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Prevalence and influence of tibial tunnel widening after isolated anterior cruciate ligament reconstruction using patella-bone-tendon-bone-graft: long-term follow-up

Johannes Struewer, Turgay Efe, Thomas Manfred Frangen, Tim Schwarting, Benjamin Buecking, Steffen Ruchholtz, Karl Friedrich Schüttler, Ewgeni Ziring
  • Johannes Struewer
    Department of Trauma, Hand and Reconstructive Surgery, University Hospital Marburg, Germany | struewer@med.uni-marburg.de
  • Turgay Efe
    Department of Orthopedics and Rheumatology, University Hospital Marburg, Germany
  • Thomas Manfred Frangen
    Department of Trauma, Hand and Reconstructive Surgery, University Hospital Marburg, Germany
  • Tim Schwarting
    Department of Trauma, Hand and Reconstructive Surgery, University Hospital Marburg, Germany
  • Benjamin Buecking
    Department of Trauma, Hand and Reconstructive Surgery, University Hospital Marburg, Germany
  • Steffen Ruchholtz
    Department of Trauma, Hand and Reconstructive Surgery, University Hospital Marburg, Germany
  • Karl Friedrich Schüttler
    Department of Orthopedics and Rheumatology, University Hospital Marburg, Germany
  • Ewgeni Ziring
    Department of Trauma, Hand and Reconstructive Surgery, University Hospital Marburg, Germany

Abstract

The aim of the present study was to evaluate incidence, degree and impact of tibial tunnel widening (TW) on patient-reported long-term clinical outcome, knee joint stability and prevalence of osteoarthritis (OA) after isolated anterior cruciate ligament (ACL) reconstruction. On average, 13.5 years after ACL reconstruction via patella-bone-tendon-bone autograft, 73 patients have been re-evaluated. Inclusion criteria consisted of an isolated anterior cruciate ligament rupture and reconstruction, a minimum of 10-year follow-up and no previous anterior cruciate ligament repair or associated intra-articular lesions. Clinical evaluation was performed via the International Knee Documentation Committee (IKDC) score and the Tegner and Lysholm scores. Instrumental anterior laxity testing was carried out with the KT-1000™ arthrometer. The degree of degenerative changes and the prevalence of osteoarthritis were assessed with the Kellgren-Lawrence score. Tibial tunnel enlargement was radiographically evaluated on both antero-posterior and lateral views under establishment of 4 degrees of tibial tunnel widening by measuring the actual tunnel diameters in mm on the sclerotic margins of the inserted tunnels on 3 different points (T1-T3). Afterwards, a conversion of the absolute values in mm into a 4 staged ratio, based on the comparison to the results of the initial drill-width, should provide a better quantification and statistical analysis. Evaluation was performed postoperatively as well as on 2 year follow-up and 13 years after ACL reconstruction. Minimum follow-up was 10 years. 75% of patients were graded A or B according to IKDC score. The mean Lysholm score was 90.2 ± 4.8 (25-100). Radiological assessment on long-term follow-up showed in 45% a grade I, in 24% a grade II, in 17% a grade III and in additional 12% a grade IV enlargement of the tibial tunnel. No evident progression of TW was found in comparison to the 2 year results. Radiological evaluation revealed degenerative changes in sense of a grade II OA in 54% of patients. Prevalence of a grade III or grade IV OA was found in 20%. Correlation analysis showed no significant relationship between the amount of tibial tunnel enlargement (P>0.05), long-term clinical results, anterior joint laxity or prevalence of osteoarthritis. Tunnel widening remains a radiological phenomenon which is most commonly observed within the short to midterm intervals after anterior cruciate ligament reconstruction and subsequently stabilises on mid and long- term follow-up. It does not adversely affect long-term clinical outcome and stability. Furthermore, tunnel widening doesn’t constitute an increasing prevalence of osteoarthritis.

Keywords

anterior cruciate ligament reconstruction, long-term follow-up, IKDC-score, tibial tunnel widening, osteoarthritis, long-term anterior laxity

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Submitted: 2012-03-27 17:28:30
Published: 2012-06-21 15:15:46
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Copyright (c) 2012 Johannes Struewer, Turgay Efe, Thomas Manfred Frangen, Tim Schwarting, Benjamin Buecking, Steffen Ruchholtz, Karl Friedrich Schüttler, Ewgeni Ziring

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