title: Evaluation of tibial bone tunnel enlargement using MRI scan cross-sectional area measurement after autologous hamstring tendon ACL replacement.
abstract: The aim of this study was to evaluate tibial bone tunnel enlargement following four-strand hamstring tendon anterior cruciate ligament (ACL) reconstruction, using a new method of magnetic resonance imaging (MRI) assessment. Correlation with clinical outcome was also examined. In a prospective study following ACL reconstruction, 24 patients underwent MRI and clinical assessment, at a mean follow-up of 6.5 months. A four-strand semitendinosus and gracilis (STG) tendon graft with the polyester Soffix (Surgicraft Ltd) fixation device was placed via an instrument guided tibial tunnel and an over-the-top femoral route. Cross-sectional area (CSA) perpendicular to the long axis of the tibial tunnel was calculated digitally at three levels, using MRI. Clinical assessment included physical examination, Lysholm subjective self-evaluation score and KT 2000 arthrometric measurement. A mean CSA tibial tunnel enlargement of 33% was found. The mean side-to-side KT-2000 arthrometric difference was 1.66 mm and the mean Lysholm score was 92. We concluded that this previously unused MRI evaluation using digital direct CSA measurements provides a highly accurate method of tunnel assessment. We found no correlation between tibial tunnel enlargement, knee stability, joint function and patient satisfaction scores in the short term.
authors.affiliation: Department of Orthopaedic Surgery, Mayday University Hospital, London Road, Croydon, Surrey CR7 7YE, UK.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Fules
authors.forename: Rohit T
authors.initials: RT
authors.lastname: Madhav
authors.forename: Richard K
authors.initials: RK
authors.lastname: Goddard
authors.forename: Anthony
authors.initials: A
authors.lastname: Newman-Sanders
authors.forename: Michael A S
authors.initials: MA
authors.lastname: Mowbray
mesh_terms: D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D003430:Cross-Sectional Studies; D005260:Female; D006085:Graft Survival; D006801:Humans; D007091:Image Processing, Computer-Assisted; D015601:Injury Severity Score; D007718:Knee Injuries / Q000175:diagnosis / Q000601:surgery*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal; D011184:Postoperative Period; D011336:Probability; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000379:methods; D012494:Sampling Studies; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D013709:Tendon Transfer / Q000379:methods*; D013977:Tibia / Q000473:pathology*; D014182:Transplantation, Autologous