Can the outside-in half-tunnel technique reduce femoral tunnel widening in anterior cruciate ligament reconstruction? A CT study

• Published in: European journal of orthopaedic surgery & traumatology Vol. 27; no. 5; pp. 659 - 664
• Main Authors: Lanzetti, Riccardo Maria, Lupariello, Domenico, De Carli, Angelo, Monaco, Edoardo, Guzzini, Matteo, Fabbri, Mattia, Vadalà, Antonio, Ferretti, Andrea
• Format: Journal Article
• Language: English
• Published: Paris Springer Paris 01.07.2017; Springer Nature B.V
• Subjects: Adult; Anterior Cruciate Ligament Injuries - complications; Anterior Cruciate Ligament Injuries - surgery; Anterior Cruciate Ligament Reconstruction - adverse effects; Anterior Cruciate Ligament Reconstruction - methods; Clinical outcomes; Drilling; Female; Femur - diagnostic imaging; Femur - surgery; Follow-Up Studies; Humans; Hypotheses; Joint Instability - etiology; Knee; Knee Joint - diagnostic imaging; Knee Joint - surgery; Ligaments; Lysholm Knee Score; Male; Medicine; Medicine & Public Health; Original Article • KNEE - IMAGING; Osteotomy - methods; Patients; Prospective Studies; Rehabilitation; Sports injuries; Surgery; Surgical Orthopedics; Surgical techniques; Tomography, X-Ray Computed; Traumatic Surgery; Young Adult; CT imaging; Femoral tunnel enlargement; Anterior cruciate ligament reconstruction; Drilling technique
• ISSN: 1633-8065; 1432-1068; 1432-1068
• DOI: 10.1007/s00590-017-1950-8

Background There are different techniques for drilling the femoral tunnel in the anterior cruciate ligament reconstruction (ACLR), but their influence in the bone tunnel enlargement in unknown. The purpose of this study was to compare two different surgical techniques for evaluating femoral tunnel enlargement in ACLR. The hypothesis was that tunnel placement using the outside-in technique leads to less tunnel enlargement compared to the transtibial technique. Methods Forty-four patients treated for ACLR between March 2013 and March 2014 were prospectively enrolled in this study. According to the surgical technique, subjects were assigned to Group A (Out-in) or Group B (Transtibial). All patients underwent CT examination in order to evaluate the femoral tunnel enlargement at four different levels. Moreover, all patients were evaluated with the Lachman test and pivot shift test, and the KT1000 arthrometer was used to measure the anterior laxity of the knee. A subjective evaluation was performed using the 2000 International Knee Documentation Committee Subjective Knee score, Lysholm knee score and Tegner activity scale. All patients were assessed after 24 months of follow-up. Results At the final follow-up, there were statistically significant differences ( p  < 0.05) in femoral tunnel enlargement between the two groups at all four femoral levels in favor of the out-in group. No statistical significant differences were found in the objective and subjective clinical outcomes between the two groups ( p  > 0.05). Conclusions In ACLR with a suspension system, the outside-in technique leads to less enlargement of the femoral tunnel lower than the transtibial technique.