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Rate of Tibial Tunnel Malposition Is Not Changed by Drilling Entirely Within the Stump of Preserved Remnants During ACL Reconstruction: A Prospective Comparative 3D-CT Study
| Content Provider | SAGE Publishing |
|---|---|
| Author | Vitor Barion C. de Padua Saithna, Adnan Eduardo Federighi B. Chagas Tereza Lais M. Zutin Piazzalunga, Lucas Fernandes Patriarcha, Luis Fernando Paulo Jose de Lorenzetti Gelas Helito, Camilo P. |
| Copyright Year | 2021 |
| Abstract | Remnant preservation during anterior cruciate ligament (ACL) reconstruction (ACLR) is controversial, and it is unclear whether the stump aids or obscures tibial tunnel positioning.Purpose/Hypothesis:The aim of this study was to determine whether the rate of tibial tunnel malposition is influenced by remnant preservation. The hypothesis was that using a remnant-preserving technique to drill entirely within the tibial stump would result in a significant reduction in tibial tunnel malposition as determined by postoperative 3-dimensional computed tomography (3D-CT).Study Design:Cohort study; Level of evidence, 2.Methods:Patients undergoing ACLR between October 2018 and December 2019 underwent surgery with a remnant-preserving technique (RP group) if they had a large stump present (>50% of the native ACL length) or if there was no remnant or if it was <50% of the native length of the ACL, they underwent remnant ablation (RA group) and use of standard landmarks for tunnel positioning. The postoperative tunnel location was reported as a percentage of the overall anteroposterior (AP) and mediolateral (ML) dimensions of the tibia on axial 3D-CT. The tunnel was classified as anatomically placed if the center lay between 30% and 55% of the AP length and between 40% and 51% of the ML length.Results:Overall, 52 patients were included in the study (26 in each group). The mean tunnel positions were 36.8% ± 5.5% AP and 46.7% ± 2.9% ML in the RP group and 35.6% ± 4.8% AP and 47.3% ± 2.3% ML in the RA group. There were no significant differences in the mean AP (P = .134) and ML (P = .098) tunnel positions between the groups. Inter- and intraobserver reliability varied between fair to excellent and good to excellent, respectively. There was no significant difference in the rate of malposition between groups (RP group, 7.7%; RA group, 11.5%; P ≥ .999).Conclusion:Drilling entirely within the ACL tibial stump using a remnant-preserving reconstruction technique did not significantly change the rate of tunnel malposition when compared with stump ablation and utilization of standard landmarks. |
| Related Links | https://journals.sagepub.com/doi/pdf/10.1177/23259671211037324?download=true |
| ISSN | 23259671 |
| Issue Number | 10 |
| Volume Number | 9 |
| Journal | Orthopaedic Journal of Sports Medicine (OJS) |
| e-ISSN | 23259671 |
| DOI | 10.1177/23259671211037324 |
| Language | English |
| Publisher | Sage Publications CA |
| Publisher Date | 2021-10-06 |
| Publisher Place | Los Angeles |
| Access Restriction | Open |
| Rights Holder | © The Author(s) 2021 |
| Subject Keyword | ACL reconstruction ACL tunnel position remnant preservation computed tomography anatomic ACL reconstruction |
| Content Type | Text |
| Resource Type | Article |
| Subject | Orthopedics and Sports Medicine |
