González PAA, Negrete CJ, Chávez HE

Language: Spanish
References: 18
Page: 76-83
PDF size: 211.87 Kb.

ABSTRACT

The purpose of this work is to correlate the clinical, functional and radiographic results of the anterior cruciate ligament (ACL) reconstruction with the angulation and orientation of the femoral and tibial tunnels. Introduction: The ACL is one of the most frequently injured articular structures of the knee. The reason for this being that it is the primary limiting structure of anterior tibial translation; its tear causes kinematic alterations and results in long-term degenerative and functional changes. Repair can restore the kinematics. Material and methods: 26 patients, 20-50 years old, post-ACL reconstruction with the semitendinous-gracilis technique. From November 2006 to July 2007. Clinical and functional assessments: Tegner and Lysholm. Radiographic assessment: anteroposterior view with knee extension and lateral view with 30° flexion. Pearson correlations (r) were used in the analysis. Results: 26 patients (100%), 20 males (76.92%), 6 females (23.08%). Mean of 2.4 in the Lysholm scale (fair to good); standard deviation 1.2. Bernard-Lysholm quadrant r= -0.772. Tegner quadrant r=0.790. Conclusions. The Lysholm and Tegner scale is associated with the graft quadrant. The situation of the tibial implant in the saggital plane is associated with the Lysholm scale. The correlation of patients with an inadequate placement with respect to the quadrants was associated with good-to-excellent results and fair-to-good results. Two patients had a poor clinical outcome; the orientation of the AP angle and the quadrant were within acceptable parameters, with the exception of the lateral angle-shaft axis.

REFERENCES

1. Bernard M, Hertel P, Hornung H, et al: Femoral insertion of the ACL. Radiographic quadrant method. Am J Knee Surg 1997; 10: 14-22.

2. Dienst M, Burks RT, Patrick E, Greis MD: Anatomy and biomechanics of the anterior cruciate ligament. Orthop Clin N Am 2002; 33: 605-20.

3. Beynnon BD, Johnson RJ, Abate JA, Fleming BC, Nichols CE. Treatment of Anterior Cruciate Ligament Injuries, Part 1 Journal Sport Med 33(10)A. 2005.

4. Lawhorn KW, Stephen M, Howell MD: Correct placement of tibial and femoral tunnels for anterior cruciate ligament reconstruction using the transtibial technique. Techniques in Knee Surgery 2003: 2(1).

5. Dargel J, Gotter M, Mader K, Pennig D, Koebke J, Schmidt-Wiethoff R: Biomechanics of the anterior cruciate ligament and implications for surgical Reconstruction. Strat Traum Limb Recon 2007; 2: 1-12.

6. Beynnon BD, Johnson RJ, Abate JA, Fleming BC, Nichols CE. Treatment of Anterior Cruciate Ligament Injuries, Part 2 The American Journal of Sports Medicine 2005: 33(11).

7. Dargel M, Gotter K, Mader D, Pennig J, Koebke R: Schmidt-Wiethoff Biomechanics of the anterior cruciate ligament and implications for surgical reconstruction. Strat Traum Limb Recon 2007; 2: 1-12.

8. Schiavone PA, Milano G, Tartarone M, Demontis A, Fabbriciani C: Clinical and radiographic results of ACL reconstruction: a 5- to 7-year follow-up study of outside-in versus inside-out reconstruction techniques. Knee Surg, Sports Traumatol, Arthrosc 2001; 9: 77-85.

9. Arnold MP, Verdonschot N, Kampen AV: ACL graft can replicate the normal gament’s tension curve Knee. Surg Sports Traumatol Arthrosc 2005; 13: 625-631.

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

11. Stephen M: Howell principles for placing the tibial tunnel and avoiding roof impingement during reconstruction of a torn anterior cruciate ligament. Knee Surg, Sports Traumatol, Arthrosc 1998; 6 [Suppl 1]: S49-S55.

12. Behrend H, Stutz G, Kessler MA, Rukavina A, Giesinger K, Kuster MS. Tunnel placement in anterior cruciate ligament (ACL) reconstruction: quality control in a teaching hospital. Knee Surg Sports Traumatol Arthrosc 2006; 14: 1159-65.

13. Fink JC, Lundberg-Jensen AK, Faunoe P: Does the Position of the Femoral Tunnel Affect the Laxity or Clinical Outcome of the Anterior Cruciate Ligament–Reconstructed Knee? A Clinical, Prospective, Randomized, Double-Blind Study Arthroscopy. The Journal of Arthroscopic and Related Surgery 2007; 23(12) 1326-33.

14. Kobayashi M, Nakagawa Y, Suzuki T, Okudaira S, Nakamura T: Retrospective review of bone tunnel enlargement after anterior cruciate ligament reconstruction with hamstring tendons fixed with a metal round cannulated interference screw in the femur arthroscopy: The Journal of Arthroscopic and Related Surgery. 2006; 22(10): 1093-9.

15. Van de Velde SK, DeFrate LE, Gill TJ, Moses JM, Papannagari R, Li G, Ramprasad PM: The effect of anterior cruciate ligament deficiency on the in vivo elongation of the medial and lateral collateral ligaments. Am J Sports Med 2007; 35: 294-300.

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

17. L’Insalata JC, Klatt B, Fu FH, Harner CD: Tunnel expansion following anterior cruciate ligament reconstruction: a comparison of hamstring and patellar tendon autografts. Knee Surg, Sports Traumatol, Arthrosc 1997; 5: 234-8.

18. Clatworthy MG, Annear P, Bulow JU, Bartlett RJ: Tunnel widening in anterior cruciate ligament reconstruction: a prospective evaluation of hamstring and patella tendon grafts. Knee Surg, Sports Traumatol, Arthrosc 1999; 7: 138-45.