Cedric Robbrecht1, Steven Claes2, Michiel Cromheecke3, Peter Mahieu3, Kyriakos Kakavelakis4, Jan Victor3, Johan Bellemans2, Peter Verdonk5. 1. Department of Orthopedic Surgery and Traumatology, Ghent University, Ghent, Belgium. Electronic address: cedric.robbrecht@gmail.com. 2. Division of Orthopedics, Department of Musculoskeletal Sciences, University Hospital Leuven, Pellenberg, Belgium. 3. Department of Orthopedic Surgery and Traumatology, Ghent University, Ghent, Belgium. 4. Department of Orthopedics, Creta Interclinic Hospital, Heraklion, Crete, Greece. 5. Department of Orthopedic Surgery, Monica Hospitals, Antwerp, Belgium; Department of Physiotherapy and Orthopedic Surgery, Faculty of Medicine, Ghent University, Belgium.
Abstract
BACKGROUND: Post-operative widening of tibial and/or femoral bone tunnels is a common observation after ACL reconstruction, especially with soft-tissue grafts. There are no studies comparing tunnel widening in hamstring autografts versus tibialis anterior allografts. The goal of this study was to observe the difference in tunnel widening after the use of allograft vs. autograft for ACL reconstruction, by measuring it with a novel 3-D computed tomography based method. METHODS: Thirty-five ACL-deficient subjects were included, underwent anatomic single-bundle ACL reconstruction and were evaluated at one year after surgery with the use of 3-D CT imaging. Three independent observers semi-automatically delineated femoral and tibial tunnel outlines, after which a best-fit cylinder was derived and the tunnel diameter was determined. Finally, intra- and inter-observer reliability of this novel measurement protocol was defined. RESULTS: In femoral tunnels, the intra-observer ICC was 0.973 (95% CI: 0.922-0.991) and the inter-observer ICC was 0.992 (95% CI: 0.982-0.996). In tibial tunnels, the intra-observer ICC was 0.955 (95% CI: 0.875-0.985). The combined inter-observer ICC was 0.970 (95% CI: 0.987-0.917). Tunnel widening was significantly higher in allografts compared to autografts, in the tibial tunnels (p=0.013) as well as in the femoral tunnels (p=0.007). CONCLUSIONS: To our knowledge, this novel, semi-automated 3D-computed tomography image processing method has shown to yield highly reproducible results for the measurement of bone tunnel diameter and area. This series showed a significantly higher amount of tunnel widening observed in the allograft group at one-year follow-up. LEVEL OF EVIDENCE: Level II, Prospective comparative study.
BACKGROUND: Post-operative widening of tibial and/or femoral bone tunnels is a common observation after ACL reconstruction, especially with soft-tissue grafts. There are no studies comparing tunnel widening in hamstring autografts versus tibialis anterior allografts. The goal of this study was to observe the difference in tunnel widening after the use of allograft vs. autograft for ACL reconstruction, by measuring it with a novel 3-D computed tomography based method. METHODS: Thirty-five ACL-deficient subjects were included, underwent anatomic single-bundle ACL reconstruction and were evaluated at one year after surgery with the use of 3-D CT imaging. Three independent observers semi-automatically delineated femoral and tibial tunnel outlines, after which a best-fit cylinder was derived and the tunnel diameter was determined. Finally, intra- and inter-observer reliability of this novel measurement protocol was defined. RESULTS: In femoral tunnels, the intra-observer ICC was 0.973 (95% CI: 0.922-0.991) and the inter-observer ICC was 0.992 (95% CI: 0.982-0.996). In tibial tunnels, the intra-observer ICC was 0.955 (95% CI: 0.875-0.985). The combined inter-observer ICC was 0.970 (95% CI: 0.987-0.917). Tunnel widening was significantly higher in allografts compared to autografts, in the tibial tunnels (p=0.013) as well as in the femoral tunnels (p=0.007). CONCLUSIONS: To our knowledge, this novel, semi-automated 3D-computed tomography image processing method has shown to yield highly reproducible results for the measurement of bone tunnel diameter and area. This series showed a significantly higher amount of tunnel widening observed in the allograft group at one-year follow-up. LEVEL OF EVIDENCE: Level II, Prospective comparative study.
Authors: Soheil Sabzevari; Amir Ata Rahnemai-Azar; Humza S Shaikh; Justin W Arner; James J Irrgang; Freddie H Fu Journal: Knee Surg Sports Traumatol Arthrosc Date: 2017-03-04 Impact factor: 4.342
Authors: Thomas Tampere; Tom Van Hoof; Michiel Cromheecke; Hans Van der Bracht; Jorge Chahla; Peter Verdonk; Jan Victor Journal: Knee Surg Sports Traumatol Arthrosc Date: 2016-09-13 Impact factor: 4.342
Authors: Dong Won Suh; Seung Beom Han; Woo Jin Yeo; Won Hee Lee; Jae Ho Kwon; Bong Soo Kyung Journal: Indian J Orthop Date: 2017 Mar-Apr Impact factor: 1.251