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Comparison of transtibial and retrograde outside-in techniques of anterior cruciate ligament reconstruction in terms of graft nature and clinical outcomes: a case control study using 3T MRI.
Arch Orthop Trauma Surg. 2017 Mar; 137(3):357-365.AO

Abstract

INTRODUCTION

This study was performed to compare ACL graft maturation and morphologies using MRI between trans-tibial (TT) and retrograde outside-in (OI) techniques, and to compare clinical outcomes between the two groups.

MATERIALS AND METHODS

Patients underwent single-tunnel ACL reconstruction using quadrupled hamstring autografts, with the TT technique used on 42 patients (TT group) and the retrograde OI technique used on 39 patients (OI group). All patients were examined with 3 T MRI at 6 months (between 5 and 7 months) after surgery. The signal intensity of the reconstructed graft was analyzed and compared between the two groups, using the signal/noise quotient (SNQ), the orientation of the ACL graft and the tibial tunnel location of the graft. The SNQ value is indicative of graft maturation, and the orientation of the graft and the tibial tunnel location of the graft represent graft morphology. Clinical evaluation was performed before the surgery and 2 years or more after the surgery.

RESULTS

The mean SNQ value of the TT group was significantly (P = 0.030) lower than that of the OI group. The mean sagittal ACL angle (P < 0.001) and the mean coronal ACL angle (P < 0.001) were more vertical in the TT group. The tibial tunnel aperture was located at a significantly (P < 0.001) more posterior position in the TT group. There was no statistically significant difference in the clinical results between the two groups.

CONCLUSIONS

The OI technique showed a more anteriorly positioned tibial tunnel and a more oblique graft orientation in both sagittal and coronal planes. However, in comparison with the TT group, a significantly higher SNQ value was noticed in the follow-up MRI of the OI group at 6 months, although clinical results of the two groups were not significantly different during at least the 2-year follow-up.

Authors+Show Affiliations

Department of Orthopaedic Surgery, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, South Korea.Department of Orthopaedic Surgery, Seoul National University College of Medicine, Bundang Hospital, Seongnam-si, Gyeonggi-do, South Korea.Department of Orthopaedic Surgery, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, South Korea.Department of Orthopaedic Surgery, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, South Korea.Department of Orthopaedic Surgery, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, South Korea.Department of Orthopaedic Surgery, Jeju National University Hospital, Jeju, South Korea.Department of Orthopaedic Surgery, Barunbone Hospital, 261 Neungdong-ro, Gwangjin-gu, Seoul, 04998, South Korea. colorko@naver.com.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

28132087

Citation

Ahn, Jin Hwan, et al. "Comparison of Transtibial and Retrograde Outside-in Techniques of Anterior Cruciate Ligament Reconstruction in Terms of Graft Nature and Clinical Outcomes: a Case Control Study Using 3T MRI." Archives of Orthopaedic and Trauma Surgery, vol. 137, no. 3, 2017, pp. 357-365.
Ahn JH, Lee YS, Jeong HJ, et al. Comparison of transtibial and retrograde outside-in techniques of anterior cruciate ligament reconstruction in terms of graft nature and clinical outcomes: a case control study using 3T MRI. Arch Orthop Trauma Surg. 2017;137(3):357-365.
Ahn, J. H., Lee, Y. S., Jeong, H. J., Park, J. H., Cho, Y., Kim, K. J., & Ko, T. S. (2017). Comparison of transtibial and retrograde outside-in techniques of anterior cruciate ligament reconstruction in terms of graft nature and clinical outcomes: a case control study using 3T MRI. Archives of Orthopaedic and Trauma Surgery, 137(3), 357-365. https://doi.org/10.1007/s00402-016-2606-6
Ahn JH, et al. Comparison of Transtibial and Retrograde Outside-in Techniques of Anterior Cruciate Ligament Reconstruction in Terms of Graft Nature and Clinical Outcomes: a Case Control Study Using 3T MRI. Arch Orthop Trauma Surg. 2017;137(3):357-365. PubMed PMID: 28132087.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of transtibial and retrograde outside-in techniques of anterior cruciate ligament reconstruction in terms of graft nature and clinical outcomes: a case control study using 3T MRI. AU - Ahn,Jin Hwan, AU - Lee,Yong Seuk, AU - Jeong,Hwa Jae, AU - Park,Jai Hyung, AU - Cho,Yohan, AU - Kim,Kwang-Jeong, AU - Ko,Taeg Su, Y1 - 2017/01/28/ PY - 2016/06/06/received PY - 2017/1/31/pubmed PY - 2017/5/26/medline PY - 2017/1/30/entrez KW - Anterior cruciate ligament KW - Outside-in technique KW - Signal/noise quotient KW - Trans-tibial technique SP - 357 EP - 365 JF - Archives of orthopaedic and trauma surgery JO - Arch Orthop Trauma Surg VL - 137 IS - 3 N2 - INTRODUCTION: This study was performed to compare ACL graft maturation and morphologies using MRI between trans-tibial (TT) and retrograde outside-in (OI) techniques, and to compare clinical outcomes between the two groups. MATERIALS AND METHODS: Patients underwent single-tunnel ACL reconstruction using quadrupled hamstring autografts, with the TT technique used on 42 patients (TT group) and the retrograde OI technique used on 39 patients (OI group). All patients were examined with 3 T MRI at 6 months (between 5 and 7 months) after surgery. The signal intensity of the reconstructed graft was analyzed and compared between the two groups, using the signal/noise quotient (SNQ), the orientation of the ACL graft and the tibial tunnel location of the graft. The SNQ value is indicative of graft maturation, and the orientation of the graft and the tibial tunnel location of the graft represent graft morphology. Clinical evaluation was performed before the surgery and 2 years or more after the surgery. RESULTS: The mean SNQ value of the TT group was significantly (P = 0.030) lower than that of the OI group. The mean sagittal ACL angle (P < 0.001) and the mean coronal ACL angle (P < 0.001) were more vertical in the TT group. The tibial tunnel aperture was located at a significantly (P < 0.001) more posterior position in the TT group. There was no statistically significant difference in the clinical results between the two groups. CONCLUSIONS: The OI technique showed a more anteriorly positioned tibial tunnel and a more oblique graft orientation in both sagittal and coronal planes. However, in comparison with the TT group, a significantly higher SNQ value was noticed in the follow-up MRI of the OI group at 6 months, although clinical results of the two groups were not significantly different during at least the 2-year follow-up. SN - 1434-3916 UR - https://www.unboundmedicine.com/medline/citation/28132087/Comparison_of_transtibial_and_retrograde_outside_in_techniques_of_anterior_cruciate_ligament_reconstruction_in_terms_of_graft_nature_and_clinical_outcomes:_a_case_control_study_using_3T_MRI_ L2 - https://dx.doi.org/10.1007/s00402-016-2606-6 DB - PRIME DP - Unbound Medicine ER -