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Serial dilation reduces graft slippage compared to extraction drilling in anterior cruciate ligament reconstruction: a randomized controlled trial using radiostereometric analysis

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

Abstract

Purpose

This study tested the hypothesis that serial dilation of the tibial tunnel could provide a stronger anchorage of the graft-fixation-device complex compared to traditional extraction drilling.

Methods

Forty patients (22 men and 18 women) undergoing ACL reconstruction were randomized to either extraction drilling (group ED) or compaction by serial dilation (group SD) of the tibial tunnel. Tantalum beads were placed in the tibia, femur, and in the hamstring graft. Radiostereometric analysis (RSA) was performed postoperatively and again after 6, 12, and 24 weeks. Migration of graft in the bone tunnels as well as knee laxity was assessed using RSA and a TELOS stress device.

Results

Six patients (three men and three women) were excluded during follow-up, which resulted in 17 patients in group ED [median age 30 years (range 20–50)] and 17 patients in group SD [median age 32 years (range 20–49)]. The mean migration of the graft in the tibial bone canal after 3 months was 1.3 (SD 0.6) mm in group ED and 0.8 (SD 0.5) mm in group SD (P = 0.02). The overall knee laxity after 3 months was 13.0 (SD 4.0) mm in group ED and 10.9 (SD 3.1) mm in group SD.

Conclusion

This study found less slippage of the hamstring graft in the tibial bone canal in the serial dilated group compared to the extraction drilling group. The clinical relevance of the difference is unknown. No difference in stress radiographic knee laxity was found between the two groups.

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Acknowledgments

The authors would like to thank Smith and Nephew for providing the instruments used for serial dilation during the study.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Orthopaedics, Hospital Unit West, Gl. Landevej 61, 7400, Herning, Denmark

    O. G. Sørensen, K. Larsen, T. B. Hansen & S. Taudal

  2. Department of Orthopaedics, University Hospital of Aarhus, Tage Hansensgade 2, 8000, Aarhus, Denmark

    O. G. Sørensen, B. Lund, S. E. Christiansen, M. Lind & K. Søballe

  3. Department of Orthopaedics, University Hospital of Aalborg, Hobrovej 18-22, 9100, Aalborg, Denmark

    S. Kold

  4. Eira Private Hospital, Science Center Skejby, Brendstrupgaardsvej 21, 8200, Aarhus N, Denmark

    B. W. Jakobsen

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  1. O. G. Sørensen
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Correspondence to O. G. Sørensen.

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Sørensen, O.G., Larsen, K., Jakobsen, B.W. et al. Serial dilation reduces graft slippage compared to extraction drilling in anterior cruciate ligament reconstruction: a randomized controlled trial using radiostereometric analysis. Knee Surg Sports Traumatol Arthrosc 19, 347–354 (2011). https://doi.org/10.1007/s00167-010-1220-3

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  • DOI: https://doi.org/10.1007/s00167-010-1220-3

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