2017 ISAKOS Biennial Congress ePoster #1078

 

Tunnel Position of Remnant Preserving Anterior Cruciate Ligament Reconstruction Evaluated by Three-Dimensional Computed Tomography: Comparison Between Split and Non-Split Remnant Preserving Technique

Hyuk-Soo Han, MD, PhD, Seoul KOREA, REPUBLIC OF
Yoonho Kwak, Seoul KOREA, REPUBLIC OF
Junghwan Park, Seoul KOREA, REPUBLIC OF
Sahnghoon Lee, MD, PhD, Seoul KOREA, REPUBLIC OF
Myung Chul Lee, MD, PhD, Prof., Seoul KOREA, REPUBLIC OF

Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Korea, Seoul, KOREA, REPUBLIC OF

FDA Status Cleared

Summary

Tunnel positions of both techniques were within anatomic position and both groups have no significant difference in clinical outcome. It may be necessary to understand that tunnel position changes according to remnant preserving technique

Abstract

Introduction

Recently there has been various surgical techniques seeking to preserve Anterior Cruciate Ligament Remnants in knowledge that these bundles play a role in graft healing process, proprioception preservation as well as biomechanical stability. Maximal preservation of ACL remnant has become a consideration in new approaches of remnant preservation. But remnant preservation technique has problem like poor arthroscopic view to search for proper tunnel position. Therefore, We compare clinical results and tunnel position between split, non-split remnant preservation technique and remnant non-preservation technique by three-dimensional computed tomography

Methods

95 patients 9 between January 2008 and December 2013 with a minimum of 1 year follow up and a postoperative 3D-CT were retrospectively studied; 24 reconstructions were performed without preserving remnants, 48 reconstructions were allotted in split group and 23 reconstructions were operated by nonsplitting technique. In splitting technique, the surgeon make a longitudinal slit in the ACL remnant tissue using scalpel blade, then place the tibial tunnel guide near the center of ACL footprint. But, in nonsplitting technique, the surgeon place the tibial tunnel guide at posterolateral to remnant and pull the guide toward center of ACL foot print in order to preserve more remnant tissues. Quadrant method was used to assess the tunnel location in 3D-CT. KT-2000 arthrometry and manual laxity test including Anterior drawar test, Lachmann test, Pivot-shift test were evaluated for analysis. IKDC score, Lysholm score, Tegner activity scale were utilized as functional parameters

Results

Tibial tunnel position in anterior-posterior position was significantly different between splitting technique group and non-splitting technique group.(splitting vs nonsplitting group; 38.7±11.1 % vs 44.9±5.2%; p=0.001). But, Tibial tunnel position in medial-lateral position and femoral tunnel position was not significantly different between the three groups. The three groups did not differ significantly in the clinical outcome, KT-2000 arthrometry and manual laxity test

Discussion And Conclusion

Tunnel position was different according to remnant preserving technique. The tibial tunnel was placed at a more posterior position in non-Splitting technique compared with splitting technique. Considering the anatomical positions from previous cadevaric studies, tibial tunnel tended to locate near AM bundle with splitiing technique while with non-splitting technique, tibial tunnel tended to locate near PL bundle tunnel. However, Tunnel positions of both techniques were within anatomic position and both groups have no significant difference in clinical outcome. It may be necessary to understand that tunnel position changes according to remnant preserving technique