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Non-anatomic tunnel...
Non-anatomic tunnel position increases the risk of revision anterior cruciate ligament reconstruction
- Article/chapterEnglish2022
Publisher, publication year, extent ...
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2021-05-13
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Springer Science and Business Media LLC,2022
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LIBRIS-ID:oai:gup.ub.gu.se/305297
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https://gup.ub.gu.se/publication/305297URI
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https://doi.org/10.1007/s00167-021-06607-7DOI
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Subject category:ref swepub-contenttype
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Subject category:art swepub-publicationtype
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Purpose Anterior cruciate ligament (ACL) graft failure is a complication that may require revision ACL reconstruction (ACL-R). Non-anatomic placement of the femoral tunnel is thought to be a frequent cause of graft failure; however, there is a lack of evidence to support this belief. The purpose of this study was to determine if non-anatomic femoral tunnel placement is associated with increased risk of revision ACL-R. Methods After screening all 315 consecutive patients who underwent primary single-bundle ACL-R by a single senior orthopedic surgeon between January 2012 and January 2017, 58 patients were found to have both strict lateral radiographs and a minimum of 24 months follow-up without revision. From a group of 456 consecutive revision ACL-R, patients were screened for strictly lateral radiographs and 59 patients were included in the revision group. Femoral tunnel placement for each patient was determined using a strict lateral radiograph taken after the primary ACL-R using the quadrant method. The center of the femoral tunnel was measured in both the posterior-anterior (PA) and proximal-distal (PD) dimensions and represented as a percentage of the total distance (normal center of anatomic footprint: PA 25% and PD 29%). Results In the PA dimension, the revision group had significantly more anterior femoral tunnel placement compared with the primary group (38% +/- 11% vs. 28% +/- 6%, p < 0.01). Among patients who underwent revision; those with non-traumatic chronic failure had statistically significant more anterior femoral tunnel placement than those who experienced traumatic failure (41% +/- 13% vs. 35% +/- 8%, p < 0.03). In the PD dimension, the revision group had significantly more proximal femoral tunnel placement compared with the primary group (30% +/- 9% vs 38% +/- 9%, p < 0.01). Conclusion In this retrospective study of 58 patients with successful primary ACL-R compared with 59 patients with failed ACL-R, anterior and proximal (high) femoral tunnels for ACL-R were shown to be independent risk factors for ACL revision surgery. As revision ACL-R is associated with patient- and economic burden, particular attention should be given to achieving an individualized, anatomic primary ACL-R. Surgeons may reduce the risk of revision ACL-R by placing the center of the femoral tunnel within the anatomic ACL footprint.
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Hughes, Jonathan D.Gothenburg University,Göteborgs universitet,Institutionen för kliniska vetenskaper, Avdelningen för ortopedi,Institute of Clinical Sciences, Department of Orthopaedics(Swepub:gu)xhjoni
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Gibbs, C.
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Vaswani, R.
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Meredith, S. J.
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Popchak, A.
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Lesniak, B. P.
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Karlsson, Jón,1953Gothenburg University,Göteborgs universitet,Institutionen för kliniska vetenskaper, Avdelningen för ortopedi,Institute of Clinical Sciences, Department of Orthopaedics(Swepub:gu)xkajon
(author)
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Irrgang, J. J.
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Musahl, V.
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Göteborgs universitetInstitutionen för kliniska vetenskaper, Avdelningen för ortopedi
(creator_code:org_t)
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In:Knee Surgery Sports Traumatology Arthroscopy: Springer Science and Business Media LLC:30, s. 1388-13950942-20561433-7347
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Byrne, K. J.
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Hughes, Jonathan ...
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Gibbs, C.
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Vaswani, R.
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Meredith, S. J.
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Popchak, A.
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Lesniak, B. P.
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Karlsson, Jón, 1 ...
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Irrgang, J. J.
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Musahl, V.
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- About the subject
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Orthopaedics
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Knee Surgery Spo ...
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University of Gothenburg