Differentiation between intraoperative and postoperative bone tunnel widening and communication in double-bundle anterior cruciate ligament reconstruction: a prospective study.
OBJECTIVE
The purpose of this study was to determine the amount of intraoperative and postoperative bone tunnel enlargement and communication in double-bundle (DB) anterior cruciate ligament (ACL) reconstruction.


METHODS
Twenty-four consecutive patients undergoing anatomic anteromedial (AM) and posterolateral (PL) 4-tunnel DB ACL reconstruction with a 5-strand hamstring graft and extracortical fixation were included in a prospective case series. Magnetic resonance imaging scans were performed on the second postoperative day and at 7 months' follow up to assess intraoperative and postoperative bone tunnel enlargement and communication. Tunnel widening was determined in different planes by digitally measuring the diameters of the AM and PL bone tunnels.


RESULTS
Intraoperative communication of the AM bone tunnel with the PL bone tunnel caused by drilling was observed in 23.8% of patients on the tibia and in no case on the femur. At 7 months postoperatively, significant bone tunnel widening occurred at all 4 bone tunnels. It was a mean of 20% for the tibial AM bone tunnel, 38% for the tibial PL bone tunnel, 34% for the femoral AM bone tunnel, and 46% for the femoral PL bone tunnel. Postoperative communication of the AM and PL bone tunnels caused by postoperative bone tunnel widening was observed in 19% of patients on the tibia and femur.


CONCLUSIONS
Intraoperative bone tunnel communication in anatomic DB ACL reconstruction was caused by drilling and occurred only on the tibia. Significant postoperative bone tunnel widening occurred at all 4 bone tunnels and was the highest for the PL bone tunnel. Postoperative bone tunnel communication developed in 19% of patients on the tibia and femur and was caused by bone tunnel widening.


METHODS
Level IV, therapeutic case series.
Siebold
Rainer
R
Center for Knee and Foot Surgery, Sports Traumatology, ATOS Hospital, Heidelberg, Germany.
Cafaltzis
Konstantin
K
D000293:Adolescent; D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D005260:Female; D005269:Femur / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007432:Intraoperative Period; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D019651:Plastic Surgery Procedures; D013710:Tendons / Q000637:transplantation*; D013977:Tibia / Q000473:pathology / Q000601:surgery*; D055815:Young Adult