2015 ISAKOS Biennial Congress ePoster #1287

Does Femoral Bone Tunnel Coalition During Double-Bundle ACL Reconstruction Affect Postoperative Results?

Izumi Kanisawa, MD, Chiba, Chiba JAPAN
Akihiro Tsuchiya, MD, Funabashi, Chiba JAPAN
Kenji Takahashi, MD, PhD, Funabashi, Chiba JAPAN
Hiroki Sakai, MD, Funabashi-City, Chiba JAPAN
Hideaki Fukuda, MD, Funabashi, Chiba JAPAN
Shigehiro Asai, MD, Tokyo JAPAN
Tatsuya Takahashi, MD, Funabashi, Chiba JAPAN
Jun Houki, MD, Miyakonojo, Miyazaki JAPAN

Funabashi Orthopaedic Hospital Sports Medicine Center, Funabashi, Chiba, JAPAN

FDA Status Cleared

Summary: We examined femoral bone tunnel coalition during transtibial double-bundle ACL reconstruction using CT scan, postoperative stabilities and the second-look arthroscopy findings, and as a result, femoral tunnel coalition did not seem to be a risk factor to affect postoperative results.

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Abstract:

Background

Although some surgeons recommend avoiding bone tunnel coalition during double-bundle ACL reconstruction, it is still unclear whether bone tunnel coalition really affect postoperative results.

Objectives
The objective of this study was to examine femoral bone tunnel coalition using 3D-CT and compare with postoperative stability and second-look arthroscopy findings.

Subjects and methods
Forty-six consecutive patients who received second-look arthroscopies and removals of fixation devices by the same single surgeon between January, 2010 and December, 2010 were included in this study. Initial double-bundle ACL reconstructions using hamstrings tendon were performed by the same surgeon, and femoral bone tunnels were drilled by the transtibial technique. The subjects included 29 males and 17 females, and mean age at the second-look arthroscopy was 27.0 +- 8.5 years, and the duration after ACL reconstruction was 16.6 +- 6.3 months.
Postoperative CT examinations were routinely performed at 3 weeks after reconstruction and 3D images were used for examination. Coalition of intra-joint openings of the femoral tunnels was examined by the lateral view of the lateral wall of femoral notch.
Postoperative stabilities were examined by anterior translation measured using KT-2000 and the pivot shift test performed by the operated surgeon at the final hospital visit before the second-look arthroscopy. The pivot shift test was decided to be negative only if there was no question about rotational stability.
The second-look arthroscopy findings were evaluated by the damage of the reconstructed ligament fibers.

Results

CT examination revealed no coalition of the two femoral tunnels in 22 patients, and coalition in 24 patients.
Mean side to side differences of anterior translation measured with KT-2000 were 1.6 +- 0.6 mm in the patients with no coalition and 1.7 +- 1.6 mm in the patients with coalition. The pivot shift tests were negative in 45 % of the patients with no coalition, and 79 % of the patients with coalition.
The second-look arthroscopy revealed no fibrous damages in the reconstructed ligament at the femoral side in all the patients.

Conclusion

Although sometimes it is difficult to avoid femoral tunnel coalition during our transtibial double bundle ACL reconstruction, femoral tunnel coalition does not seem to be a risk factor to affect postoperative results regarding stability and the second-look arthroscopy findings.