title: The attic of the femoral tunnel in anterior cruciate ligament reconstruction: a comparison of outcomes of two suspensory femoral fixation systems.
abstract: OBJECTIVE
  This study aimed to find answers to the following questions: (1) Is it possible to determine and measure the space between the top of the graft and entrance of implant tunnel by magnetic resonance imaging (MRI)? (2) Is there any correlation between the hole above the graft in femoral tunnel and the femoral tunnel widening? (3) Does the tunnel widening affect clinical outcomes? (4) Are clinical and radiological outcomes of Toggle Loc with Zip Loop implant-loop design better than Endobutton CL?
  
  
  METHODS
  The operative data of two surgeons were analysed. One surgeon used Endobutton CL femoral fixation (E-CL group, n = 46); the other used Toggle Loc with Zip Loop femoral fixation (TL-ZL group, n = 32). At the last follow-up, clinical evaluation was performed with International Knee Documentation Committee Subjective Knee Form (IKDC), Tegner activity scale, Lysholm score, active and passive ROM, Lachman and pivot shift tests, and KT-1000 arthrometer. Radiological evaluation including measurement of tunnel widening on X-ray and MRI and the height of attic of femoral tunnel (space above the graft in femoral tunnel) on MRI was performed.
  
  
  RESULTS
  No difference was found in patient demographics, concomitant meniscal surgery and clinical outcomes. The femoral tunnel widening was evaluated significantly low in TL-ZL group on the PA X-ray and MRI. No difference was observed in the tibial tunnel widening on X-ray and MRI. A correlation between the height of attic of femoral tunnel and the femoral tunnel widening was determined. Thus, the greater the height of attic of femoral tunnel, the greater the femoral tunnel widening. No correlation was established between the tunnel widening and IKDC and Lysholm scores.
  
  
  CONCLUSIONS
  The results of this study demonstrate that a positive correlation exists between the height of the attic of the femoral tunnel and femoral tunnel widening. Therefore, increasing the height of the attic of the femoral tunnel may contribute to graft motion, which would then enhance femoral tunnel widening.
  
  
  METHODS
  III.
authors.affiliation: Kecioren Training and Research Hospital, Orthopaedics and Traumatology Clinic, Ankara, Turkey, ahmetfirat24@yahoo.com.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Firat
authors.forename: Faruk
authors.initials: F
authors.lastname: Catma
authors.forename: Birol
authors.initials: B
authors.lastname: Tunc
authors.forename: Ciğdem
authors.initials: C
authors.lastname: Hacihafizoglu
authors.forename: Murat
authors.initials: M
authors.lastname: Altay
authors.forename: Murat
authors.initials: M
authors.lastname: Bozkurt
authors.forename: Mehmet Ismail S
authors.initials: MI
authors.lastname: Kapicioglu
mesh_terms: D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D059549:Anterior Cruciate Ligament Reconstruction / Q000295:instrumentation* / Q000379:methods; D064592:Autografts; D005260:Female; D005269:Femur / Q000601:surgery*; D006801:Humans; D007593:Joint Instability / Q000601:surgery; D007719:Knee Joint / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D013710:Tendons / Q000637:transplantation*; D055815:Young Adult
references.citation: Arthroscopy. 2011 Jul;27(7):923-32
references.pmid: 21621372
references.citation: Arthroscopy. 2011 Jun;27(6):776-83
references.pmid: 21624672
references.citation: Arthroscopy. 2009 Nov;25(11):1275-80
references.pmid: 19896050
references.citation: Knee Surg Sports Traumatol Arthrosc. 2010 Aug;18(8):1059-64
references.pmid: 19953224
references.citation: Am J Sports Med. 2005 Nov;33(11):1751-67
references.pmid: 16230470
references.citation: Am J Sports Med. 2006 Nov;34(11):1790-800
references.pmid: 16861579
references.citation: Am J Sports Med. 2003 Jul-Aug;31(4):564-73
references.pmid: 12860546
references.citation: Arthroscopy. 2009 Jul;25(7):767-76
references.pmid: 19560641
references.citation: Am J Sports Med. 1982 May-Jun;10(3):150-4
references.pmid: 6896798
references.citation: J Bone Joint Surg Am. 2004 Oct;86(10):2143-55
references.pmid: 15466722
references.citation: Knee Surg Sports Traumatol Arthrosc. 2004 Mar;12(2):98-103
references.pmid: 14504722
references.citation: Knee Surg Sports Traumatol Arthrosc. 2008 Dec;16(12):1108-13
references.pmid: 18791702
references.citation: Knee Surg Sports Traumatol Arthrosc. 1998;6(4):231-40
references.pmid: 9826805
references.citation: J Biomed Mater Res. 2001 Aug;56(2):177-83
references.pmid: 11340587
references.citation: Am J Sports Med. 2001 Sep-Oct;29(5):600-13
references.pmid: 11573919
references.citation: Arthroscopy. 2003 May-Jun;19(5):485-92
references.pmid: 12724677
references.citation: Arthroscopy. 2006 Oct;22(10):1107-12
references.pmid: 17027409
references.citation: Arthroscopy. 2004 Jan;20(1):34-6
references.pmid: 14716276
references.citation: Arthroscopy. 2003 May-Jun;19(5):470-6
references.pmid: 12724675
references.citation: Knee Surg Sports Traumatol Arthrosc. 2012 Aug;20(8):1520-7
references.pmid: 22048746
references.citation: J Orthop Res. 2000 May;18(3):481-4
references.pmid: 10937637
references.citation: Arthroscopy. 2004 Jul;20(6):572-80
references.pmid: 15241306
references.citation: Knee Surg Sports Traumatol Arthrosc. 2002 Mar;10(2):80-5
references.pmid: 11914764
references.citation: Arthroscopy. 2007 Mar;23(3):291-8
references.pmid: 17349473
references.citation: Arthroscopy. 1999 May;15(4):379-87
references.pmid: 10355713
references.citation: Knee Surg Sports Traumatol Arthrosc. 1997;5(4):234-8
references.pmid: 9430573
references.citation: Knee Surg Sports Traumatol Arthrosc. 1999;7(3):138-45
references.pmid: 10401649
references.citation: Am J Sports Med. 1994 May-Jun;22(3):410-4
references.pmid: 8037283
references.citation: Arthroscopy. 1998 Nov-Dec;14(8):810-5
references.pmid: 9848590
references.citation: Arthroscopy. 2001 Feb;17(2):138-43
references.pmid: 11172242
references.citation: Arthroscopy. 2005 Nov;21(11):1337-41
references.pmid: 16325084
references.citation: Knee Surg Sports Traumatol Arthrosc. 2012 Nov;20(11):2243-50
references.pmid: 22249205
references.citation: Am J Sports Med. 2007 Oct;35(10):1725-30
references.pmid: 17687123