Relationship between Widening and Position of the Tunnels and Clinical Results of Anterior Cruciate Ligament Reconstruction to Knee Osteoarthritis: 30 Patients at a Minimum Follow-Up of 10 Years.
To evaluate the relationship between tunnel position and widening and long-term clinical results in anterior cruciate ligament (ACL) reconstruction, a retrospective cohort of 30 patients undergoing ACL reconstruction with double semitendinous plus double gracilis (SAC technique) with longer than 10-year follow-up was selected. CT scans in the first 3 months and at final follow-up was evaluated. Position, angle, and widening of tunnels including Nebelung criteria were recorded in all CT scans. Physical, KT-1000, and clinical evaluation were performed at final follow-up. Outcomes and knee arthritis severity were evaluated at final follow-up. Mean follow-up was 11.2 ± 1.2. At final follow-up, 85 and 57% of tibial and femoral tunnels, respectively, developed some degree of enlargement. Frontal tibial angle (mean) was 72°, sagittal tibial angle 63°, frontal femoral angle 47°, sagittal femoral angle 20°, and tunnels divergence angle 36°. Preoperatively, KT-1000 30L and Lachman test scores were 5.52 and 5.79 respectively. In the last follow-up, 30L and manual Lachman test scores were 0.97 and 1.13, respectively (p< 0.001). In IKDC scale, pivot shift and Jerk tests showed 83 and 84% grade A results, respectively (p< 0.0001). In Fairbank scale, 23% worsened one grade and 27% worsened more than one grade (p< 0.005). Tibial tunnels widened more than femoral tunnels and further dilatation was found between intermediate and final follow-up. Higher incidence of tibial tunnel widening was observed in patients with tunnel verticalization. Tibial tunnel dilation was associated with long-term degenerative changes but not with final knee instability.
Department of Orthopaedic Surgery, Hospital San Rafael, Madrid, Spain.
Juan Diego
JD
Ayala-Mejias
Department of Orthopaedic Surgery, Hospital San Rafael, Madrid, Spain.
Benjamin
B
Garcia-Gonzalez
Sanatorio Quirúrgico Virgen del Mar, Madrid, Spain.
Luis
L
Alcocer-Perez-España
IRCCS Don Gnocchi Foundation, Milan, Italy.
Jorge Hugo
JH
Villafañe
IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.
Pedro
P
Berjano
D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery; D000070598:Anterior Cruciate Ligament Injuries / Q000150:complications* / Q000601:surgery; D059549:Anterior Cruciate Ligament Reconstruction / Q000009:adverse effects* / Q000379:methods; D053587:Arthrometry, Articular; D001182:Arthroscopy; D005260:Female; D005269:Femur / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D007593:Joint Instability / Q000209:etiology; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000209:etiology*; D012189:Retrospective Studies; D013977:Tibia / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D055815:Young Adult