant method. Am J Knee Surg. 1997;10(1):14-22.
  26. Маланин Д.А., Демещенко М.В., Краюшкин А.И., Сучилин И.А., Черезов Л.Л. Область большеберцового прикрепления передней крестообразной связки с позиций хирургической анатомии. Вестник ВолгГМУ. 2015;53(1):43-46. Malanin D.A., Demeshchenko M.V., Krayushkin A.I., Suchilin I.A., Cherezov L.L. [Area of the tibial attachment of the anterior cruciate ligament from the perspective of surgical anatomy]. Vestnik VolgGMU [Journal of VolgSMU]. 2015;53(1):43-46.
  27. Кавалерский Г.М., Ченский А.Д., Сорокин А.А., Сухарева А.Г. Современные аспекты артроскопической реконструкции передней крестообразной связки. Кафедра травматологии и ортопедии. 2014;(1):10-14. Kavalerskii G.M., Chenskii A.D., Sorokin A.A., Sukhareva A.G. [Modern aspects of arthroscopic anterior cruciate ligament reconstruction]. Kafedra travmatologii i ortopedii [The Department of Traumatology and Orthopedics]. 2014;(1):10-14.
  28. Robin B.N., Jani S.S., Marvil S.C., Reid J.B., Schillhammer C.K., Lubowitz J.H. Advantages and disadvantages of transtibial, anteromedial portal, and outside-in femoral tunnel drilling in single-bundle anterior cruciate ligament reconstruction: a systematic review. Arthroscopy. 2015;31(7):1412-1419. doi: 10.1016/j.arthro.2015.01.018.
  29. Tompkins M., Milewski M.D., Brockmeier S.F., Gaskin C.M., Hart J.M., Miller M.D. Anatomic femoral tunnel drilling in anterior cruciate ligament reconstruction: use of an accessory medial portal versus traditional transtibial drilling. Am J Sports Med. 2012;40(4):1313-1321. doi: 10.1177/0363546512443047.
  30. Bohn M.B., Sorensen H., Petersen M.K., Soballe K., Lind M. Rotational laxity after anatomical ACL reconstruction measured by 3-D motion analysis: a prospective randomized trial comparing anatomic and nonanatomic ACL reconstruction techniques. Knee Surg Sports Traumatol Arthrosc. 2015;23(12):3473-3481. doi: 10.1007/s00167-014-3156-5.
  31. Прохоренко В.М, Фоменко С.М., Симагаев Р.О. Хирургическое лечение нестабильности коленного сустава (обзор литературы). Современные проблемы науки и образования. 2016;(2):63-71. Prokhorenko V.M, Fomenko S.M., Simagaev R.O. [Surgical treatment of knee joint instability (literature review). Sovremennye problemy nauki i obrazovaniya [Modern problems of science and education]. 2016;(2):63-71.
  32. Janssen R.P.A., du Me´e A.V.F., van Valkenburg J., Sala H.A.G.M., Tseng C.M. Anterior cruciate ligament reconstruction with 4-strand hamstring autograft and accelerated rehabilitation: a 10-year prospective study on clinical results, knee osteoarthritis and its predictors. Knee Surg Sports Traumatol Arthrosc. 2013;21(9):1977-1988. doi: 10.1007/s00167-012-2234-9.
  33. Streich N.A., Reichenbacher S., Barié A., Buchner M., Schmitt H. Long-term outcome of anterior cruciate ligament reconstruction with an autologous fourstrand semitendinosus tendon autograft. Int Orthop. 2013;37(2):279-284. doi: 10.1007/s00264-012-1757-5.

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