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Effect of Femoral Tunnel Position on Stability and Clinical Outcomes After Single-Bundle Anterior Cruciate Ligament Reconstruction Using the Outside-In Technique.

Abstract

PURPOSE

To evaluate the effects of the femoral tunnel location in the femoral footprint of the anterior cruciate ligament (ACL) on postoperative knee stability and clinical outcomes after ACL reconstruction (ACLR) using the outside-in technique.

METHODS

From December 2012 to August 2014, ACLR was performed using the outside-in technique in 137 patients. Among these patients, those who had a follow-up period of over 2 years were retrospectively reviewed. A total of 102 patients met the inclusion criteria. The relative location of the femoral tunnel in the lateral condyle was evaluated as a percentage using the standardized grid system on a 3-dimensional computed tomography image. Each patient was then classified into the anterior group, center group (anteroposterior plane, 29.3% ± 3.5%), or posterior group depending on the location of the femoral tunnel. Knee laxity was evaluated using a GNRB knee arthrometer, stress radiography, and the pivot-shift test. From a clinical perspective, patient-reported outcomes (International Knee Documentation Committee subjective form and Lysholm knee score) were then evaluated.

RESULTS

Of 102 patients, 31 (30.4%) were assigned to the anterior group, 46 (45.1%) were assigned to the center group, and 25 (24.5%) were assigned to the posterior group. Postoperative side-to-side differences, which were measured using stress radiographs and the GNRB arthrometer, were significantly smaller in the posterior group (1.7 ± 0.6 mm and 1.5 ± 0.5 mm, respectively) than in the center group (2.3 ± 0.9 mm and 2.2 ± 2.8 mm, respectively) and anterior group (2.4 ± 0.7 mm and 2.4 ± 1.3 mm, respectively) (P = .002 for stress radiography and P = .002 for GNRB arthrometer). No significant between-group differences were observed in the pivot-shift test results and patient-reported outcomes among the 3 groups.

CONCLUSIONS

The location of the femoral tunnel in the anatomic ACL footprint did not affect postoperative stability and clinical outcomes in the case of ACLR using the outside-in technique.

LEVEL OF EVIDENCE

Level III, retrospective comparative study.

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  • Publisher Full Text
  • Authors+Show Affiliations

    ,

    Department of Orthopedic Surgery, Haeundae Bumin Hospital, Busan, Republic of Korea.

    ,

    Department of Orthopedic Surgery, Inje University Busan Paik Hospital, Busan, Republic of Korea.

    ,

    Department of Orthopedic Surgery, Inje University Busan Paik Hospital, Busan, Republic of Korea. Electronic address: leechangrack@inje.ac.kr.

    ,

    Department of Orthopedic Surgery, Inje University Busan Paik Hospital, Busan, Republic of Korea.

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    Department of Orthopedic Surgery, Bumin Hospital, Busan, Republic of Korea.

    ,

    Department of Orthopedic Surgery, Bumin Hospital, Busan, Republic of Korea.

    Department of Orthopedic Surgery, Inje University Busan Paik Hospital, Busan, Republic of Korea.

    Source

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    30979621

    Citation

    Seo, Seung-Suk, et al. "Effect of Femoral Tunnel Position On Stability and Clinical Outcomes After Single-Bundle Anterior Cruciate Ligament Reconstruction Using the Outside-In Technique." Arthroscopy : the Journal of Arthroscopic & Related Surgery : Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association, vol. 35, no. 6, 2019, pp. 1648-1655.
    Seo SS, Kim CW, Lee CR, et al. Effect of Femoral Tunnel Position on Stability and Clinical Outcomes After Single-Bundle Anterior Cruciate Ligament Reconstruction Using the Outside-In Technique. Arthroscopy. 2019;35(6):1648-1655.
    Seo, S. S., Kim, C. W., Lee, C. R., Kwon, Y. U., Kim, M. W., Kim, O. G., & Seo, H. W. (2019). Effect of Femoral Tunnel Position on Stability and Clinical Outcomes After Single-Bundle Anterior Cruciate Ligament Reconstruction Using the Outside-In Technique. Arthroscopy : the Journal of Arthroscopic & Related Surgery : Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association, 35(6), pp. 1648-1655. doi:10.1016/j.arthro.2018.11.055.
    Seo SS, et al. Effect of Femoral Tunnel Position On Stability and Clinical Outcomes After Single-Bundle Anterior Cruciate Ligament Reconstruction Using the Outside-In Technique. Arthroscopy. 2019;35(6):1648-1655. PubMed PMID: 30979621.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Effect of Femoral Tunnel Position on Stability and Clinical Outcomes After Single-Bundle Anterior Cruciate Ligament Reconstruction Using the Outside-In Technique. AU - Seo,Seung-Suk, AU - Kim,Chang-Wan, AU - Lee,Chang-Rack, AU - Kwon,Yong-Uk, AU - Kim,Mu-Won, AU - Kim,Ok-Gul, AU - Seo,Hyeong-Won, Y1 - 2019/04/09/ PY - 2018/04/25/received PY - 2018/11/16/revised PY - 2018/11/21/accepted PY - 2019/4/14/pubmed PY - 2019/4/14/medline PY - 2019/4/14/entrez SP - 1648 EP - 1655 JF - Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association JO - Arthroscopy VL - 35 IS - 6 N2 - PURPOSE: To evaluate the effects of the femoral tunnel location in the femoral footprint of the anterior cruciate ligament (ACL) on postoperative knee stability and clinical outcomes after ACL reconstruction (ACLR) using the outside-in technique. METHODS: From December 2012 to August 2014, ACLR was performed using the outside-in technique in 137 patients. Among these patients, those who had a follow-up period of over 2 years were retrospectively reviewed. A total of 102 patients met the inclusion criteria. The relative location of the femoral tunnel in the lateral condyle was evaluated as a percentage using the standardized grid system on a 3-dimensional computed tomography image. Each patient was then classified into the anterior group, center group (anteroposterior plane, 29.3% ± 3.5%), or posterior group depending on the location of the femoral tunnel. Knee laxity was evaluated using a GNRB knee arthrometer, stress radiography, and the pivot-shift test. From a clinical perspective, patient-reported outcomes (International Knee Documentation Committee subjective form and Lysholm knee score) were then evaluated. RESULTS: Of 102 patients, 31 (30.4%) were assigned to the anterior group, 46 (45.1%) were assigned to the center group, and 25 (24.5%) were assigned to the posterior group. Postoperative side-to-side differences, which were measured using stress radiographs and the GNRB arthrometer, were significantly smaller in the posterior group (1.7 ± 0.6 mm and 1.5 ± 0.5 mm, respectively) than in the center group (2.3 ± 0.9 mm and 2.2 ± 2.8 mm, respectively) and anterior group (2.4 ± 0.7 mm and 2.4 ± 1.3 mm, respectively) (P = .002 for stress radiography and P = .002 for GNRB arthrometer). No significant between-group differences were observed in the pivot-shift test results and patient-reported outcomes among the 3 groups. CONCLUSIONS: The location of the femoral tunnel in the anatomic ACL footprint did not affect postoperative stability and clinical outcomes in the case of ACLR using the outside-in technique. LEVEL OF EVIDENCE: Level III, retrospective comparative study. SN - 1526-3231 UR - https://www.unboundmedicine.com/medline/citation/30979621/Effect_of_Femoral_Tunnel_Position_on_Stability_and_Clinical_Outcomes_After_Single-Bundle_Anterior_Cruciate_Ligament_Reconstruction_Using_the_Outside-In_Technique L2 - https://linkinghub.elsevier.com/retrieve/pii/S0749-8063(18)31141-1 DB - PRIME DP - Unbound Medicine ER -