Skip to main content
SpringerLink
Log in

No long-term tunnel enlargement following anterior cruciate ligament reconstruction using autograft hamstring tendon with dual suspensory fixation

  • KNEE
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Bone tunnel widening following anterior cruciate ligament reconstruction (ACLR) is well documented, although the aetiology and clinical significance of this phenomenon remain unclear. At mid-term follow-up, a greater prevalence of tunnel enlargement has been reported with the use of hamstring (HS) grafts. However, there are paucity of data on what happens in the longer term. The aim of this study was to assess the change in femoral and tibial tunnel dimensions 15 years after four-strand HS ACLR.

Methods

This is a retrospective review of 15 patients who underwent arthroscopic ACLR using HS autograft tendon and were followed up radiographically at 4 months, 2 years and 15 years. Suspensory fixation was used for both ends of the graft. The diameters of the bone tunnels on posteroanterior (PA) and lateral radiographs were measured using digital callipers. Repeated measures analysis of variance (ANOVA) was used to examine change in tunnel width over time.

Results

Radiographic tunnel width did not significantly change between 4 months and 2 years. However, a significant decrease in width was found for both the femoral and tibial tunnels between the 2- and 15-year follow-up (P < 0.01): the femoral tunnel decreased by 50% and 51% in the PA and lateral views, respectively; the tibial tunnel decreased by 77% and 91% in the PA and lateral views respectively. There was no significant correlation between femoral or tibial tunnel width and flexion and extension deficits or with side to side differences in anterior tibial laxity at 15 years.

Conclusions

This radiographic follow-up study of bone tunnel widening following HS ACLR with suspensory fixation demonstrated that tunnel width did not increase beyond 4 months and in fact had decreased significantly at long-term (15 years) follow-up. There was no correlation between tunnel width changes and clinical assessment of flexion and extension deficits or with side-to-side anterior knee laxity at 15-years.

Level of evidence

IV

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Asik M, Sen C, Tuncay I, Erdil M, Avci C, Taser OF (2007) The mid- to long-term results of the anterior cruciate ligament reconstruction with hamstring tendons using Transfix technique. Knee Surg Sports Traumatol Arthrosc 15:965–972

    Article  Google Scholar 

  2. Baumfeld JA, Diduch DR, Rubino LJ, Hart JA, Miller MD, Barr MS, Hart JM (2008) Tunnel widening following anterior cruciate ligament reconstruction using hamstring autograft: a comparison between double cross-pin and suspensory graft fixation. Knee Surg Sports Traumatol Arthrosc 16:1108–1113

    Article  Google Scholar 

  3. Buchner M, Schmeer T, Schmitt H (2007) Anterior cruciate ligament reconstruction with quadrupled semitendinosus tendon—minimum 6 year clinical and radiological follow-up. Knee 14:321–327

    Article  Google Scholar 

  4. Buck DC, Simonian PT, Larson RV, Borrow J, Nathanson DA (2004) Timeline of tibial tunnel expansion after single-incision hamstring anterior cruciate ligament reconstruction. Arthroscopy 20:34–36

    Article  Google Scholar 

  5. Buelow JU, Siebold R, Ellermann A (2002) A prospective evaluation of tunnel enlargement in anterior cruciate ligament reconstruction with hamstrings: extracortical versus anatomical fixation. Knee Surg Sports Traumatol Arthrosc 10:80–85

    Article  Google Scholar 

  6. Chen CH, Chang CH, Su CI, Wang KC, Liu HT, Yu CM, Wong CB, Wang IC (2010) Arthroscopic single-bundle anterior cruciate ligament reconstruction with periosteum-enveloping hamstring tendon graft: clinical outcome at 2 to 7 years. Arthroscopy 26:907–917

    Article  Google Scholar 

  7. Clatworthy MG, Annear P, Bulow JU, Bartlett RJ (1999) Tunnel widening in anterior cruciate ligament reconstruction: a prospective evaluation of hamstring and patella tendon grafts. Knee Surg Sports Traumatol Arthrosc 7:138–145

    Article  CAS  Google Scholar 

  8. Colombet P, Saffarini M, Bouguennec N (2018) Clinical and functional outcomes of anterior cruciate ligament reconstruction at a minimum of 2 years using adjustable suspensory fixation in both the femur and tibia: a prospective study. Orthop J Sports Med 6:2325967118804128

    Article  Google Scholar 

  9. Dave LY, Leong OK, Karim SA, Chong CH (2014) Tunnel enlargement 5 years after anterior cruciate ligament reconstruction: a radiographic and functional evaluation. Eur J Orthop Surg Traumatol 24:217–223

    Article  Google Scholar 

  10. Fauno P, Kaalund S (2005) Tunnel widening after hamstring anterior cruciate ligament reconstruction is influenced by the type of graft fixation used: a prospective randomized study. Arthroscopy 21:1337–1341

    Article  Google Scholar 

  11. Feller JA, Webster KE (2003) A randomized comparison of patellar tendon and hamstring tendon anterior cruciate ligament reconstruction. Am J Sports Med 31:564–573

    Article  Google Scholar 

  12. Fink C, Zapp M, Benedetto KP, Hackl W, Hoser C, Rieger M (2001) Tibial tunnel enlargement following anterior cruciate ligament reconstruction with patellar tendon autograft. Arthroscopy 17:138–143

    Article  CAS  Google Scholar 

  13. Ito MM, Tanaka S (2006) Evaluation of tibial bone-tunnel changes with X-ray and computed tomography after ACL reconstruction using a bone-patella tendon-bone autograft. Int Orthop 30:99–103

    Article  CAS  Google Scholar 

  14. Jansson KA, Harilainen A, Sandelin J, Karjalainen PT, Aronen HJ, Tallroth K (1999) Bone tunnel enlargement after anterior cruciate ligament reconstruction with the hamstring autograft and endobutton fixation technique. A clinical, radiographic and magnetic resonance imaging study with 2 years follow-up. Knee Surg Sports Traumatol Arthrosc 7:290–295

    Article  CAS  Google Scholar 

  15. Klein JP, Lintner DM, Downs D, Vavrenka K (2003) The incidence and significance of femoral tunnel widening after quadrupled hamstring anterior cruciate ligament reconstruction using femoral cross pin fixation. Arthroscopy 19:470–476

    Article  Google Scholar 

  16. L’Insalata JC, Klatt B, Fu FH, Harner CD (1997) Tunnel expansion following anterior cruciate ligament reconstruction: a comparison of hamstring and patellar tendon autografts. Knee Surg Sports Traumatol Arthrosc 5:234–238

    Article  Google Scholar 

  17. Lind M, Feller J, Webster KE (2009) Bone tunnel widening after anterior cruciate ligament reconstruction using EndoButton or EndoButton continuous loop. Arthroscopy 25:1275–1280

    Article  Google Scholar 

  18. Maak TG, Voos JE, Wickiewicz TL, Warren RF (2010) Tunnel widening in revision anterior cruciate ligament reconstruction. J Am Acad Orthop Surg 18:695–706

    Article  Google Scholar 

  19. Marchant MH Jr, Willimon SC, Vinson E, Pietrobon R, Garrett WE, Higgins LD (2010) Comparison of plain radiography, computed tomography, and magnetic resonance imaging in the evaluation of bone tunnel widening after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 18:1059–1064

    Article  Google Scholar 

  20. Mermerkaya MU, Atay OA, Kaymaz B, Bekmez S, Karaaslan F, Doral MN (2015) Anterior cruciate ligament reconstruction using a hamstring graft: a retrospective comparison of tunnel widening upon use of two different femoral fixation methods. Knee Surg Sports Traumatol Arthrosc 23:2283–2291

    Article  Google Scholar 

  21. Nebelung W, Becker R, Merkel M, Ropke M (1998) Bone tunnel enlargement after anterior cruciate ligament reconstruction with semitendinosus tendon using Endobutton fixation on the femoral side. Arthroscopy 14:810–815

    Article  CAS  Google Scholar 

  22. Peyrache MD, Djian P, Christel P, Witvoet J (1996) Tibial tunnel enlargement after anterior cruciate ligament reconstruction by autogenous bone-patellar tendon-bone graft. Knee Surg Sports Traumatol Arthrosc 4:2–8

    Article  CAS  Google Scholar 

  23. Plaweski S, Rossi J, Merloz P (2009) Anterior cruciate ligament reconstruction: assessment of the hamstring autograft femoral fixation using the EndoButton CL. Orthop Traumatol Surg Res 95:606–613

    Article  CAS  Google Scholar 

  24. Sabat D, Kundu K, Arora S, Kumar V (2011) Tunnel widening after anterior cruciate ligament reconstruction: a prospective randomized computed tomography–based study comparing 2 different femoral fixation methods for hamstring graft. Arthroscopy 27:776–783

    Article  Google Scholar 

  25. Sakai H, Yajima H, Hiraoka H, Fukuda A, Hayashi M, Tamai K, Saotome K (2004) The influence of tibial fixation on tunnel enlargement after hamstring tendon anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 12:364–370

    Article  Google Scholar 

  26. Segawa H, Omori G, Tomita S, Koga Y (2001) Bone tunnel enlargement after anterior cruciate ligament reconstruction using hamstring tendons. Knee Surg Sports Traumatol Arthrosc 9:206–210

    Article  CAS  Google Scholar 

  27. Shelbourne KD, Nitz P (1990) Accelerated rehabilitation after anterior cruciate ligament reconstruction. Am J Sports Med 18:292–299

    Article  CAS  Google Scholar 

  28. Silva A, Sampaio R, Pinto E (2010) Femoral tunnel enlargement after anatomic ACL reconstruction: a biological problem? Knee Surg Sports Traumatol Arthrosc 18:1189–1194

    Article  Google Scholar 

  29. Webster KE, Chiu JJ, Feller JA (2005) Impact of measurement error in the analysis of bone tunnel enlargement after anterior cruciate ligament reconstruction. Am J Sports Med 33:1680–1687

    Article  Google Scholar 

  30. Webster KE, Feller JA, Elliott J, Hutchison A, Payne R (2004) A comparison of bone tunnel measurements made using computed tomography and digital plain radiography after anterior cruciate ligament reconstruction. Arthroscopy 20:946–950

    Article  Google Scholar 

  31. Webster KE, Feller JA, Hameister KA (2001) Bone tunnel enlargement following anterior cruciate ligament reconstruction: a randomised comparison of hamstring and patellar tendon grafts with 2-year follow-up. Knee Surg Sports Traumatol Arthrosc 9:86–91

    Article  CAS  Google Scholar 

  32. Webster KE, Feller JA, Hartnett N, Leigh WB, Richmond AK (2016) Comparison of patellar tendon and hamstring tendon anterior cruciate ligament reconstruction: a 15-year follow-up of a randomized controlled trial. Am J Sports Med 44:83–90

    Article  Google Scholar 

  33. Wilson TC, Kantaras A, Atay A, Johnson DL (2004) Tunnel enlargement after anterior cruciate ligament surgery. Am J Sports Med 32:543–549

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. OrthoSport Victoria, Epworth HealthCare, Melbourne, Australia

    B. M. Devitt, M. Maes & J. A. Feller

  2. School of Allied Health, La Trobe University, Melbourne, Australia

    B. M. Devitt, J. A. Feller & K. E. Webster

  3. ZNA Hospitals, Antwerp, Belgium

    M. Maes

Authors
  1. B. M. Devitt
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Maes
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. A. Feller
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. K. E. Webster
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to K. E. Webster.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Funding

No funding.

Ethical approval

Ethical approval was from La Trobe University Human Ethics Committee.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Devitt, B.M., Maes, M., Feller, J.A. et al. No long-term tunnel enlargement following anterior cruciate ligament reconstruction using autograft hamstring tendon with dual suspensory fixation. Knee Surg Sports Traumatol Arthrosc 28, 2157–2162 (2020). https://doi.org/10.1007/s00167-019-05741-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-019-05741-7

Keywords

Search

Navigation