title: Analysis of tunnel widening after double-bundle ACL reconstruction.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the tunnel widening using a multi-planar reformation of MRI (Magnetic Resonance Imaging) in the orientation of the tunnel. The hypotheses of this study were as follows: (1) tunnel widening would be reduced with the above-mentioned technique, (2) the degree of tunnel widening would be different at the site of the tunnels, and (3) the time interval from surgery to MRI acquisition would affect the magnitude of tunnel widening.
  
  
  METHODS
  Forty double-bundle ACL reconstructed patients who underwent postoperative MRI were enrolled in this study. The postoperative MRI was performed at 26.7 ± 7.4 months in terms of time. The tunnel widening was examined using a multi-planar reformation of MRI in the orientation of the tunnel. Site-specific analysis was performed according to the depth (the entrance, mid, and exit portion) and wall (anterior, posterior, medial, and lateral walls). The correlation between MRI and widening was also evaluated.
  
  
  RESULTS
  The mean tunnel widening of the femoral AM (Anteromedial), femoral PL (Posterolateral), tibial AM, and tibial PL in terms of the most widened diameter was 1.9 (25.4), 2.1 (30.8), 2.5 (32.8), and 3.2 mm (44.5%), respectively. The tibial PL tunnel showed significant widening than the other tunnels. At the entrance, tunnel widening occurred mostly, followed by the order of the mid and exit portion. Correlation analysis of the time interval of MRI acquisition and tunnel widening showed little association.
  
  
  CONCLUSIONS
  Tunnel widening after a double-bundle ACL reconstruction using an outside-in technique with press-fitting of the graft was acceptable compared to previously published studies. The tibial PL tunnel showed the most widening among the 4 tunnels examined with the tunnel entrance being most widened area.
  
  
  METHODS
  Therapeutic case series, Level IV.
authors.affiliation: Department of Orthopedic Surgery, Gil Hospital, Gachon University School of Medicine, Incheon, Korea. smcos1@hanmail.net
authors.forename: Yong Seuk
authors.initials: YS
authors.lastname: Lee
authors.forename: Sheen-Woo
authors.initials: SW
authors.lastname: Lee
authors.forename: Shin Woo
authors.initials: SW
authors.lastname: Nam
authors.forename: Won Seok
authors.initials: WS
authors.lastname: Oh
authors.forename: Jae Ang
authors.initials: JA
authors.lastname: Sim
authors.forename: Ji Hoon
authors.initials: JH
authors.lastname: Kwak
authors.forename: Beom Koo
authors.initials: BK
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D000328:Adult; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods*; D001182:Arthroscopy; D005260:Female; D005269:Femur / Q000473:pathology* / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D007719:Knee Joint / Q000473:pathology* / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D013710:Tendons / Q000637:transplantation; D013977:Tibia / Q000473:pathology* / Q000601:surgery; D055815:Young Adult