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Anatomic double-bundle anterior cruciate ligament reconstruction could not achieve sufficient control of pivot-shift when accompanying tibial tunnel coalition

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To evaluate the effect of tibial tunnel coalition on knee rotatory laxity and clinical outcomes after double-bundle (DB) anterior cruciate ligament (ACL) reconstruction.

Methods

Forty-one patients who underwent anatomic DB ACL reconstruction were included prospectively. Three-dimensional computed tomography of the knee joint was obtained at approximately 1 year postoperatively to determine if tunnel coalition occurred. After excluding seven cases of femoral tunnel coalition, two groups were established based on the existence of a tibial tunnel coalition. The pivot-shift test was quantitatively evaluated on the basis of tibial acceleration preoperatively and at 1 year postoperatively. Two subjective scores, the International Knee Documentation Committee (IKDC) subjective and Lysholm scores, were also collected. The pivot-shift measurement and subjective scores were compared between the ACL-reconstructed knees with and without tibial tunnel coalition. The independent t test, Pearson’s chi-square test, and Student t tests were used in data analysis.

Results

Twenty-one knees had tibial tunnel coalition (group C), whereas 13 knees did not have tunnel coalition(group N). Pivot-shift was significantly diminished postoperatively in both groups on the basis of the clinical examination and quantitative evaluations (p < 0.05). However, there was a small but significant difference in tibial acceleration demonstrating larger pivot-shift in group C (1.0 ± 0.6 m/s2) than in group N (0.5 ± 0.3 m/s2, p < 0.05). No significant difference was observed in the IKDC subjective and Lysholm scores (both n.s.).

Conclusion

When the tibial tunnel coalition occurs after DB ACL reconstruction, knee rotatory laxity may not be restored in ACL-reconstructed knees, as expected in those without tunnel coalition. It is recommended that two tibial tunnels should be created separately when performing DB-ACL reconstruction to achieve better control of rotatory knee laxity.

Level of evidence

III.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Graduate School of Medicine, Kobe University, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan

    Koji Nukuto, Yuichi Hoshino, Tetsuya Yamamoto, Nobuaki Miyaji, Kanto Nagai, Daisuke Araki, Noriyuki Kanzaki, Takehiko Matsushita & Ryosuke Kuroda

Authors
  1. Koji Nukuto
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  2. Yuichi Hoshino
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  3. Tetsuya Yamamoto
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  4. Nobuaki Miyaji
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  5. Kanto Nagai
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  6. Daisuke Araki
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  7. Noriyuki Kanzaki
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  8. Takehiko Matsushita
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  9. Ryosuke Kuroda
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Contributions

All authors have made substantial contributions to (1) the conception and design of the study, or acquisition, analysis and interpretation of data; (2) drafting the article or revising it critically for important intellectual content; (3) final approval of the version to be submitted; and (4) agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately resolved. The specific contributions of the authors are as follows: 1. Conception and design of the work; KN, YH, TM, RK. 2. Acquisition, analysis, and interpretation of data for the work: KN, YH, TY, NM, KN, DA, TM. 3. Drafting the article: KN. 4. Critical revision of the article for important intellectual content: KN, YH, TM, RK. 5. Final approval of the version to be published: KN, YH, TY, NM, KN, DA, NK, TM, RK. 6. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: YH, TM, RK.

Corresponding author

Correspondence to Yuichi Hoshino.

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The Ethics Committee of Kobe University Graduate School of Medicine approved this study.

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Nukuto, K., Hoshino, Y., Yamamoto, T. et al. Anatomic double-bundle anterior cruciate ligament reconstruction could not achieve sufficient control of pivot-shift when accompanying tibial tunnel coalition. Knee Surg Sports Traumatol Arthrosc 29, 3743–3750 (2021). https://doi.org/10.1007/s00167-020-06383-w

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