title: Femoral and Tibial Tunnel Widening following Anterior Cruciate Ligament Reconstruction using Various Modalities of Fixation: A Prospective Observational Study.
abstract: BACKGROUND
  Bone tunnel enlargement after Anterior Cruciate Ligament Reconstruction (ACL-R) is a well-accepted phenomenon but there are very few published data comparing the extent of tunnel widening by various methods of fixation after ACL-R.
  
  
  OBJECTIVE
  To compare the femoral and tibial tunnel widening following ACL-R with different methods of fixation using CT scan.
  
  
  METHODS
  This one year prospective study included all patients with chronic Anterior Cruciate Ligament (ACL) injury who underwent primary arthroscopic ACL-R using tripled hamstring tendon autograft. The graft was fixed to the tibial tunnel by Interference Screw (IFS) or Suture Disc (SD) and to the femoral tunnel by IFS, SD, Cross-Pin (CP) or Endo-button CL (Smith & Nephew). The widening of the tibial and femoral tunnels in different methods of fixation was assessed by Computed Tomography (CT) at 12 months follow-up; and was compared using paired sample test.
  
  
  RESULTS
  A total of 63 patients were included in the study of which 58 (92%) were males and 5 (8%) were females, with a mean age of 29.1 ± 5.9 years. The tibial tunnel widening at one year follow-up was 1.680 ± 1.08794 (19.37%) and 1.517 ± 0.94834 mm (17.39%) by IFS and SD methods respectively. Femoral tunnel widening at one year follow-up was 1.294 ± 0.231, 1.809 ± 0.912, 1.320 ± 0.238, 1.779 ± 0.889 mm by IFS, SD, EB, and CP methods respectively. Femoral tunnel widening following suture disc method of fixation was very highly significant (p<0.001) in comparison with other methods.
  
  
  CONCLUSIONS
  Femoral tunnel and tibial tunnel widening varies with different methods of fixation and was maximum with suture disc method compared to others at one year follow-up after ACL-R.
authors.affiliation: Assistant Professor, Deparatment of Orthopaedics, K.S.Hegde Medical Academy , Mangalore, Karnataka, India .
authors.forename: Dileep Krishnamoorthy
authors.initials: DK
authors.lastname: Srinivas
authors.affiliation: Consultant Orthopaedic Surgeon, Mangalore, Karnataka, India .
authors.forename: Mahesha
authors.initials: M
authors.lastname: Kanthila
authors.affiliation: Associate Professor, Department of Medicine, JIPMER , Pondicherry, Pondicherry, India .
authors.forename: Rama Prakasha
authors.initials: RP
authors.lastname: Saya
authors.affiliation: Consultant, Department of Orthopedic and Arthroscopy, Aware Global Hospitals , Hyderabad, Telangana, India .
authors.forename: Jvs
authors.initials: J
authors.lastname: Vidyasagar
keywords: Computed tomography; Femoral tunnel; Graft