Bone tunnel enlargement in anterior cruciate ligament reconstruction done using hamstring tendon autografts: A prospective clinical and computed tomography-based evaluation

Abstract

Context: Enlargement of osseous tunnels following anterior cruciate ligament (ACL) reconstruction is a newer discovery. This phenomenon is particularly valuable in planning for revision ACL reconstruction. Aim: The purpose of this study was to evaluate prospectively the increase in size of the tibial and femoral bone tunnel following arthroscopic ACL reconstruction with quadrupled hamstring autograft and fixation with biodegradable interference screws. Materials and Methods: A prospective study was conducted on 10 patients who underwent arthroscopic ACL reconstruction with quadrupled hamstring autograft and fixation with biodegradable interference screws. Tunnel width was measured at postoperative 2 weeks and an average of 1-year follow-up (range: 10–13 months). Clinical evaluation was done as per the International Knee Documentation Committee form. Paired Student's t-test and linear regression were used for statistical analysis. Results: There was a mean 14% enlargement in the femoral tunnel (from 9 mm at postoperative 2 weeks to 10.3 mm at postoperative 1 year) and 18% enlargement in the tibial tunnel (from 10.4 mm at postoperative 2 weeks to 12.2 mm at the postoperative 1-year follow-up). Both of these were statistically significant (P = 0.005 for femoral tunnel enlargement and P = 0.008 for the enlargement of the tibial tunnel). No statistically significant association was noted between tunnel enlargement and clinical results. Conclusion: Compared to previous similar studies, less tunnel widening was observed in the present study. We come to a conclusion that less aggressive rehabilitation program and anatomical graft fixation technique can help achieve the goal of minimum tunnel enlargement after ACL reconstruction.