title: Reduction of tunnel enlargement with use of autologous ruptured tissue in anterior cruciate ligament reconstruction: a pilot clinical trial.
abstract: OBJECTIVE
  To compare the tunnel enlargement of double-bundle (DB) anterior cruciate ligament reconstruction (ACLR) with and without suturing of autologous ruptured tissue to hamstring graft in patients with subacute anterior cruciate ligament injury.
  
  
  METHODS
  Ten patients with subacute (≤3 months after injury) anterior cruciate ligament rupture were randomly allocated to undergo DB ACLR with suturing of the ruptured tissue to hamstring graft (n = 5) or conventional DB ACLR (n = 5). When autologous ruptured tissue was used, remnant ruptured tissue was then harvested, divided into 4 pieces, placed between the loops at the distal and proximal portions of the graft, and secured with the suture. As the primary endpoint, tunnel volume assessment by 3-dimensional multi-detector row computed tomography (MDCT) was performed 1 year after ACLR. To assess the efficacy of these procedures, the Lysholm score, anterior tibial translation (measured with a KT-1000 arthrometer [MEDmetric, San Diego, CA]), and rotational instability (measured by the pivot-shift test) were evaluated after 2 years.
  
  
  RESULTS
  Tunnel volume enlargement between 3 weeks and 1 year after ACLR as assessed by 3-dimensional MDCT was significantly less for ACLR using ruptured tissue than for conventional ACLR, especially at the femoral site (P < .05). However, the postoperative Lysholm score, anterior stability of the knee measured with the KT-1000 arthrometer, and rate of negative manual pivot-shift test results did not differ significantly between the 2 groups. There was no correlation to the clinical outcomes in terms of tunnel size.
  
  
  CONCLUSIONS
  The Lysholm score, anterior laxity measured with the KT-1000 arthrometer, and rotational instability according to the pivot-shift test did not differ significantly between ACLR using ruptured tissue and the conventional technique. However, ACLR using ruptured tissue produced less femoral tunnel enlargement as assessed by MDCT, warranting further long-term follow-up to elucidate its effectiveness.
  
  
  METHODS
  Level II, prospective comparative study.
authors.affiliation: Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan. Electronic address: matsun@m4.dion.ne.jp.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Matsumoto
authors.affiliation: Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Ryosuke
authors.initials: R
authors.lastname: Kuroda
authors.affiliation: Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Takehiko
authors.initials: T
authors.lastname: Matsushita
authors.affiliation: Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Araki
authors.affiliation: Department of Orthopaedic Surgery, Kobe Kaisei Hospital, Kobe, Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Hoshino
authors.affiliation: Human and Artificial Intelligent Systems, University of Fukui Graduate School of Engineering, Fukui, Japan.
authors.forename: Kouki
authors.initials: K
authors.lastname: Nagamune
authors.affiliation: Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kurosaka
mesh_terms: D000293:Adolescent; D000328:Adult; D000070598:Anterior Cruciate Ligament Injuries; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods*; D001182:Arthroscopy; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000601:surgery; D007718:Knee Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D007719:Knee Joint / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D061330:Multidetector Computed Tomography; D018482:Muscle, Skeletal / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery; D010865:Pilot Projects; D011446:Prospective Studies; D012421:Rupture; D014182:Transplantation, Autologous; D055815:Young Adult