Minimal Ablation of the Tibial Stump Using Bony Landmarks Improved Stability and Synovial Coverage Following Double-Bundle Anterior Cruciate Ligament Reconstruction.

Yuya Kodama,Toshifumi Ozaki,Tomohito Hino,Takayuki Furumatsu,Yusuke Kamatsuki

doi:10.5792/ksrr.18.024

Yuya Kodama, Toshifumi Ozaki + Show 3 more

Open Access

https://doi.org/10.5792/ksrr.18.024

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Journal: Knee surgery & related research	Publication Date: Dec 1, 2018
Citations: 8	License type: CC BY-NC 4.0

Affiliation: Okayama University

Abstract

PurposeTo evaluate the clinical effects of using anatomical bony landmarks (Parsons’ knob and the medial intercondylar ridge) and minimal ablation of the tibial footprint to improve knee anterior instability and synovial graft coverage after double-bundle anterior cruciate ligament reconstruction.Materials and MethodsWe performed a retrospective comparison of outcomes between patients who underwent reconstruction with minimal ablation of the tibial footprint, using an anatomical tibial bony landmark technique, and those who underwent reconstruction with wide ablation of the tibial footprint. Differences between the two groups were evaluated using second-look arthroscopy, radiological assessment of the tunnel position, postoperative anterior knee joint laxity, and clinical outcomes.ResultsUse of the anatomical reference and minimal ablation of the tibial footprint resulted in a more anterior positioning of the tibial tunnel, with greater synovial coverage of the graft postoperatively (p=0.01), and improved anterior stability of the knee on second-look arthroscopy. Both groups had comparable clinical outcomes.ConclusionsUse of anatomical tibial bony landmarks that resulted in a more anteromedial tibial tunnel position improved anterior knee laxity, and minimal ablation improved synovial coverage of the graft; however, it did not significantly improve subjective and functional short-term outcomes.

Highlights

One study has reported on the importance of preserving a tibial stump as a minimum, if the remnant cannot be fully preserved12), another study demonstrated that the tunnel position rather than remnant preservation is more important to reproduce the func tion of the original anterior cruciate ligament (ACL) after reconstruction13)
We focused on two aspects of the recon struction technique mainly to acquire good synovial coverage and to create a reproducible anatomical tibial tunnel: preservation of a tibial stump by the use of minimal ablation (MA) of the tibial footprint of the ACL12) and the use of bony landmarks (Parsons’ knob14) and the medial intercondylar ridge15)) on the tibia to de termine the position of the tibial tunnel
Our aim was to compare the outcomes of our double-bundle ACL reconstruction, using bony anatomical landmarks on the tibia performed with MA of tibial stump, to those of double-bundle reconstruction performed with wide ablation (WA) of the tibial stump of the ACL

Summary

Introduction

One study has reported on the importance of preserving a tibial stump as a minimum, if the remnant cannot be fully preserved12), another study demonstrated that the tunnel position rather than remnant preservation is more important to reproduce the func tion of the original ACL after reconstruction[13]). We focused on two aspects of the recon struction technique mainly to acquire good synovial coverage and to create a reproducible anatomical tibial tunnel: preservation of a tibial stump by the use of minimal ablation (MA) of the tibial footprint of the ACL12) and the use of bony landmarks (Parsons’ knob14) and the medial intercondylar ridge15)) on the tibia to de termine the position of the tibial tunnel. We hy pothesized that MA would improve synovial coverage of the graft and that placement of the tibial tunnel based on the tibial bony landmarks during ACL reconstruction would enhance anterior knee stability post-reconstruction

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