Location of femoral/tibial tunnels in anterior cruciate ligament reconstruction and their impact on graft integrity: Magnetic resonance imaging review
Article Sidebar
Views | PDF/EPUB Downloads:
14
/ 4
/ 2
Main Article Content
Abstract
Context: Despite advances in surgical techniques for anterior cruciate ligament (ACL) repair, a significant proportion of patients encounter persisting pain/instability of the knee postoperatively.
Objectives: To assess the location of femoral/tibial tunnels on magnetic resonance imaging (MRI) and to correlate the findings with the ACL graft integrity/graft-related complications. Study Design/Settings: This was a cross-sectional study done at Burjeel Medical Centre, Muscat, Oman.
Materials and Methods: The study period was between November 2015 and June 2017 on Philips Ingenia 1.5 Tesla MRI machine. A total of 30 male patients, age ranged from 20 to 43 years who presented with knee pain/instability 1 year postreconstruction of ACL, were recruited for the study.
Results: Of 30 cases, 10 (33.33%) patients had an intact graft on MRI. Of the remaining 20 patients, graft impingement was noted in 15 patients (50%), graft tear in 3 cases (10%), and graft stretching with abnormal high T2 signal in the remaining 2 cases (6.67%). Associated findings of focal arthrofibrosis in the anterior knee joint space and tibial tunnel cysts were encountered in few patients who were not dealt with in this study. Out of 20 patients with graft abnormality, femoral tunnel was abnormally located in 3 (15%), tibial
tunnel was located anterior to the MRI equivalent of Blumensaat’s extension line partly or completely in 16(80%) and both tunnels were normally located in 1(5%).
Conclusion: The location of the femoral/tibial tunnels is the most important determinant factor of postoperative graft integrity in ACL reconstruction patients.
Downloads
Article Details
Section
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
How to Cite
References
1. Wagner M, Kääb MJ, Schallock J, Haas NP, WeilerA. Hamstring tendon versus patellar tendon anterior cruciate ligament reconstruction using
biodegradable interference fit fixation: A prospective matched‑group analysis. Am J Sports Med 2005;33:1327‑36.
2. Freedman KB, D’Amato MJ, Nedeff DD, Kaz A, Bach BR Jr. Arthroscopic anterior cruciate ligament reconstruction: A metaanalysis comparing patellar tendon and hamstring tendon autografts. Am J Sports Med 2003;31:2‑11.
3. Recht MP, Kramer J. MR imaging of the postoperative knee: A pictorial essay. Radiographics 2002;22:765‑74.
4. Galal A, Abdul‑Maksoud S, Al‑Kandary S, Abdul‑Salam S, Awad A. Anterior cruciate ligament reconstruction: Magnetic resonance imaging and factors influencing outcome. Egypt J Radiol Nucl Med 2011;42:193‑200.
5. Howell SM, Clark JA. Tibial tunnel placement in anterior cruciate ligament reconstructions and graft impingement. Clin Orthop Relat Res 1992;(283):187-95.
6. Tomczak RJ, Hehl G, Mergo PJ, Merkle E, Rieber A, Brambs HJ, et al. Tunnel placement in anterior cruciate ligament reconstruction: MRI
analysis as an important factor in the radiological report. Skeletal Radiol 1997;26:409‑13.
7. Sanders TG. MR imaging of postoperative ligaments of the knee. Semin Musculoskelet Radiol 2002;6:19‑33.
8. Papakonstantinou O, Chung CB, Chanchairujira K, Resnick DL. Complications of anterior cruciate ligament reconstruction: MR imaging. Eur Radiol 2003;13:1106‑17.
9. Meyers AB, Haims AH, Menn K, Moukaddam H. Imaging of anterior cruciate ligament repair and its complications. AJR Am J Roentgenol
2010;194:476‑84.
10. Jansson KA, Linko E, Sandelin J, Harilainen A. A prospective randomized study of patellar versus hamstring tendon autografts for anterior cruciate ligament reconstruction. Am J Sports Med 2003;31:12‑8.
11. Bencardino JT, Beltran J, Feldman MI, Rose DJ. MR imaging of complications of anterior cruciate ligament graft reconstruction. Radiographics 2009; 29:2115‑26.
12. Kheder EM, Abd El‑Bagi ME, El‑Hosan MH. Anterior cruciate ligament graft tear. Primary and secondary magnetic resonance signs. Saudi Med J 2009;30:465‑71.
13. Saupe N, White LM, Chiavaras MM, Essue J, Weller I, Kunz M, et al. Anterior cruciate ligament reconstruction grafts: MR imaging features
at long‑term follow‑up – Correlation with functional and clinical evaluation. Radiology 2008;249:581‑90.
14. El Ameen NF, Ghany HS, Kader MG. MRI assessment of tibial tunnel and its relation to complication following arthroscopic reconstruction
of anterior cruciate ligament. Egypt J Radiol Nucl Med 2014;45:811‑7.
15. White LM, Kramer J, Recht MP. MR imaging evaluation of the postoperative knee: Ligaments, menisci, and articular cartilage. Skeletal
Radiol 2005;34:431‑52.