The Study Of Tunnel Enlargement After ACL Reconstruction With Different Fixation And Grafts

Objective To compare the changes in femoral bone tunnel after arthroscopically assisted hamstring ACL reconstruction with different graft fixation and investigate the relation with clinical effect.Methods Eighty-eight cases in three groups were included and underwent hamstring ACL reconstruction with different femoral graft fixation for average 16.5-month follow-up evaluation. Twenty-six cases in group A received Endobutton fixation, twenty-two cases (group B) interference screw, and forty cases (group C) Rigidfix system. Femoral bone tunnel diameters at the articular line level, the widest point,1 cm away from tunnel aperture on sagittal MRI were compared at one week postoperatively. Lysholm score was used to evaluate the clinical effect.Results Tunnel enlargement after ACL surgery was noted in the three groups. At the femoral widest point and 1 cm away from tunnel aperture, the tunnel enlargement was larger in group B and smaller in group C. At the femoral articular line level, the bone tunnel enlargement in group C was smallest. There was no difference between groups A and B. The shape of femoral tunnel was lineal in groups A and C, and conical in group B. No significant difference was found by Lysholm score.Conclusions The type of graft fixation is a major factor in the development of tunnel enlargement after ACL surgery. No correlation between graft fixation, bone tunnel enlargement and clinical effect, was found. Objective To compare the changes in bone tunnel after arthroscopic assisted ACL reconstruction with autograft and allograft and investigate the relation with clinical effect.Methods From Jun,2007 to Dec,2008,61 cases were undergone ACL reconstruction.According to ACL graft, two groups were included.27cases in group A were performed with allograft for average 8.4 months follow-up evaluation.34 cases in group B with autograft. Bone tunnel diameter in 6-12months at the articular line level, the widest point,1 cm away from tunnel aperture in saggital and coronal MRI was compared with the results from 1 week postoperatively. Lysholm score was used to evaluate the clinical effect in groups.Results Tunnel enlargement after ACL surgery in both groups was noted. The extent of bone tunnel was larger in tibia than in femur.At the femoral and tibial widest point,1 cm away from tunnel aperture and the articular line level, there was no difference in group A and B for bone tunnel enlargement. No significant difference was found with respect to Lysholm score.Conclusions The type of ACL graft is a factor in the development of tunnel enlargement after ACL surgery. No evidence is proved correlation in ACL graft, bone tunnel enlargement and clinical effect. Objective To compare the changes and the outcome of the tibial bone tunnel after arthroscopically assisted hamstring ACL reconstruction by preservation of the remnents of ACL or not and evaluate the relation with clinical effect.Methods Sixty-five cases in two groups were included and underwent hamstring ACL reconstruction with Rigidfix and Intrafix fixation system by preservation of the remnents of ACL or not for MRI evaluation. Twenty-seven cases in group A received ACL reconstruction by preservation of the remnents of ACL, thirty-eight cases (group B) by non-preservative remnents. Tibial bone tunnel diameters at the widest point on sagittal MRI were compared at one week postoperatively. Lysholm score was used to evaluate the clinical effect.Results Twenty-five cases in group A and thirty-five cases in group B were followed-up for average 12.4 and 12.1 months respectively.Tunnel enlargement after ACL surgery was noted in the two groups,the extent of enlargement of ACL tunnel was larger in group B comparatively. The changes of tibial tunnel enalargement was distinct in six weeks postoperatively and stable in three months postoperatively.The percentage of ACL tunnel enlargement decreased in the six and subsequent months There was no difference between groups A and B by the extent of tibial tunnel enlargement(p>0.05). All the cases in the two groups had stable knee function.No significant difference was found by Lysholm score in follow-up time.Conclusions The preservation of the remnents of ACL had no evident advantages in the decreasement of ACL tunnel enlargement. No correlation of bone tunnel enlargement and clinical effect was found between the preservative and non-preservative ACL remnents.