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Arakawa T, Hiraoka H, Kuribayashi S, Okinaga S. Graft Suturing Method Affects on Graft Diameter in Hamstring-Based Anterior Cruciate Ligament Reconstruction. Cureus 2024; 16:e61054. [PMID: 38916006 PMCID: PMC11196011 DOI: 10.7759/cureus.61054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2024] [Indexed: 06/26/2024] Open
Abstract
INTRODUCTION Various benefits of needleless suture loop techniques in anterior cruciate ligament reconstruction graft preparation have been discussed, yet their impact on graft diameter remains unexplored. We hypothesized that the suture loop technique would reduce the graft diameter compared to the conventional locking suture technique. METHODS Fifty-seven patients whose grafts were made with the Krackow stitch (group K) and 54 patients with the suture loop (group SL) were analyzed retrospectively. (1) The distal (sutured side) diameter of each anteromedial bundle and posterolateral bundle was compared to the proximal (non-sutured side) diameter, and (2) the average of the proximal and distal graft diameters in each group was calculated. RESULTS In group K, 78.9% of anteromedial bundles and 40.3% of posterolateral bundles exhibited a larger distal diameter than the proximal, while in group SL, 42.6% of anteromedial bundles and 3.7% of posterolateral bundles showed a larger distal diameter. In both bundles, there were significantly fewer grafts with larger distal diameters in group SL (p < 0.001). The mean distal diameter of anteromedial bundles was smaller in group SL (6.33 ± 0.43 mm vs. 6.07 ± 0.43 mm, p < 0.005). Consequently, the distal cross-sectional area of anteromedial bundles in group SL was 8% smaller than that in group K. CONCLUSION The use of the suture loop technique resulted in a significantly smaller distal diameter of the anteromedial bundle. This reduces the size of the tibial tunnel and may contribute to a reduction in potential damage to adjacent structures.
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Affiliation(s)
- Takahiro Arakawa
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, JPN
- Department of Orthopaedic Surgery, Tokyo Teishin Hospital, Tokyo, JPN
| | - Hisatada Hiraoka
- Department of Orthopaedic Surgery, Tokyo Teishin Hospital, Tokyo, JPN
| | - So Kuribayashi
- Department of Orthopaedic Surgery, Tokyo Teishin Hospital, Tokyo, JPN
| | - Shuji Okinaga
- Department of Orthopaedic Surgery, Tokyo Teishin Hospital, Tokyo, JPN
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Espejo-Reina A, Prado-Novoa M, Espejo-Baena A, Estebanez B, Perez-Blanca A. Improved tibiofemoral contact restoration after transtibial reinsertion of the anterior root of the lateral meniscus compared to in situ repair: a biomechanical study. INTERNATIONAL ORTHOPAEDICS 2023; 47:2419-2427. [PMID: 36944816 PMCID: PMC10522501 DOI: 10.1007/s00264-023-05769-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 03/08/2023] [Indexed: 03/23/2023]
Abstract
PURPOSE To compare biomechanical behaviour of the anterior root of the lateral meniscus (ARLM) after a transtibial repair (TTR) and after an in situ repair (ISR), discussing the reasons for the efficacy of the more advantageous technique. METHODS Eight cadaveric human knees were tested at flexion angles from 0° to 90° in four conditions of their ARLM: intact, detached, reinserted using TTR, and reinserted using ISR. Specimens were subjected to 1000 N of compression, and the contact area (CA), mean pressure (MP), and peak pressure (PP) on the tibial cartilage were computed. For the TTR, traction force on the sutures was registered. RESULTS ARLM detachment significantly altered contact biomechanics, mainly at shallow flexion. After ISR, differences compared to the healthy group persisted (extension, CA 22% smaller (p = 0.012); at 30°, CA 30% smaller (p = 0.012), MP 21%, and PP 32% higher (both p = 0.017); at 60°, CA 28% smaller (p = 0.012), MP 32%, and PP 49% higher (both p = 0.025). With TTR, alterations significantly decreased compared to the injured group, with no statistical differences from the intact ones observed, except for CA at extension (15% decrease, p = 0.012) and at 30° (12% decrease, p = 0.017). The suture tension after TTR, given as mean(SD), was 36.46(11.75)N, 44.32(11.71)N, 40.38(14.93)N, and 43.18(14.89)N for the four tested flexion angles. CONCLUSIONS Alterations caused by ARLM detachment were partially restored with both ISR and TTR, with TTR showing better results on recovering CA, MP, and PP in the immediate postoperative period. The tensile force was far below the value reported to cause meniscal cut-out in porcine models.
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Affiliation(s)
- Alejandro Espejo-Reina
- Laboratory of Clinical Biomechanics of Andalusia, Escuela de Ingenierías Industriales, Universidad de Málaga, Pedro Ortiz Ramos, s/n., 29071, Málaga, Spain
- Clinica Espejo, Málaga, Spain
- Hospital Vithas Parque San Antonio, Málaga, Spain
| | - Maria Prado-Novoa
- Laboratory of Clinical Biomechanics of Andalusia, Escuela de Ingenierías Industriales, Universidad de Málaga, Pedro Ortiz Ramos, s/n., 29071, Málaga, Spain.
- Department of Mechanical Engineering, Universidad de Málaga, Andalucia Tech, Málaga, Spain.
| | - Alejandro Espejo-Baena
- Laboratory of Clinical Biomechanics of Andalusia, Escuela de Ingenierías Industriales, Universidad de Málaga, Pedro Ortiz Ramos, s/n., 29071, Málaga, Spain
- Clinica Espejo, Málaga, Spain
- Hospital Vithas Parque San Antonio, Málaga, Spain
| | - Belen Estebanez
- Laboratory of Clinical Biomechanics of Andalusia, Escuela de Ingenierías Industriales, Universidad de Málaga, Pedro Ortiz Ramos, s/n., 29071, Málaga, Spain
- Department of Mechanical Engineering, Universidad de Málaga, Andalucia Tech, Málaga, Spain
| | - Ana Perez-Blanca
- Laboratory of Clinical Biomechanics of Andalusia, Escuela de Ingenierías Industriales, Universidad de Málaga, Pedro Ortiz Ramos, s/n., 29071, Málaga, Spain
- Department of Mechanical Engineering, Universidad de Málaga, Andalucia Tech, Málaga, Spain
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Hiranaka T, Furumatsu T, Okazaki Y, Kintaka K, Higashihara N, Tamura M, Nakata E, Ozaki T. Accuracy of the newly developed Zimmer Biomet Root Aiming guide in tibial tunnel creation compared with that of conventional guides. Asia Pac J Sports Med Arthrosc Rehabil Technol 2023; 32:1-6. [PMID: 37092123 PMCID: PMC10120359 DOI: 10.1016/j.asmart.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 10/12/2022] [Accepted: 03/16/2023] [Indexed: 04/25/2023] Open
Abstract
Background/objective Accurate tibial tunnel creation is crucial for successful transtibial pullout repair of medial meniscus (MM) posterior root tears (MMPRTs). This study aimed to evaluate the accuracy of the newly developed Zimmer Biomet Root Aiming (ZeBRA) guide for transtibial pullout repair of MMPRTs. Methods This study included 50 patients who underwent transtibial pullout repair using the Unicorn Meniscal Root (UMR) (n = 25) and ZeBRA (n = 25) guides. The expected anatomic centre (AC) and tibial tunnel centre (TC) were assessed using three-dimensional postoperative computed tomography (CT) images. The expected AC was defined as the centre of the circle tangent to the triangular footprint of the MM posterior root. The expected AC and TC on the tibial surface were assessed using the percentage-based posterolateral location on the tibial surface. The absolute distance between the AC and TC (mm) was evaluated. Results The mean AC location was 76.1% ± 3.1% posterior and 40.8% ± 2.1% lateral, whereas the mean TC location was 76.7% ± 5.3% posterior and 37.2% ± 3.6% lateral using the UMR guide and 75.8% ± 3.1% posterior and 36.5% ± 2.4% lateral using the ZeBRA guide. No significant difference was observed in the absolute distance between the UMR and ZeBRA guides (3.9 ± 1.4 and 3.8 ± 1.3 mm, respectively; p = 0.617). Conclusions The newly developed ZeBRA guide allows accurate tibial tunnel creation, and its accuracy is comparable to that of the conventional UMR guide. Tibial tunnels were created at optimal positions using both guides, and the choice of the guide would depend on the surgeon's preference.
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Affiliation(s)
- Takaaki Hiranaka
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan
- Department of Orthopaedic Surgery, Ako Central Hospital, 52‑6 Sohmon‑cho, Ako, Hyogo 678‑0241, Japan
| | - Takayuki Furumatsu
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan
- Corresponding author. Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan.
| | - Yuki Okazaki
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan
| | - Keisuke Kintaka
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan
| | - Naohiro Higashihara
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan
| | - Masanori Tamura
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan
| | - Eiji Nakata
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan
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Oshima T, Putnis S, Grasso S, Lim YP, Oshima M, Parker DA. A balance between native footprint coverage and overlap of the anterolateral meniscal root in tibial tunnel positioning during anterior cruciate ligament reconstruction: A 3D MRI study. Knee 2023; 41:106-114. [PMID: 36642034 DOI: 10.1016/j.knee.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 10/13/2022] [Accepted: 12/08/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND Tibial footprint of anterior cruciate ligament (ACL) is situated close to the anterior lateral meniscal root (ALMR) attachment. PURPOSE To investigate the impact of the size and location of the tibial tunnel for ACL reconstruction on the ACL footprint coverage and overlap to the ALMR. STUDY DESIGN Controlled laboratory study. METHODS Twenty knee MRI scans from twenty healthy subjects were recruited, and three-dimensional (3D) tibia models were created to show the tibial attachment sites of ACL and ALMR. Surgical simulation of the tibial tunnel drilling was performed on each 3D model, entering the joint at an angle set at 60 degrees from the tibial plateau plane and 55 degrees from the posterior tibial condylar axis, with analysis for six different drill sizes; 7.5, 8, 8.5, 9, 9.5 and 10 mm; and nine locations; the center of the ACL attachment and eight locations 2% of the tibial width apart surrounding it. The width of the tibial plateau, the distance between ACL and ALMR attachment centers, and the size and location of the potential tibial tunnel were evaluated to determine association with the area of the ACL footprint coverage and ALMR overlap using a linear mixed effects model. RESULTS A large tunnel (p <.001), a central and anterior location (p <.029), and small tibial width (p =.015) were all associated with larger coverage of the ACL footprint. A large tunnel (p <.001), posteriorly and laterally located (p ≤ 0.001), and a small distance between the ACL and ALMR centers (p =.001) were significantly associated with a larger ALMR overlap. The association of the tunnel size to ALMR overlap reduced with a medial tunnel location. CONCLUSIONS The short distance between the centers of the ALMR attachment and native ACL footprint suggests that the ALMR will always be susceptible to overlap when the tibial tunnel is drilled in ACL reconstruction. Small alterations in tunnel location can lead to a statistically significant alteration with the amount of ALMR overlap. To minimize this overlap, whilst maintaining acceptable coverage of the ACL footprint, a tibial tunnel positioned in a medial or anteromedial location from the center of the ACL footprint is recommended.
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Affiliation(s)
- Takeshi Oshima
- Sydney Orthopaedic Research Institute, Chatswood, NSW, Australia; Asanogawa General Hospital, Kanazawa, Ishikawa, Japan
| | - Sven Putnis
- Sydney Orthopaedic Research Institute, Chatswood, NSW, Australia; Bristol Royal Infirmary, University Hospitals Bristol & Weston NHS Foundation Trust, UK
| | - Samuel Grasso
- Sydney Orthopaedic Research Institute, Chatswood, NSW, Australia; The University of Sydney, Sydney, NSW, Australia
| | - Yoong Ping Lim
- Sydney Orthopaedic Research Institute, Chatswood, NSW, Australia; The University of Sydney, Sydney, NSW, Australia.
| | - Megumi Oshima
- Department of Nephrology and Laboratory Medicine, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - David Anthony Parker
- Sydney Orthopaedic Research Institute, Chatswood, NSW, Australia; The University of Sydney, Sydney, NSW, Australia
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Makiev KG, Vasios IS, Georgoulas P, Tilkeridis K, Drosos G, Ververidis A. Clinical significance and management of meniscal extrusion in different knee pathologies: a comprehensive review of the literature and treatment algorithm. Knee Surg Relat Res 2022; 34:35. [PMID: 35851067 PMCID: PMC9290229 DOI: 10.1186/s43019-022-00163-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 07/03/2022] [Indexed: 01/04/2023] Open
Abstract
The menisci are crescent-shaped, fibrocartilaginous structures that play a crucial role in the load transition and distribution of the contact forces along the tibiofemoral articulation. Meniscal extrusion (ME) is a radiological finding, especially in magnetic resonance imaging (MRI) scans, for which there has been growing interest in recent years. ME, in the coronary plane, is defined as the maximum distance of the most distal end of the meniscus from the border of the tibial plateau, where the tibial eminences are the most prominent, without taking into account the osteophytes. Although there is still controversy in the literature in respect of the optimal cutoff value, a threshold of 3 mm is considered significant. ME has no specific clinical finding or sign and it is encountered in many knee pathologies. It is associated with either rapidly progressive knee osteoarthritis or early onset of knee osteoarthritis and increased morbidity. In this review, we delineate the clinical significance of ME in various knee pathologies, as well as when, why and how it should be managed. To the best of our knowledge, this is the first study to elaborate on these topics.
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Affiliation(s)
- Konstantinos G Makiev
- Orthopaedics, University General Hospital of Alexandroupolis, St. Niarhos 1, Dragana, 68100, Alexandroupolis, Greece.
| | - Ioannis S Vasios
- Orthopaedics, University General Hospital of Alexandroupolis, St. Niarhos 1, Dragana, 68100, Alexandroupolis, Greece
| | - Paraskevas Georgoulas
- Orthopaedics, University General Hospital of Alexandroupolis, St. Niarhos 1, Dragana, 68100, Alexandroupolis, Greece
| | - Konstantinos Tilkeridis
- Orthopaedics, Democritus University of Thrace, University General Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Georgios Drosos
- Orthopaedics, Democritus University of Thrace, University General Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Athanasios Ververidis
- Orthopaedics, Democritus University of Thrace, University General Hospital of Alexandroupolis, Alexandroupolis, Greece
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Hiranaka T, Furumatsu T, Okazaki Y, Kintaka K, Yamawaki T, Ozaki T. A newly-developed guide can create tibial tunnel at an optimal position during medial meniscus posterior root repairs. J Orthop Sci 2022; 27:815-820. [PMID: 34039522 DOI: 10.1016/j.jos.2021.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 02/25/2021] [Accepted: 04/03/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND During transtibial pullout repair of medial meniscus (MM) posterior root tears (MMPRTs), accurate tibial tunnel creation within the anatomic MM posterior root attachment seems critical. This study aimed to evaluate the tibial tunnel position created by a newly-developed Precision guide during pullout repair of MMPRTs. METHODS In 40 patients who underwent transtibial pullout repairs, the tibial tunnel was created using the Unicorn Meniscal Root (UMR) (n = 20) or Precision guide (n = 20). Three-dimensional computed tomography images of the tibial surface were evaluated postoperatively, using Tsukada's measurement method. The expected anatomic center of the MM posterior root attachment was defined as the center of three tangential lines corresponding to anatomic bony landmarks. The expected anatomic center (AC) and the tibial tunnel center (TC) were evaluated using the percentage-based posterolateral location on the tibial surface. The difference in the mediolateral and anteroposterior percentage distance between the AC and TC was calculated, as was the absolute distance between the AC and TC. RESULTS The mean AC was located 77.4% posterior and 40.1% lateral. The mean TC was similar in the UMR and Precision guide groups. There was no significant difference in the mediolateral percentage distance (UMR 3.9% vs. Precision 3.6%, p = 0.405), but a significant difference was observed in the anteroposterior percentage distance (UMR 3.5% vs. Precision 2.6%, p = 0.031). The mean absolute distance between the AC and TC was 3.9 mm and 3.5 mm (UMR and Precision guide groups, respectively) (p = 0.364). CONCLUSIONS The new Precision guide can create tibial tunnel in an optimal and stable position during pullout repair of MMPRTs.
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Affiliation(s)
- Takaaki Hiranaka
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan
| | - Takayuki Furumatsu
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan.
| | - Yuki Okazaki
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan
| | - Keisuke Kintaka
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan
| | - Tadashi Yamawaki
- Department of Orthopaedic Surgery, Kosei Hospital, 3-8-35 Koseicho, Kitaku, Okayama 700-0985, Japan
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan
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Choi NH, Hwangbo BH, Kang HK, Yang BS, Victoroff BN. Accuracy of the Arthroscopic Location of the Center of the Anterior Horn During Lateral Meniscal Allograft Transplantation. Orthop J Sports Med 2022; 10:23259671221089250. [PMID: 35592017 PMCID: PMC9112417 DOI: 10.1177/23259671221089250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 01/21/2022] [Indexed: 11/17/2022] Open
Abstract
Background Anatomic placement of the meniscal allograft is imperative to achieve satisfactory outcomes after meniscal allograft transplantation (MAT). Few studies have reported on the accuracy of the provisional location of the center of the anterior horn of the lateral meniscus (AHLM). Hypothesis The authors hypothesized that the provisional center would not coincide with the anatomic center of the AHLM. Study Design Descriptive laboratory study. Methods Tibial plateaus were retrieved from 93 consecutive patients who underwent total knee arthroplasty. A complete radial cut was made 2 cm lateral to the insertion of the AHLM on the retrieved tibial plateau. While moving the stump of the anterior horn with forceps, the center of the insertion was determined, and a Kirschner wire (provisional wire) was drilled into the location. The insertion area of the AHLM was dissected carefully, and the periphery of the insertion area of the anterior horn was marked. Another Kirschner wire (anatomic wire) was drilled into the center of the dissected anterior horn. The resected tibial plateau was positioned so that the longitudinal line of the tibial plateau was aligned on a plastic ruler. The distance between the provisional and anatomic wires was measured by a digital caliper along the longitudinal and vertical axes. Results The mean distance between the provisional and anatomic wires was 2.5 ± 1.2 mm. The provisional wire in 14 patients (15%) was placed at the anatomic center. In 36 patients (39%), the provisional wire was drilled anterolateral to the anatomic center, and in 18 patients (19%), the wire was drilled anteromedial to the anatomic center. In 21 patients (23%), the provisional wire was located within 2 mm of the anatomic center, and in 62 patients (67%), the wire was located within 3 mm of the anatomic center. Conclusion The provisional wire was located a mean of 2.5 mm from the anatomic center, and only 23% of patients had wires that were located within 2 mm of the anatomic center. In 39% of patients, the provisional wire was drilled anterolateral to the anatomic center. This finding needs to be considered during lateral MAT. Clinical Relevance Without dissection of the AHLM, the determination of the anatomic center of the anterior horn is not accurate during lateral MAT.
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Affiliation(s)
- Nam-Hong Choi
- Department of Orthopaedic Surgery, Eulji Medical Center, Seoul, Republic of Korea
| | - Byung-Hun Hwangbo
- Department of Orthopaedic Surgery, Eulji Medical Center, Seoul, Republic of Korea
| | - Hang-Ki Kang
- Department of Orthopaedic Surgery, Eulji Medical Center, Seoul, Republic of Korea
| | - Bong-Seok Yang
- Department of Orthopaedic Surgery, Shihwa Medical Center, Siheung, Republic of Korea
| | - Brian N Victoroff
- Department of Orthopaedic Surgery, Case Western Reserve University, Cleveland, Ohio, USA
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Muro S, Kim J, Tsukada S, Akita K. Significance of the broad non-bony attachments of the anterior cruciate ligament on the tibial side. Sci Rep 2022; 12:6844. [PMID: 35477722 PMCID: PMC9046205 DOI: 10.1038/s41598-022-10806-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 04/12/2022] [Indexed: 11/09/2022] Open
Abstract
Knowledge of the anatomy of the anterior cruciate ligament (ACL) is important to understand the function and pathology of the knee joint. However, on the tibial side of ACL, its structural relationships with the articular cartilage and lateral meniscus remain unclear. Furthermore, conventional research methods are limited to analyzing the bone attachments. We provide a comprehensive, three-dimensional anatomical description of the tibial side of the ACL that questions the principle that “a ligament is necessarily a structure connecting a bone to another bone.” In our study, 11 knees from 6 cadavers were used for macroscopic anatomical examinations, serial-section histological analyses, and three-dimensional reconstructions. The attachments of the tibial side of ACL consisted of attachments to the bone (102.6 ± 27.5 mm2), articular cartilage (40.9 ± 13.6 mm2), and lateral meniscus (6.5 ± 4.6 mm2), suggesting that the ACL has close structural relationships with the articular cartilage and lateral meniscus. Our study demonstrates that the tibial side of the ACL is not attached to the bone surface only and provides new perspectives on ligamentous attachments. Considering its attachment to the articular cartilage would enable more accurate functional evaluations of the mechanical tensioning of the ACL.
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Affiliation(s)
- Satoru Muro
- Department of Clinical Anatomy, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan.
| | - Jiyoon Kim
- Department of Clinical Anatomy, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Sachiyuki Tsukada
- Department of Clinical Anatomy, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Keiichi Akita
- Department of Clinical Anatomy, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
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Shao J, Zhang J, Ren S, Liu P, Ma Y, Ao Y. Better Coverage of the ACL Tibial Footprint and Less Injury to the Anterior Root of the Lateral Meniscus Using a Rounded-Rectangular Tibial Tunnel in ACL Reconstruction: A Cadaveric Study. Orthop J Sports Med 2022; 10:23259671221083581. [PMID: 35340730 PMCID: PMC8949746 DOI: 10.1177/23259671221083581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 12/08/2021] [Indexed: 11/15/2022] Open
Abstract
Background To better restore the anatomy of the native anterior cruciate ligament (ACL) attachment and fiber arrangement, researchers have developed techniques for changing the shape of the ACL bone tunnel during ACL reconstruction. Purpose To compare the coverage of the ACL tibial footprint and influence on the anterior root of lateral meniscus (ARLM) between a rounded-rectangular tibial tunnel and a conventional round tibial tunnel for ACL reconstruction. Study Design Controlled laboratory study. Methods A total of 16 (8 matched-paired) fresh-frozen human cadaveric knees were distributed randomly into 2 groups: a rounded-rectangular tunnel (RRT) group and a round tunnel (RT) group. One of the knees from each pair was reamed with rounded-rectangular tibial tunnel, whereas the other was reamed with round tibial tunnel. Coverage of the ACL tibial footprint and areas of ARLM attachment before and after reaming were measured using 3-dimensional isotropic magnetic resonance imaging. Results In the RRT group, the average percentage of ACL tibial footprint covered by the tunnel was 70.8% ± 2.5%, which was significantly higher than that in the RT group (48.2% ± 6.4%) (P = .012). As for the ARLM attachment area, in the RT group, there was a significant decrease (22.5% ± 5.9%) in ARLM attachment area after tibial tunnel reaming compared with the intact state (P < .001). Conversely, in the RRT group, the ARLM attachment area was not significantly affected by tibial tunnel reaming. Conclusion Rounded-rectangular tibial tunnel was able to better cover the native ACL tibial footprint and significantly lower the risk of iatrogenic injury to the ARLM attachment than round tibial tunnel during ACL reconstruction.
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Affiliation(s)
- Jiayi Shao
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Jiahao Zhang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Shuang Ren
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Ping Liu
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Yong Ma
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Yingfang Ao
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
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Furumatsu T, Hiranaka T, Kodama Y, Kamatsuki Y, Okazaki Y, Yamawaki T, Endo H, Ozaki T. Intraarticular lengths of double-bundle grafts can change during knee flexion: Intraoperative measurements in anatomic anterior cruciate ligament reconstructions. Orthop Traumatol Surg Res 2021; 107:102816. [PMID: 33484904 DOI: 10.1016/j.otsr.2021.102816] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 08/11/2020] [Accepted: 09/14/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND The lengths of the anteromedial bundle (AMB) and posterolateral bundle (PLB) change during knee motion in double-bundle anterior cruciate ligament (ACL) reconstruction. However, the actual intraarticular graft length would be affected by the bone tunnel position and tunnel creation angle during ACL reconstruction. The aim of this study was to investigate the intraarticular length change of the AMB and PLB in patients who underwent anatomic double-bundle ACL reconstruction. HYPOTHESIS We hypothesized that the PLB would show a more dynamic length change pattern than the AMB during knee flexion at ACL reconstruction. METHODS Thirty-two patients (16 men and 16 women) who had isolated ACL injuries with intact menisci were investigated. Anatomic double-bundle ACL reconstructions were performed using semitendinosus tendon autografts at a mean age of 30.6 years. The graft and tunnel lengths were measured intraoperatively. Intraarticular graft lengths and length changes were calculated at 0° and 90° of knee flexion during ACL reconstruction. Intraoperative data were collected prospectively, and analyses were performed retrospectively. RESULTS The intraarticular length of the AMB at 0° of knee flexion was 28.1±5.5mm. At 90° of knee flexion, the AMB intraarticular length decreased to 25.6±4.8mm. The intraarticular length of the PLB decreased to 17.7±4.6mm at 90° of knee flexion compared to 22.0±4.2mm at 0° of knee flexion. Changes in the intraarticular graft length during knee flexion were detected more in the PLB (4.1mm) than in the AMB (2.0mm, p=0.01). DISCUSSION This study demonstrated that the intraarticular length change of the PLB during knee motion was larger than that of the AMB in anatomic double-bundle ACL reconstructions with semitendinosus tendon autografts and suspensory femoral fixation devices. LEVEL OF EVIDENCE IV; retrospective cohort study.
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Affiliation(s)
- Takayuki Furumatsu
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, 700-8558 Okayama, Japan; Department of Orthopaedic Surgery, Sumitomo Besshi Hospital, 3-1 Oujicho, Niihama, 792-8543 Ehime, Japan; Department of Orthopaedic Surgery, Kousei Hospital, 3-8-35 Kouseicho, Kitaku, 700-0985 Okayama, Japan.
| | - Takaaki Hiranaka
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, 700-8558 Okayama, Japan; Department of Orthopaedic Surgery, Sumitomo Besshi Hospital, 3-1 Oujicho, Niihama, 792-8543 Ehime, Japan
| | - Yuya Kodama
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, 700-8558 Okayama, Japan
| | - Yusuke Kamatsuki
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, 700-8558 Okayama, Japan
| | - Yuki Okazaki
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, 700-8558 Okayama, Japan
| | - Tadashi Yamawaki
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, 700-8558 Okayama, Japan; Department of Orthopaedic Surgery, Kousei Hospital, 3-8-35 Kouseicho, Kitaku, 700-0985 Okayama, Japan
| | - Hirosuke Endo
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, 700-8558 Okayama, Japan
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, 700-8558 Okayama, Japan
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Reply to the letter by Haitao Chen and Liaobin Chen. Orthop Traumatol Surg Res 2021; 107:102743. [PMID: 33321244 DOI: 10.1016/j.otsr.2020.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 10/13/2020] [Indexed: 02/03/2023]
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Partial lateral meniscus anterior root injuries during anatomical single-bundle anterior cruciate ligament reconstruction are likely to occur in women with small skeletons. Knee Surg Sports Traumatol Arthrosc 2020; 28:3517-3523. [PMID: 32060591 DOI: 10.1007/s00167-020-05896-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 01/31/2020] [Indexed: 10/25/2022]
Abstract
PURPOSE This study aimed to investigate the occurrence and characteristics of lateral meniscus anterior root injuries during anatomical single-bundle anterior cruciate ligament (ACL) reconstruction. METHODS Between 2011 and 2018, 70 women who had ACL injuries without lateral meniscal tears underwent anatomical single-bundle ACL reconstruction. Using computed tomography, the anatomical relationship between the predicted lateral meniscus anterior root insertion and the tibial tunnel was retrospectively assessed, and the patients were divided into partial lateral meniscus anterior root injury and intact groups. The demographic characteristics, the distances between bony landmarks, the tibial tunnel sizes, and lateral meniscal extrusion assessed by magnetic resonance imaging were compared between the two groups. RESULTS Thirteen of the 70 patients had suspected partial lateral meniscus anterior root injuries. Patient height was significantly shorter in the injury group than in the intact group (157.7 ± 6.4 vs. 161.4 ± 5.4 cm: p = 0.03); the distance from the apex to the bottom of the slope of the medial intercondylar ridge was significantly shorter in the injury group than in the intact group (15.1 ± 1.9 vs. 16.7 ± 1.4 mm: p = 0.001). CONCLUSIONS Partial lateral meniscus anterior root injury during anatomical single-bundle ACL reconstruction was suspected in 18% of cases. Patient height and the distance between bony landmarks were significantly shorter in the injury group than in the intact group. Surgeons should understand that even a slight deviation of the tibial tunnel position can lead to partial lateral meniscus anterior root injury in patients with small skeletons. LEVEL OF EVIDENCE IV.
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Sakamoto Y, Tsukada H, Sasaki S, Kimura Y, Yamamoto Y, Tsuda E, Ishibashi Y. Effects of the tibial tunnel position on knee joint stability and meniscal contact pressure after double-bundle anterior cruciate ligament reconstruction. J Orthop Sci 2020; 25:1040-1046. [PMID: 31937484 DOI: 10.1016/j.jos.2019.12.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 08/13/2019] [Accepted: 12/12/2019] [Indexed: 02/09/2023]
Abstract
BACKGROUND To investigate the effect of the tibial tunnel position on knee stability and the maximum contact area and peak contact pressure on the menisci after double-bundle anterior cruciate ligament (ACL) reconstruction. METHODS Ten human knee specimens (mean age: 74.1 ± 15.8 years) were used in this study. The anterior tibial loading test was conducted using a material testing machine at 30°, 60°, and 90° of knee flexion, with the anterior tibial translation (ATT) and the maximum contact area and peak contact pressure on the menisci measured. Outcome measures were compared between the following groups: 1) intact ACL (intact group); 2) anatomical tibial tunnel position (anatomical group) and 3) posterior tibial tunnel position (posterior group) with double-bundle reconstruction, and 4) ACL-deficient (deficient group). RESULTS In response to a 100 N anterior tibial load, the ATT was greater for the posterior and ACL-deficient groups compared to that in the intact group. The normalized maximum contact area of the medial meniscus significantly decreased for the posterior group compared to that in the intact group. The normalized peak contact pressure on the medial meniscus increased in all groups compared to that in the intact group, but with no between-group differences in pressure applied to the lateral meniscus. CONCLUSIONS ATT and contact pressure on the medial meniscus increased, concomitant with a decrease in contact area of the medial meniscus, as the position of the tibial tunnel position moved towards a posterior position.
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Affiliation(s)
- Yukiko Sakamoto
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
| | - Harehiko Tsukada
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Shizuka Sasaki
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yuka Kimura
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yuji Yamamoto
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Eiichi Tsuda
- Department of Rehabilitation Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yasuyuki Ishibashi
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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Hiranaka T, Furumatsu T, Miyazawa S, Okazaki Y, Okazaki Y, Takihira S, Kodama Y, Kamatsuki Y, Masuda S, Saito T, Ozaki T. Comparison of the clinical outcomes of transtibial pull-out repair for medial meniscus posterior root tear: Two simple stitches versus modified Mason-Allen suture. Knee 2020; 27:701-708. [PMID: 32563426 DOI: 10.1016/j.knee.2020.04.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 03/27/2020] [Accepted: 04/23/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Transtibial pullout repair of a medial meniscus posterior root tear (MMPRT) is a commonly used procedure, and several techniques have been reported. We hypothesised that pull-out repairs using two simple stitches (TSS) would have similar postoperative outcomes as those using the modified Mason-Allen suture with FasT-Fix (F-MMA). We aimed to investigate the clinical outcomes of these techniques, including the meniscal healing status and osteoarthritic change. METHODS The data of 68 patients who underwent transtibial pull-out repair were retrospectively investigated. The patients were divided into two groups of 41 and 27 patients using F-MMA and TSS, respectively. The clinical outcomes were assessed preoperatively and at second-look arthroscopy (the mean period from surgery was one year) using the Knee injury and Osteoarthritis Outcome Score. The meniscal healing status, evaluated at second-look arthroscopy, was compared between the two groups. The cartilage damage was graded as per the classification of the International Cartilage Repair Society and compared at the primary surgery and second-look arthroscopy. RESULTS Both groups showed significant improvement in each clinical score. No significant difference was seen in the clinical outcome scores and the meniscal healing status between the two groups at second-look arthroscopy. Moreover, no significant progression of cartilage damage was observed in both groups. Fourteen patients in the F-MMA group developed a complication of suture bar failures postoperatively; however, there were no complications in the TSS group. CONCLUSIONS The TSS and F-MMA techniques showed favourable clinical outcomes and would be established as clinically useful techniques for the MMPRT treatment.
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Affiliation(s)
- Takaaki Hiranaka
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan
| | - Takayuki Furumatsu
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan.
| | - Shinichi Miyazawa
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan
| | - Yoshiki Okazaki
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan
| | - Yuki Okazaki
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan
| | - Shota Takihira
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan
| | - Yuya Kodama
- Department of Orthopaedic Surgery, National Hospital Organization Iwakuni Clinical Center, 1-1-1 Atagomachi, Iwakuni, Yamaguchi 740-8510, Japan
| | - Yusuke Kamatsuki
- Department of Orthopaedic Surgery, Kochi Health Science Center, 2125-1 Ike, Kochi 781-8555, Japan
| | - Shin Masuda
- Department of Orthopaedic Surgery, Chikamori Hospital, 1-1-16 Ookawasuji, Kochi 780-8522, Japan
| | - Taichi Saito
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan
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Hiranaka T, Furumatsu T, Kamatsuki Y, Miyazawa S, Okazaki Y, Masuda S, Okazaki Y, Kodama Y, Ozaki T. The distance between the tibial tunnel aperture and meniscal root attachment is correlated with meniscal healing status following transtibial pullout repair for medial meniscus posterior root tear. Knee 2020; 27:899-905. [PMID: 32249020 DOI: 10.1016/j.knee.2020.02.025] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 02/14/2020] [Accepted: 02/28/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND To investigate the relationship between tibial tunnel aperture location and postoperative meniscal healing. METHODS We enrolled 25 patients (20 women and five men, mean age: 62.5 years) who underwent transtibial pullout repair for medial meniscus (MM) posterior root repair. The expected MM posterior root attachment center (AC) and tibial tunnel center (TC) were identified using three-dimensional computed tomography, and the minimum AC-TC distance was calculated. The meniscal healing status following transtibial pullout repair was assessed by second-look arthroscopy (mean postoperative period: 15 months) using a previously reported scoring system (meniscal healing score; range: 0-10). The association between AC-TC distance and meniscal healing score was investigated using univariate linear regression models. The optimal AC-TC distance cut-off for improved MM healing score (≥7) was determined using receiver operating characteristic analysis. RESULTS The AC-TC distance and meniscal healing score were significantly associated (y = -0.42x + 9.48, R2 = 0.342; P = 0.002), with the optimum AC-TC distance being 5.8 mm. This cut-off had a sensitivity of 100% and specificity of 53%. CONCLUSIONS This study demonstrates that AC-TC distance is significantly correlated with postoperative meniscal healing. Anatomical repair within 5.8 mm of the AC may result in improved meniscal healing.
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Affiliation(s)
- Takaaki Hiranaka
- Department of Orthopaedic Surgery, Okayama University Hospital, Okayama, Japan
| | - Takayuki Furumatsu
- Department of Orthopaedic Surgery, Okayama University Hospital, Okayama, Japan.
| | - Yusuke Kamatsuki
- Department of Orthopaedic Surgery, Kochi Health Science Center, Kochi, Japan
| | - Shinichi Miyazawa
- Department of Orthopaedic Surgery, Okayama University Hospital, Okayama, Japan
| | - Yoshiki Okazaki
- Department of Orthopaedic Surgery, Okayama University Hospital, Okayama, Japan
| | - Shin Masuda
- Department of Orthopaedic Surgery, Okayama University Hospital, Okayama, Japan
| | - Yuki Okazaki
- Department of Orthopaedic Surgery, Okayama University Hospital, Okayama, Japan
| | - Yuya Kodama
- Department of Orthopaedic Surgery, National Hospital Organization Iwakuni Clinical Center, Yamaguchi, Japan
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University Hospital, Okayama, Japan
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Oshima T, Nakase J, Ohashi Y, Shimozaki K, Asai K, Tsuchiya H. Intraoperative fluoroscopy shows better agreement and interchangeability in tibial tunnel location during single bundle anterior cruciate ligament reconstruction with postoperative three-dimensional computed tomography compared with an intraoperative image-free navigation system. Knee 2020; 27:809-816. [PMID: 32178971 DOI: 10.1016/j.knee.2020.02.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 01/30/2020] [Accepted: 02/24/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Fluoroscopy and navigation systems provide an accurate and reproducible method of guiding anatomical tunnel positioning during anterior cruciate ligament reconstruction (ACLR). The aim was to evaluate the differences in tibial tunnel location assessed by both an intraoperative navigation system and fluoroscopy, validated using a one-week postoperative three-dimensional computed tomography (3DCT). METHODS The tibial tunnel location in a consecutive series of 35 patients who received a single-bundle ACLR was evaluated by intraoperative navigation system, fluoroscopic image and compared with postoperative 3DCT position. The location to the anterior-posterior (AP) and medial-lateral (ML) direction were compared between all three methods. RESULTS The tibial tunnel locations were 46.7 ± 4.5%, 44.5 ± 1.9%, and 43.6 ± 2.4% in ML direction, and 42.8 ± 7.6%, 37.9 ± 3.8%, and 37.9 ± 3.7% in AP direction using an intraoperative navigation system, fluoroscopic image and postoperative 3DCT, respectively. Significant differences between the navigation system and fluoroscopic image (ML, P = 0.001; AP, P = 0.006), and the navigation system and 3DCT (ML, P = 0.001; AP, P < 0.001) were seen. However, there was no significant difference between fluoroscopy and 3DCT (ML, P = 0.315; AP, P = 0.999). There was a significant lack of agreement for analyses measured using a navigation system and 3DCT. Fluoroscopy and 3DCT demonstrated an acceptable agreement (ML, rpt = -0.21, P = 0.232; AP, rpt = 0.04, P = 0.826). CONCLUSIONS A tibial tunnel location assessed by intraoperative fluoroscopy shows better agreement and interchangeability with one-week postoperative 3DCT validation during single-bundle ACLR compared with an intraoperative image-free navigation system.
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Affiliation(s)
- Takeshi Oshima
- Department of Orthopaedic Surgery, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Junsuke Nakase
- Department of Orthopaedic Surgery, Kanazawa University, Kanazawa, Ishikawa, Japan.
| | - Yoshinori Ohashi
- Department of Orthopaedic Surgery, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Kengo Shimozaki
- Department of Orthopaedic Surgery, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Kazuki Asai
- Department of Orthopaedic Surgery, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Kanazawa University, Kanazawa, Ishikawa, Japan
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Posttraumatic cartilage degradation progresses following anterior cruciate ligament reconstruction: A second-look arthroscopic evaluation. J Orthop Sci 2019; 24:1058-1063. [PMID: 31444009 DOI: 10.1016/j.jos.2019.08.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 06/13/2019] [Accepted: 08/04/2019] [Indexed: 02/09/2023]
Abstract
BACKGROUND Several studies have demonstrated that posttraumatic knee osteoarthritis progresses even after anterior cruciate ligament reconstruction. Few reports described zone-specific cartilaginous damages after anterior cruciate ligament reconstruction. This study aimed to compare the status of articular cartilage at anterior cruciate ligament reconstruction with that at second-look arthroscopy. METHODS This study included 20 patients (20 knees, 10 males and 10 females, mean age 22.4 years, Body mass index 24.4 kg/m2) that underwent arthroscopic anatomic double-bundle anterior cruciate ligament reconstruction and second-look arthroscopy. Mean periods from injury to reconstruction and from reconstruction to second-look arthroscopy were 3.4 and 15.3 months, respectively. Cartilage lesions were evaluated arthroscopically in the 6 articular surfaces and 40 articular subcompartments independently, and these features were graded with the International Cartilage Repair Society articular cartilage injury classification; comparisons were made between the grades at reconstruction and at second-look arthroscopy. Furthermore, clinical outcomes were assessed at reconstruction and at second-look arthroscopy, using the Lysholm knee score, Tegner activity scale, International Knee Documentation Committee score, Knee injury and Osteoarthritis Outcome Score, side-to-side difference of the KT-2000 arthrometer, and pivot shift test. RESULTS Each compartment showed a deteriorated condition at second-look arthroscopy compared with the pre-reconstruction period. A significant worsening of the articular cartilage was noted in all compartments except the lateral tibial plateau and was also observed in the central region of the medial femoral condyle and trochlea after reconstruction. However, each clinical outcome was significantly improved postoperatively. CONCLUSIONS Good cartilage conditions were restored in most subcompartments at second-look arthroscopy. Furthermore, posttraumatic osteoarthritic changes in the patellofemoral and medial compartments progressed even in the early postoperative period, although good knee stability and clinical outcomes were obtained. Care is necessary regarding the progression of osteoarthritis and the appearance of knee symptoms in patients undergoing anterior cruciate ligament reconstruction.
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Oshima T, Grasso S, Beach A, Fritsch B, Parker DA. Lateral location of the tibial tunnel increases lateral meniscal extrusion after anatomical single-bundle anterior cruciate ligament reconstruction. J ISAKOS 2019. [DOI: 10.1136/jisakos-2019-000303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Tensho K, Iwaasa T, Koyama S, Yoshida K, Shimodaira H, Horiuchi H, Kato H, Saito N, Fukushima N. The interrelationship between anterior cruciate ligament tibial footprint and anterolateral meniscal root insertions: Quantitative, morphological and positional analyses using three-dimensional computed tomography images. Knee 2019; 26:969-977. [PMID: 31375445 DOI: 10.1016/j.knee.2019.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 06/18/2019] [Accepted: 07/03/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate quantitative, morphological and positional differences between the anterior cruciate ligament (ACL) tibial footprint and anterolateral meniscal root (ALMR) insertion and investigate an intraoperative landmark to estimate their boundaries. METHODS Thirty-three fixed human cadaveric knees were evaluated. After resecting the components, the anterior fiber (AF) and posterior fiber (PF) of ALMR, the tibial center of ACL bundles (anteromedial (AM) and posterolateral (PL) bundles) and ACL were marked. Insertion morphology was classified into three categories, and the distance and relative positional relationship between AF/PF insertions and the center of each attachment were measured on three-dimensional computed tomography images. RESULTS There was no significant difference between the AF of AM and ACL (P = 0.16), but both were significantly shorter than the AF of PL (both P < 0.001). There was no significant difference between the PF of ACL and PL (P = 0.99), which were significantly shorter than PF of AM (both P < 0.001). Morphology of the ACL tibial insertion was classified as follows: triangular, 15 knees (45.5%); oval, 18 knees (54.5%); none, C-shape. Quantitative and positional analyses showed that the AF insertion was significantly closer to AM and ACL centers in the oval type than in the triangular type. Excluding two cases, the AF/PF insertion was located laterally to the ML center of the medial and lateral intercondylar tubercles. CONCLUSION Proximity of ACL tibial footprint and ALMR varies by their footprint morphology. The medial and lateral intercondylar tubercles were useful landmarks for ALMR injury prevention.
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Affiliation(s)
- Keiji Tensho
- Department of Orthopedic Surgery, Shinshu University School of Medicine, Nagano, Japan.
| | - Tomoya Iwaasa
- Department of Orthopedic Surgery, Shinshu University School of Medicine, Nagano, Japan
| | - Suguru Koyama
- Department of Orthopedic Surgery, Shinshu University School of Medicine, Nagano, Japan
| | - Kazushige Yoshida
- Department of Orthopedic Surgery, Shinshu University School of Medicine, Nagano, Japan
| | - Hiroki Shimodaira
- Department of Orthopedic Surgery, Shinshu University School of Medicine, Nagano, Japan
| | - Hiroshi Horiuchi
- Department of Orthopedic Surgery, Shinshu University School of Medicine, Nagano, Japan
| | - Hiroyuki Kato
- Department of Orthopedic Surgery, Shinshu University School of Medicine, Nagano, Japan
| | - Naoto Saito
- Department of Orthopedic Surgery, Shinshu University School of Medicine, Nagano, Japan
| | - Nanae Fukushima
- Department of Orthopedic Surgery, Shinshu University School of Medicine, Nagano, Japan
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Furumatsu T, Okazaki Y, Kodama Y, Okazaki Y, Kamatsuki Y, Masuda S, Hiranaka T, Ozaki T. The accuracy of a newly developed guide system in medial meniscus posterior root repair: a comparison between two aiming guides. Knee Surg Relat Res 2019; 31:7. [PMID: 32660577 PMCID: PMC7219562 DOI: 10.1186/s43019-019-0007-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 07/16/2019] [Indexed: 11/20/2022] Open
Abstract
Purpose Posterior root repair of the medial meniscus (MM) can prevent rapid progression of knee osteoarthritis in patients with a MM posterior root tear (MMPRT). The anatomic reattachment of the MM posterior root is considered to be critical in a transtibial pullout repair. However, tibial tunnel creation at the anatomic attachment is technically difficult. We hypothesized that a newly developed point-contact aiming guide [Unicorn Meniscal Root (UMR) guide] can create the tibial tunnel at a better position rather than a previously designed MMPRT guide. The aim of this study was to compare the position of the created tibial tunnel between the two meniscal root repair guides. Materials and methods Thirty-eight patients underwent transtibial pullout repairs. Tibial tunnel creation was performed using the UMR guide (19 cases) or MMPRT guide (19 cases). Three-dimensional computed tomography images of the tibial surface were evaluated using the Tsukada’s measurement method postoperatively. The expected anatomic center of the MM posterior root attachment was defined as the center of three tangential lines referring to three anatomic bony landmarks (anterior border of the posterior cruciate ligament, lateral margin of the medial tibial plateau, and retro-eminence ridge). The expected anatomic center and tibial tunnel center were evaluated using the percentage-based posterolateral location on the tibial surface. The distance between the anatomic center and tunnel center was calculated. Results The anatomic center of the MM posterior root footprint was located at a position of 79.2% posterior and 39.5% lateral. The mean of the tunnel center in the UMR guide was similar to that in the MMPRT guide (posterior direction, P = 0.096; lateral direction, P = 0.280). The mean distances between the tunnel center and the anatomic center were 4.06 and 3.99 mm in the UMR and MMPRT guide group, respectively (P = 0.455). Conclusions The UMR guide, as well as the MMPRT guide, is a useful device to create favorable tibial tunnels at the MM posterior root attachment for pullout repairs in patients with MMPRTs. Level of evidence IV
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Affiliation(s)
- Takayuki Furumatsu
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
| | - Yuki Okazaki
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Yuya Kodama
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Yoshiki Okazaki
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Yusuke Kamatsuki
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Shin Masuda
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Takaaki Hiranaka
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
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Tachibana Y, Shino K, Mae T, Iuchi R, Take Y, Nakagawa S. Anatomical rectangular tunnels identified with the arthroscopic landmarks result in excellent outcomes in ACL reconstruction with a BTB graft. Knee Surg Sports Traumatol Arthrosc 2019; 27:2680-2690. [PMID: 30460396 DOI: 10.1007/s00167-018-5300-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 11/13/2018] [Indexed: 12/26/2022]
Abstract
PURPOSE To elucidate tunnel locations and clinical outcomes after anatomic rectangular tunnel (ART) anterior cruciate ligament reconstruction (ACLR) using a bone-patellar tendon-bone (BTB) graft. METHODS Sixty-one patients with a primary unilateral ACL injury were included. Tunnels were created inside the ACL attachment areas after carefully removing the ACL remnant and clearly identifying the bony landmarks. Using 3-dimensional computed tomography (3-D CT) images, the proportion of the tunnel apertures to the anatomical attachment areas was evaluated at 3 weeks. The clinical outcomes were evaluated at 2 years postoperatively. RESULTS Geographically, the 3-D CT evaluation showed the entire femoral tunnel aperture; at least 75% of the entire tibial tunnel aperture area was consistently located inside the anatomical attachment areas surrounded by the bony landmarks. In the International Knee Documentation Committee (IKDC) subjective assessment, all patients were classified as 'normal' or 'nearly normal'. The Lachman test and pivot-shift test were negative in 98.4% and 95.1% of patients, respectively. The mean side-to-side difference of the anterior laxity at the maximum manual force with a KT- 1000 Knee Arthrometer was 0.2 ± 0.9 mm, with 95.1% of patients ranging from - 1 to + 2 mm. CONCLUSION By identifying arthroscopic landmarks, the entire femoral tunnel aperture and at least 75% of the entire tibial tunnel aperture area were consistently located inside the anatomical attachment areas. With properly created tunnels inside the anatomical attachment areas, the ART ACLR using a BTB graft could provide satisfactory outcomes both subjectively and objectively in more than 95% of patients. LEVEL OF EVIDENCE Case series, Level IV.
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Affiliation(s)
- Yuta Tachibana
- Sports Orthopaedic Center, Yukioka Hospital, 2-2-3 Ukita, Kita-ku, Osaka, Osaka, 530-0021, Japan.
| | - Konsei Shino
- Sports Orthopaedic Center, Yukioka Hospital, 2-2-3 Ukita, Kita-ku, Osaka, Osaka, 530-0021, Japan
| | - Tatsuo Mae
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Ryo Iuchi
- Sports Orthopaedic Center, Yukioka Hospital, 2-2-3 Ukita, Kita-ku, Osaka, Osaka, 530-0021, Japan
| | - Yasuhiro Take
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Shigeto Nakagawa
- Sports Orthopaedic Center, Yukioka Hospital, 2-2-3 Ukita, Kita-ku, Osaka, Osaka, 530-0021, Japan
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22
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Oshima T, Leie M, Grasso S, Parker DA. Relationship between anterior cruciate ligament and anterolateral meniscal root bony attachment: High-resolution 3-T MRI analysis. Knee 2019; 26:537-544. [PMID: 31103414 DOI: 10.1016/j.knee.2019.04.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 02/24/2019] [Accepted: 04/17/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND The tibial bony attachments of the anterior cruciate ligament (ACL) and the anterolateral meniscal root (ALMR) are very close, and drilling the tibial tunnel in ACL reconstruction may damage the ALMR attachment. This study investigated the relationship between the tibial attachment of the ACL and ALMR using high-resolution 3-T magnetic resonance imaging (MRI). METHODS Twenty healthy subjects (35.8 ± 13.0 years) had 20 knees scanned using high resolution 3-T MRI. The tibial bony attachments of ACL, ALMR, and the tibia were segmented and three-dimensional models were created. The shape, area, and location of each attachment were evaluated using this model. RESULTS The ACL tibial attachment was elliptical in nine knees (45%), C-shaped in nine knees (45%) and triangle in two knees (10%). The mean values of the ACL vs ALMR tibial attachments were as follows: area, 106.2 ± 21.3 vs 56.2 ± 21.3 mm2; length, 16.8 ± 2.0 vs 11.0 ± 1.8 mm; and width, 6.9 ± 1.3 vs 6.6 ± 1.0 mm. The location of the ACL vs ALMR attachment centres was 46.5 ± 1.7% vs 56.5 ± 1.9% in the medial-lateral direction and 36.3 ± 3.6% vs 36.7 ± 3.5% in the anterior-posterior direction. The distance between the ACL and ALMR centres was 8.1 ± 1.3 mm. CONCLUSIONS ACL and ALMR tibial attachments were individually distinguished using high resolution 3-T MRI. The short distance between both centres of the attachments may suggest that ALMR can be damaged when the tibial tunnel is drilled in ACL reconstruction.
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Affiliation(s)
- Takeshi Oshima
- Sydney Orthopaedic Research Institute, Sydney, Australia.
| | - Murilo Leie
- Sydney Orthopaedic Research Institute, Sydney, Australia
| | - Samuel Grasso
- Sydney Orthopaedic Research Institute, Sydney, Australia; The University of Sydney, Sydney, Australia
| | - David A Parker
- Sydney Orthopaedic Research Institute, Sydney, Australia; The University of Sydney, Sydney, Australia
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Okazaki Y, Furumatsu T, Miyazawa S, Kodama Y, Kamatsuki Y, Hino T, Masuda S, Ozaki T. Meniscal repair concurrent with anterior cruciate ligament reconstruction restores posterior shift of the medial meniscus in the knee-flexed position. Knee Surg Sports Traumatol Arthrosc 2019; 27:361-368. [PMID: 30251100 DOI: 10.1007/s00167-018-5157-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 09/17/2018] [Indexed: 01/08/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the shape and shift of the medial meniscus before and after meniscal repair concurrent with anterior cruciate ligament (ACL) reconstruction using magnetic resonance imaging (MRI) at 90° of knee flexion. METHODS This study included 18 patients with ACL-deficient knees without meniscus tears (group A), 11 patients with medial meniscus tears alone (group M), and 15 patients with ACL-deficient knees complicated with medial meniscus tears (group AM). The posterior segment shape was evaluated using open MRI at 90° of knee flexion preoperatively and at 3 months postoperatively. The length, height, width, and posterior extrusion of the medial meniscus and posterior tibiofemoral distance were measured. These measurements were compared between the three groups. RESULTS On preoperative MRI, a significant difference was observed in the posterior extrusion of the medial meniscus (group A, 1.2 ± 0.5 mm; group M, 1.7 ± 0.3 mm; group AM, 4.1 ± 1.5 mm, p < 0.001). All parameters did not differ between the three groups on postoperative MRI. In addition, the posterior width and extrusion of the medial meniscus were decreased significantly after meniscal repair concurrent with ACL reconstruction. CONCLUSIONS This study demonstrated that the medial meniscus shifted posteriorly at 90° of knee flexion in ACL-deficient knees complicated with medial meniscus tears. Medial meniscal repair concurrent with ACL reconstruction improved the deformed morphology and posterior extrusion. MRI measurements of the posterior extrusion at the knee-flexed position may be clinically useful to assess the functional improvement of the medial meniscus following meniscal repair combined with ACL reconstruction. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Yoshiki Okazaki
- Department of Orthopaedic Surgery, Okayama University Graduate School, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan
| | - Takayuki Furumatsu
- Department of Orthopaedic Surgery, Okayama University Graduate School, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan.
| | - Shinichi Miyazawa
- Department of Orthopaedic Surgery, Okayama University Graduate School, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan
| | - Yuya Kodama
- Department of Orthopaedic Surgery, Okayama University Graduate School, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan
| | - Yusuke Kamatsuki
- Department of Orthopaedic Surgery, Okayama University Graduate School, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan
| | - Tomohito Hino
- Department of Orthopaedic Surgery, Okayama University Graduate School, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan
| | - Shin Masuda
- Department of Orthopaedic Surgery, Okayama University Graduate School, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University Graduate School, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan
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Kodama Y, Furumatsu T, Hino T, Kamatsuki Y, Ozaki T. Minimal Ablation of the Tibial Stump Using Bony Landmarks Improved Stability and Synovial Coverage Following Double-Bundle Anterior Cruciate Ligament Reconstruction. Knee Surg Relat Res 2018; 30:348-355. [PMID: 30466255 PMCID: PMC6254876 DOI: 10.5792/ksrr.18.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 07/26/2018] [Accepted: 08/09/2018] [Indexed: 01/16/2023] Open
Abstract
Purpose To evaluate the clinical effects of using anatomical bony landmarks (Parsons’ knob and the medial intercondylar ridge) and minimal ablation of the tibial footprint to improve knee anterior instability and synovial graft coverage after double-bundle anterior cruciate ligament reconstruction. Materials and Methods We performed a retrospective comparison of outcomes between patients who underwent reconstruction with minimal ablation of the tibial footprint, using an anatomical tibial bony landmark technique, and those who underwent reconstruction with wide ablation of the tibial footprint. Differences between the two groups were evaluated using second-look arthroscopy, radiological assessment of the tunnel position, postoperative anterior knee joint laxity, and clinical outcomes. Results Use of the anatomical reference and minimal ablation of the tibial footprint resulted in a more anterior positioning of the tibial tunnel, with greater synovial coverage of the graft postoperatively (p=0.01), and improved anterior stability of the knee on second-look arthroscopy. Both groups had comparable clinical outcomes. Conclusions Use of anatomical tibial bony landmarks that resulted in a more anteromedial tibial tunnel position improved anterior knee laxity, and minimal ablation improved synovial coverage of the graft; however, it did not significantly improve subjective and functional short-term outcomes.
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Affiliation(s)
- Yuya Kodama
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Takayuki Furumatsu
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Tomohito Hino
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yusuke Kamatsuki
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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25
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Kodama Y, Furumatsu T, Hino T, Kamatsuki Y, Okazaki Y, Masuda S, Okazaki Y, Ozaki T. Thymol turbidity test is associated with the risk of cyclops syndrome following anterior cruciate ligament reconstruction. BMC Musculoskelet Disord 2018; 19:367. [PMID: 30309341 PMCID: PMC6182822 DOI: 10.1186/s12891-018-2286-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 09/27/2018] [Indexed: 11/28/2022] Open
Abstract
Background Cyclops nodule formation is a serious complication after anterior cruciate ligament (ACL) reconstruction. The purpose of our study was to investigate whether an increase in thymol turbidity test (TTT) values is involved in the development of cyclops nodule formation or cyclopoid scar formation following ACL reconstruction. Methods Between 2011 and 2014, 120 cases underwent outside-in ACL reconstruction. Forty-seven patients who had high TTT values were individually matched for age, sex, body mass index, and meniscus injury to a low TTT value group of 47 patients. The primary outcome was the occurrence of cyclops nodule formation or cyclopoid scar formation. All 94 patients were divided into 3 groups using surgical records and intra-operative video to enable a sub-analysis. The groups were a no-cyclops group, a cyclopoid group, and a cyclops group. Blood examinations, including TTT, and knee range of motion evaluations were performed before surgery, 3 months after surgery, and 1 year after surgery. Results There were no differences in preoperative demographic data between the two groups. TTT values did not significantly influence cyclopoid scar formation (OR, 1.67; 95% CI, 0.62 to 4.66; p = 0.362). However, patients with cyclops nodule formation showed significantly higher TTT values than the control patients. (OR, 9.34; 95% CI, 1.94 to 90.3; p = 0.002). Knee extension loss was observed in the cyclopoid and cyclops groups 3 months after reconstruction. In the cyclops group, arthroscopic resection of the cyclops nodule was performed 3 months after reconstruction. Eventually, almost full range of motion was restored in all patients. Conclusions High TTT values before ACL reconstruction were an indicator of cyclops nodule formation. Furthermore, cyclopoid scar formations may not be the result of an individual’s immune reaction but that of extension loss in the early post-reconstruction phase.
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Affiliation(s)
- Yuya Kodama
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
| | - Takayuki Furumatsu
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan.
| | - Tomohito Hino
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
| | - Yusuke Kamatsuki
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
| | - Yoshiki Okazaki
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
| | - Shin Masuda
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
| | - Yuki Okazaki
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
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Kamatsuki Y, Furumatsu T, Fujii M, Kodama Y, Miyazawa S, Hino T, Ozaki T. Complete tear of the lateral meniscus posterior root is associated with meniscal extrusion in anterior cruciate ligament deficient knees. J Orthop Res 2018; 36:1894-1900. [PMID: 29369416 DOI: 10.1002/jor.23861] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 01/15/2018] [Indexed: 02/04/2023]
Abstract
UNLABELLED This study aimed to evaluate the relationship between preoperative lateral meniscal extrusion (LME) and arthroscopic findings of lateral meniscus posterior root tear (LMPRT) in knees with anterior cruciate ligament (ACL) tear. Thirty-five knees that had LMPRTs with concomitant ACL tears on arthroscopy were evaluated. Patients were divided into two groups, partial and complete root tears, via arthroscopic findings at the time of ACL reconstruction. For comparison, we added two groups, using the same database; 20 normal knees (normal group) and 20 ACL-injured knees without LM injury (intact LM group). We retrospectively measured preoperative LMEs using magnetic resonance imaging (MRI). Twenty-three knees had partial LMPRTs. Complete LMPRTs were observed in 12 knees. The average LME was -0.1 ± 0.4 mm in the normal group, 0.2 ± 0.5 mm in the intact LM group, 0.4 ± 0.8 mm in the partial LMPRT group, and 2.0 ± 0.6 mm in the complete LMPRT group. A significant difference in preoperative LMEs was observed between the complete LMPRT group and the other groups (p < 0.001). The receiver operating curve analysis, which distinguishes a partial tear from a complete tear, identified an optimal cut-off point of 1.1 mm for preoperative LME. This LME cut-off had a sensitivity of 100% and specificity of 83% for complete LMPRT. We found that preoperative LMEs were larger in complete LMPRTs associated with ACL injuries than in partial LMPRTs. Our results suggest that preoperative MRI-detected LME may be a useful indicator for estimating LMPRT severity in ACL-injured knees. LEVEL OF EVIDENCE Retrospective comparative study level IV. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1894-1900, 2018.
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Affiliation(s)
- Yusuke Kamatsuki
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
| | - Takayuki Furumatsu
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
| | - Masataka Fujii
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
| | - Yuya Kodama
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
| | - Shinichi Miyazawa
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
| | - Tomohito Hino
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
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Zhu M, Li S, Su Z, Zhou X, Peng P, Li J, Wang J, Lin L. Tibial tunnel placement in anatomic anterior cruciate ligament reconstruction: a comparison study of outcomes between patient-specific drill template versus conventional arthroscopic techniques. Arch Orthop Trauma Surg 2018; 138:515-525. [PMID: 29380050 DOI: 10.1007/s00402-018-2880-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Accurate anatomic graft tunnel positioning is essential for the successful application of anatomic anterior cruciate ligament (ACL) reconstruction. The accurate insertion of the tibial tunnel (TT) remains challenging. Here, we explored a novel strategy of patient-specific drill template (PDT) for the placement of TT in ACL reconstruction and assessed its efficacy and accuracy. MATERIALS AND METHODS TT placement was randomized and performed by use of the PDT technique in 40 patients (PDT group) and the conventional arthroscopic technique in 38 patients (Arthroscopic group). After surgery, the deviations at the center point of the ACL tibial attachment area and radiological TT positioning were assessed in both groups. The preoperative and follow-up examinations included pivot-shift testing, KT-1000 arthrometer testing, the Lysholm and International Knee Documentation Committee scales were used to compare the knee stability and the functional state. RESULTS The ideal center points achieved in the PDT group were more precise than that in the arthroscopic group (p < 0.001). Radiological TT positioning performed by use of the PDT technique was more accurate than that by the arthroscopic technique (p = 0.027). Statistical differences could not be found between the groups in terms of the pivot-shift test, KT-1000 arthrometer laxity measurements, the Lysholm or International Knee Documentation Committee scales. Both groups improved at follow-up compared with the preoperative assessment in terms of the pivot-shift test, the laxity tests, and scoring scales. CONCLUSIONS The novel PDT strategy could provide more accurate TT positioning than the traditional arthroscopic technique in ACL reconstruction. However, functional scales and stability tests gave similar results in the PDT and the standard techniques. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Meisong Zhu
- Department of Orthopedics, Zhujiang Hospital, Southern Medical University, 253 Gongye Zhong Road, Guangzhou, Guangdong, China
| | - Sijing Li
- Department of Orthopedics, Zhujiang Hospital, Southern Medical University, 253 Gongye Zhong Road, Guangzhou, Guangdong, China
| | - Zexin Su
- Department of Orthopedics, Zhujiang Hospital, Southern Medical University, 253 Gongye Zhong Road, Guangzhou, Guangdong, China
| | - Xiaoqi Zhou
- Department of Orthopedics, Zhujiang Hospital, Southern Medical University, 253 Gongye Zhong Road, Guangzhou, Guangdong, China
| | - Peng Peng
- Department of Anatomy, Guangdong Provincial Key Laboratory of Medical Biomechanics, School of Basic Medicine Science, Southern Medical University, 1023 Shatai Nan Road, Baiyun District, Guangzhou, Guangdong, China
| | - Jianyi Li
- Department of Anatomy, Guangdong Provincial Key Laboratory of Medical Biomechanics, School of Basic Medicine Science, Southern Medical University, 1023 Shatai Nan Road, Baiyun District, Guangzhou, Guangdong, China
| | - Jinping Wang
- Department of Orthopedics, Qingyuan People's Hospital, B24 Xinchengyinquan Road, Qingcheng District, Qingyuan, Guangdong, China.
| | - Lijun Lin
- Department of Orthopedics, Zhujiang Hospital, Southern Medical University, 253 Gongye Zhong Road, Guangzhou, Guangdong, China.
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Anterior cruciate ligament tibial insertion site is elliptical or triangular shaped in healthy young adults: high-resolution 3-T MRI analysis. Knee Surg Sports Traumatol Arthrosc 2018. [PMID: 28647841 DOI: 10.1007/s00167-017-4607-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
PURPOSE To clarify the morphology of anterior cruciate ligament (ACL) tibial insertion site in healthy young knees using high-resolution 3-T MRI. METHODS Subjects were 50 ACL-reconstructed patients with a mean age of 21.4 ± 6.8 years. The contralateral healthy knees were scanned using high-resolution 3-T MRI. The tibial insertion sites of the anteromedial (AM) and posterolateral (PL) bundle fibres, and the ACL attachment on the anterior horn of lateral meniscus (AHLM) were segmented from the MR images, and 3D models were reconstructed to evaluate the morphology. The shape of ACL footprint was qualitatively analysed, and the size of AM and PL attachments and AHLM overlapped area was measured digitally. RESULTS Tibial AM and PL bundles were clearly identified in 42 of 50 knees (84.0%). Morphology of the whole ACL tibial insertion site was elliptical in 23 knees (54.8%) and triangular in 19 knees (45.2%), but not classified as C-shape in any knees. However, the AM bundle attachment was of C-shape in 29 knees (69.0%) and band-like in 13 knees (31.0%). Overlap of ACL on AHLM was found in 26 knees (61.9%), and the size of the overlapped area was 4.8 ± 4.7% of the whole ACL insertion site. CONCLUSION 3D morphology of the intact ACL tibial insertion site analysed by high-resolution 3-T MRI was elliptical or triangular in healthy young knees. However, the AM bundle insertion site was of C-shape or band-like. A small lateral portion of the ACL was overlapped with the AHLM. As for clinical relevance, these findings should be considered in order to reproduce the native ACL insertion site sufficiently. LEVEL OF EVIDENCE III.
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Fujii M, Furumatsu T, Miyazawa S, Kodama Y, Hino T, Kamatsuki Y, Ozaki T. Bony landmark between the attachment of the medial meniscus posterior root and the posterior cruciate ligament: CT and MR imaging assessment. Skeletal Radiol 2017; 46:1041-1045. [PMID: 28314900 DOI: 10.1007/s00256-017-2625-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 02/27/2017] [Accepted: 03/05/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVES (1) To reveal the prevalence of the bony recess (posterior dimple) and (2) to determine the position of the posterior dimple on the tibial plateau using three-dimensional computed tomography (3DCT). MATERIALS AND METHODS In this study, a retrospective review of 112 patients was performed to identify the posterior dimple and to evaluate its position on 3DCT. Magnetic resonance images (MRIs) were also used to determine the positional relationship among the posterior cruciate ligament (PCL), medial meniscus posterior insertion (MMPI), and posterior dimple. RESULTS The posterior dimple was observed in 100 of 112 knees (89.3%) on 3DCT. The center of the posterior dimple was 13.6 ± 0.8 mm from the medial tibial eminence apex. MRI showed that the posterior dimple separated the tibial attachment of the PCL and MMPI. CONCLUSION This is the first study to discuss the prevalence and position of the bony recess in the posterior intercondylar fossa.
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Affiliation(s)
- Masataka Fujii
- Department of Orthopaedic Surgery, Science of Functional Recovery and Reconstruction, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Takayuki Furumatsu
- Department of Orthopaedic Surgery, Science of Functional Recovery and Reconstruction, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
| | - Shinichi Miyazawa
- Department of Orthopaedic Surgery, Science of Functional Recovery and Reconstruction, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Yuya Kodama
- Department of Orthopaedic Surgery, Science of Functional Recovery and Reconstruction, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Tomohito Hino
- Department of Orthopaedic Surgery, Science of Functional Recovery and Reconstruction, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Yusuke Kamatsuki
- Department of Orthopaedic Surgery, Science of Functional Recovery and Reconstruction, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Science of Functional Recovery and Reconstruction, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
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