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Anatomical rectangular tunnel anterior cruciate ligament reconstruction provides excellent clinical outcomes

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

Abstract

Purpose

The purpose of this study was to prospectively evaluate the clinical outcomes following anatomical rectangular tunnel anterior cruciate ligament (ACL) reconstruction with a bone–patellar tendon–bone (BTB) graft using an adjustable-length femoral cortical fixation device with enough patients and a high follow-up rate.

Methods

This study included 125 patients who underwent anatomical rectangular tunnel ACL reconstruction with a BTB graft. A BTB TightRope® was used for femoral graft fixation. Clinical evaluations were performed more than 2 years after surgery using the International Knee Documentation Committee (IKDC) Form. Patients interviewed by telephone were only subjectively evaluated. The side-to-side difference in anterior laxity at a manual maximum force was measured using the KT-2000 Arthrometer®.

Results

Among the 125 patients, 99 were ultimately included and 26 were lost to follow-up (follow-up rate: 79%). Eight patients had re-tear (re-tear rate: 8%) and six patients had ACL injuries to the contralateral knee. Three patients did not follow our rehabilitation programme. One patient suffered septic arthritis. These 18 patients were considered ineligible for clinical evaluations. Therefore, clinical evaluations were performed in 81 of the 99 patients (64 were available for direct follow-up and 17 were available for a telephone interview). The follow-up period was 30 ± 10 months (range 24–68 months). According to the IKDC subjective assessment, 48 (59%) and 33 (41%) knees were graded as normal and nearly normal, respectively. A loss of extension (3°–5°) was observed in five patients (8%), whereas one patient (2%) exhibited a loss of flexion (3°–5°). The Lachman test was negative in 63 patients (98%). The pivot shift test was negative in 59 patients (92%). The side-to-side difference in KT value was 0.4 ± 0.7 mm (range − 1–4 mm).

Conclusion

Anatomical rectangular tunnel ACL reconstruction with a BTB graft using an adjustable-length femoral cortical fixation device provided excellent clinical outcomes both subjectively and objectively more than 2 years after surgery, whereas 8 of the 99 patients had re-tear of the graft. The adjustable-length femoral cortical fixation device could be safely used in anatomical rectangular tunnel ACL reconstruction with a BTB graft.

Level of evidence

III

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Abbreviations

ACL:

Anterior cruciate ligament

HT:

Hamstring tendon

BTB:

Bone–patellar tendon–bone

CT:

Computed tomography

ART:

Anatomical rectangular tunnel

β-TCP:

Beta-tricalcium phosphate

IKDC:

International Knee Documentation Committee

R/R:

Recurrent abnormal laxity following a traumatic episode or reinjury

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Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Author information

Authors and Affiliations

  1. Department of Orthopedic Sports Medicine, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki, Hyogo, 660-0064, Japan

    Tomohiko Matsuo, Ryohei Uchida & Takayuki Tsuda

  2. Department of Orthopedics, Japan Community Healthcare Organization Osaka Hospital, 4-2-78, Fukushima, Osaka, 553-0003, Japan

    Masashi Kusano

  3. School of Health and Sports Sciences, Mukogawa Women’s University, 6-46, Ikebirakicho, Nishinomiya, Hyogo, 663-8558, Japan

    Yukiyoshi Toritsuka

Authors
  1. Tomohiko Matsuo
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  2. Masashi Kusano
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  3. Ryohei Uchida
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  4. Takayuki Tsuda
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  5. Yukiyoshi Toritsuka
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Contributions

TM designed the study and drafted the manuscript. YT was responsible for the revision of the manuscript. MK, RU, and TT assisted TM in analyzing the data. All authors approved the final manuscript.

Corresponding author

Correspondence to Yukiyoshi Toritsuka.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The Ethical Review Board of Kansai Rosai Hospital has approved this study (no. 12-10).

Informed consent

All patients provided informed consent before participation.

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Matsuo, T., Kusano, M., Uchida, R. et al. Anatomical rectangular tunnel anterior cruciate ligament reconstruction provides excellent clinical outcomes. Knee Surg Sports Traumatol Arthrosc 30, 1396–1403 (2022). https://doi.org/10.1007/s00167-021-06609-5

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  • DOI: https://doi.org/10.1007/s00167-021-06609-5

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