|
1
|
Koukoulias NE, Germanou E, Koukoulias D, Vasiliadis AV, Dimitriadis T. Intra-articular migration of tibial suture button in pediatric full epiphyseal anterior cruciate ligament reconstruction. A case report. J ISAKOS 2024; 9:100303. [PMID: 39127226 DOI: 10.1016/j.jisako.2024.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 07/27/2024] [Accepted: 08/05/2024] [Indexed: 08/12/2024]
Abstract
We report a case of a 12-years-old boy that underwent anterior cruciate ligament (ACL) reconstruction and lateral meniscus repair. The all-epiphyseal, all-inside technique, with quadriceps tendon autograft and adjustable suspensory button fixation was utilized due to the open physes. Intraoperative fluoroscopy confirmed optimal position of the buttons, while arthroscopic evaluation of the graft showed proper tension, with full range of motion and knee stability. Nevertheless, routine radiographic evaluation of the knee, 6 h postoperatively, revealed tibial button migration through the tunnel into the knee joint, while the knee was unstable in clinical examination. The graft was removed and reloaded with extended buttons. The femoral socket was retained in the revision surgery while a new tibial socket was drilled with the transphyseal technique (all-inside technique). The postoperative course was uneventful. The patient returned to unrestricted activities at twelve months after revision surgery and remains fully active two years postoperatively. This is the first case of tibial button migration reported in the literature, with immediate migration after surgery, intra-articular position of the button and negative impact on graft tension. Failure to recognize and treat this detrimental complication could be catastrophic for the knee. The technique of the surgical treatment is also described. Surgeons should be aware of this rare complication, that could adversely affect the clinical outcome.
Collapse
Affiliation(s)
- Nikolaos E Koukoulias
- Sports Trauma and Orthopaedic Department, St. Luke's Hospital, Thessaloniki, Greece.
| | - Evangelia Germanou
- Aristotle University of Thessaloniki, Department of Physical Education and Sport Science, Thessaloniki, Greece
| | - Dimitris Koukoulias
- International Hellenic University, Department of Physiotherapy, Thessaloniki, Greece
| | - Angelo V Vasiliadis
- Sports Trauma and Orthopaedic Department, St. Luke's Hospital, Thessaloniki, Greece
| | | |
Collapse
|
|
2
|
Mann O, Al-Dadah O. Anterior cruciate ligament reconstruction: Effect of graft tunnel position on early to mid-term clinical outcomes. World J Orthop 2024; 15:744-753. [PMID: 39165872 PMCID: PMC11331329 DOI: 10.5312/wjo.v15.i8.744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 05/30/2024] [Accepted: 07/09/2024] [Indexed: 08/13/2024] Open
Abstract
BACKGROUND Patient reported outcome measures (PROMs) can be used to assess knee function following anterior cruciate ligament (ACL) reconstruction. Intra-operatively, femoral and tibial tunnels are created to accommodate the new ACL graft. It is postulated that there is an optimum position and orientation of these tunnels and that outcomes from this procedure are affected by their position. AIM To evaluate the influence of graft tunnel position on early to mid-term clinical outcomes following ACL reconstruction. METHODS Six PROMs were collected following ACL reconstruction which included the Knee Injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee, Lysholm, Tegner, EuroQol-5 Dimension-5 level, and Short Form 12-item Health Survey. A total of 8 radiological parameters were measured from post-operative X-rays relating to graft tunnel positions. This data was analysed to assess for any correlations between graft tunnel position and post-operative PROMs. RESULTS A total of 87 patients were included in the study with a mean post-operative follow-up of 2.3 years (range 1 to 7 years). Posterior position of tibial tunnel was associated with improved KOOS quality of life (rho = 0.43, P = 0.002) and EQ-5D VAS (rho = 0.36, P = 0.010). Anterior position of EndoButton femoral tunnel was associated with an improved EQ-5D index (rho = -0.38, P = 0.028). There were no other significant correlations between any of the other radiological parameters and PROM scores. CONCLUSION Overall, graft tunnel position had very little correlation with clinical outcomes following ACL reconstruction. A few (posterior) tibial tunnel and (anterior) EndoButton femoral tunnel measurements were associated with better PROMs.
Collapse
Affiliation(s)
- Oliver Mann
- The Medical School, Newcastle University, Newcastle upon Tyne NE2 4HH, United Kingdom
| | - Oday Al-Dadah
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE2 4HH, United Kingdom
- Department of Trauma and Orthopaedic Surgery, South Tyneside District Hospital, Harton Lane, South Tyneside NE34 0PL, United Kingdom
| |
Collapse
|
|
3
|
Ishifuro M, Yoshida N, Yokomachi K, Fujioka C, Adachi N. Development of an Original Three-Dimensional Computed Tomography Scan Method and Imaging Process for Surgical Support of the Anterior Cruciate Ligament. Cureus 2024; 16:e59307. [PMID: 38813334 PMCID: PMC11134476 DOI: 10.7759/cureus.59307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2024] [Indexed: 05/31/2024] Open
Abstract
Three-dimensional computed tomography (3D CT) scan images are useful as they can provide information essential for surgical support, particularly in orthopedic surgery. In the case of anterior cruciate ligament (ACL) reconstruction, a 3D CT scan is important in preoperative simulation. Furthermore, it is associated with a reduced risk of revision surgery because the angle of the foramen magnum changes with the femoral muscle mass. However, the CT scan system geometry has several limitations. For example, the patient's posture is limited during the procedure. Herein, we report an original CT scan method and 3D imaging process for surgical support of the ACL.
Collapse
Affiliation(s)
- Minoru Ishifuro
- Department of Radiological Technology, Niigata University of Health and Welfare, Niigata, JPN
| | - Nobukiyo Yoshida
- Department of Radiological Technology, Niigata University of Health and Welfare, Niigata, JPN
| | - Kazushi Yokomachi
- Department of Clinical Support, Hiroshima University Hospital, Hiroshima, JPN
| | - Chikao Fujioka
- Department of Clinical Support, Hiroshima University Hospital, Hiroshima, JPN
| | - Nobuo Adachi
- Department of Orthopedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN
| |
Collapse
|
|
4
|
Daniel SJ, Timothy J, Kandagaddala M, Reka K, Poonnoose PM, Oommen AT. Decreased femur tunnel widening after augmented suspensory fixation compared to suspensory fixation for single bundle hamstring ACL reconstruction. J Clin Orthop Trauma 2024; 48:102331. [PMID: 38274644 PMCID: PMC10806195 DOI: 10.1016/j.jcot.2023.102331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/15/2023] [Accepted: 12/30/2023] [Indexed: 01/27/2024] Open
Abstract
Background Tunnel widening after Anterior cruciate ligament (ACL) reconstruction using a hamstring graft is known to occur at follow-up. Our study aimed to investigate the effect of suspensory fixation augmentation using an interference screw on tunnel widening in single-bundle hamstring ACL reconstruction. Methods 48 patients who had single bundle ACL reconstruction with femoral fixed loop fixation technique in 15 knees, and, fixed loop with augmented aperture (bio screw) fixation in 33 knees were analyzed. The width of the tunnel was measured using radiographs immediate post-op and at follow-up within 1 year. Computerized Tomogram (CT) measurements of the tunnels and functional scores were also done with overall follow-up for the fixed loop group being 21.33 months (Standard Deviation (SD)11.14) and the Augmentation group 9.12 months (SD 3.83). Results Midpoint femur tunnel widening was reduced in the augmentation group, with measurements of 0.74 (SD 1.05) mm Antero Posterior (AP) and 1.01 (SD 1.04) mm in the Lateral view, compared to 1.54 (SD 1.48) mm AP and 1.79 (SD1.47 mm) in the Lateral for the fixed button group. The radiological widening was considerably less in the augmentation group with a p-value of 0.07. AP aperture widening in the augmentation group was 1.25(SD 1.10 mm), and 1.09(SD0.98) mm in the lateral view. The fixed button-only group measured 1.53 (SD1.30) mm in the AP, and 1.65 (SD 1.29) mm in the lateral view, both of which were not statistically significant. The follow-up Lysholm and International Knee Documentation Committee (IKDC) scores were similar for the 2 groups. Conclusion Femoral tunnel midpoint and aperture widening were reduced with the fixed loop with aperture (bio screw) augmentation technique for hamstring grafts in single bundle ACL fixation within 1 year with comparable functional scores. Level of evidence 4.
Collapse
Affiliation(s)
- Sam James Daniel
- Department of Orthopaedics, Unit 2, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | - Jozy Timothy
- Department of Orthopaedics, Unit 2, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | - Madhavi Kandagaddala
- Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | - K. Reka
- Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, 632002, India
| | - Pradeep Mathew Poonnoose
- Department of Orthopaedics, Unit 2, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | - Anil Thomas Oommen
- Department of Orthopaedics, Unit 2, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| |
Collapse
|
|
5
|
Clinical outcome and computer tomography based tunnel placement evaluation following arthroscopic anteromedial portal anterior cruciate ligament reconstruction in non-athletic population. INTERNATIONAL JOURNAL OF BURNS AND TRAUMA 2022; 12:232-240. [PMID: 36660266 PMCID: PMC9845806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 12/10/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND The morphology of distal femur and proximal tibia varies between different ethnicities, and it can affect the tunnel dimensions and positions while doing ACL reconstruction which may affect the clinical outcome. There is limited data on the clinical outcome and CT based tunnel placement evaluation in femur and tibia of Indian nonathletic population. METHODS Thirty non-athletic patients with mean age of 25.50±6.9 years and ACL rupture who underwent single bundle hamstring autograft arthroscopic ACL reconstruction by anteromedial portal were included in the study. Their preoperative IKDC Score, Lysholm-Tegner score, Tegner activity level were calculated and knee stability was assessed clinically using anterior drawer test, Lachman test and pivot shift test. The CT scan of the operated knee was done once the complete extension of the knee was achieved. Using the multimodality workstation available at the department of radio-diagnosis the tunnel parameters of femoral and tibial tunnel was calculated. After 6 months the patients were reassessed for clinical and radiological outcome. The postoperative outcome was compared with preoperative outcome. RESULTS There was a significant difference in preoperative and postoperative score, the difference in IKDC score was 15.08 points, improvement of 14.65 points was seen in Lysholm-Tegner score and there was marked improvement in Tegner activity level. Tests for knee stability were normal in >90% of patients postoperatively. The CT evaluation showed that the femoral tunnels were positioned at 28.45%±3.69% (20.16%-38.35%) along the deep-shallow axis and 25.81%±3.819% (20.69%-37.35%), the mean tunnel obliquity compared to the femoral shaft axis were 47.34°±5.427° (37.68°-58.16°) in the coronal plane and 47.93°±7.023° (35.11°-63.95°), the mean tunnel length was 3.38 cm±0.331 cm (2.79 cm-4.18 cm). The tibial tunnel were positioned at 45.63%±5.832% (32.23%-58.23%) along the anterior-posterior axis and 47.70%±2.26% (42.40%-51.96%) along the medio-lateral axis. The tibial tunnel length was found to be 3.89 cm±0.519 cm (3.05 cm-5.06 cm). CONCLUSION This study helps to ascertain that the ACL reconstruction via anteromedial portal technique using femoral offset zig followed by postoperative home-based rehabilitation technique gives favorable clinical outcomes in Indian non-athletic patients. All patients had improvement in stability of knee after the surgery. The position of femoral tunnels was anatomical but in comparison to Caucasian patients its placement was deeper and higher. Hence, we conclude that the anteromedial portal technique of ACL reconstruction provides favorable clinical outcome and adequate anatomical tunnel placement in Indian non athletic patients.
Collapse
|
|
6
|
Thakur U, Gulati V, Shah J, Tietze D, Chhabra A. Anterior cruciate ligament reconstruction related complications: 2D and 3D high-resolution magnetic resonance imaging evaluation. Skeletal Radiol 2022; 51:1347-1364. [PMID: 34977965 DOI: 10.1007/s00256-021-03982-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/16/2021] [Accepted: 12/17/2021] [Indexed: 02/02/2023]
Abstract
Anterior cruciate ligament (ACL) injury is a common indication for sports-related major surgery and accounts for a large proportion of ligamentous injuries in athletes. The advancements in 2D and 3D MR imaging have provided considerable potential for a one-stop shop radiation-free assessment with an all-in-one modality examination of the knee, for both soft-tissue and bone evaluations. This article reviews ACL injuries and types of surgical managements with illustrative examples using high resolution 2D and 3D MR imaging. Various complications of ACL reconstruction procedures are highlighted with a focus on the use of advanced MR imaging and relevant arthroscopic correlations.
Collapse
Affiliation(s)
- Uma Thakur
- Department of Radiology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Vaibhav Gulati
- Department of Radiology, Imaging Associates at National Heart Institute, New Delhi, India
| | - Jay Shah
- Department of Orthopaedic Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - David Tietze
- Department of Orthopaedic Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Avneesh Chhabra
- Department of Radiology, UT Southwestern Medical Center, Dallas, Texas, USA. .,Department of Orthopaedic Surgery, UT Southwestern Medical Center, Dallas, Texas, USA.
| |
Collapse
|
|
7
|
Toyooka S, Masuda H, Nishihara N, Shimazaki N, Ando S, Kawano H, Nakagawa T. Tomosynthesis Is Equivalent to Computed Tomography for Evaluating Osseous Integration After Anterior Cruciate Ligament Reconstruction. Arthrosc Sports Med Rehabil 2020; 2:e105-e112. [PMID: 32368746 PMCID: PMC7190547 DOI: 10.1016/j.asmr.2019.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 11/25/2019] [Indexed: 11/25/2022] Open
Abstract
Purpose To compare tomosynthesis and computed tomography (CT) for evaluating bone plug integration after anterior cruciate ligament (ACL) reconstruction with a bone–patellar tendon–bone (BPTB) graft. Methods Data of consecutive adult patients who underwent ACL reconstruction with BPTB were analyzed. Bone integration between the bone plug and bone tunnel was evaluated by tomosynthesis and CT, which were both performed 3 months postoperatively. The obtained data for both modalities were reconstructed with slice thickness of 2 mm. Evaluation of bone integration were separately performed using coronal- and sagittal-reconstructed images for the femur and tibia. The ratio of bone integration between the reconstructed slices in which bone grafting was involved, for both tomosynthesis and CT, was investigated by 2 blinded examiners. The equivalence of tomosynthesis to CT was tested by comparing the bone integration ratio for both modalities. The accuracy of diagnosing bone union using tomosynthesis and CT was also investigated. Results The diagnostic accuracy of tomosynthesis and CT exceeded 80%. Interobserver agreement of bone integration in the sagittal plane on the femoral side was 0.92 (intraclass correlation coefficient) for CT and 0.76 (intraclass correlation coefficient) for tomosynthesis. Conclusions Although it showed poor reliability, tomosynthesis was equivalent to CT in evaluating bone plug integration after ACL reconstruction with BPTB. Level of Evidence Level II, diagnostic study.
Collapse
Affiliation(s)
- Seikai Toyooka
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Hironari Masuda
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Nobuhiro Nishihara
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Naoya Shimazaki
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Shuji Ando
- Department of Information and Computer Technology Faculty of Engineering, Tokyo University of Science, Tokyo, Japan
| | - Hirotaka Kawano
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Takumi Nakagawa
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| |
Collapse
|
|
8
|
Ali AM. Evaluation of Orthopedic Metal Artifact Reduction Application in Three-Dimensional Computed Tomography Reconstruction of Spinal Instrumentation: A Single Saudi Center Experience. J Clin Imaging Sci 2018; 8:11. [PMID: 29619282 PMCID: PMC5868229 DOI: 10.4103/jcis.jcis_92_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Accepted: 02/11/2018] [Indexed: 11/06/2022] Open
Abstract
Aim of the Study: The aim of the study was to evaluate the commercially available orthopedic metal artifact reduction (OMAR) technique in postoperative three-dimensional computed tomography (3DCT) reconstruction studies after spinal instrumentation and to investigate its clinical application. Materials and Methods: One hundred and twenty (120) patients with spinal metallic implants were included in the study. All had 3DCT reconstruction examinations using the OMAR software after obtaining the informed consents and approval of the Institution Ethical Committee. The degree of the artifacts, the related muscular density, the clearness of intermuscular fat planes, and definition of the adjacent vertebrae were qualitatively evaluated. The diagnostic satisfaction and quality of the 3D reconstruction images were thoroughly assessed. Results: The majority (96.7%) of 3DCT reconstruction images performed were considered satisfactory to excellent for diagnosis. Only 3.3% of the reconstructed images had rendered unacceptable diagnostic quality. Conclusion: OMAR can effectively reduce metallic artifacts in patients with spinal instrumentation with highly diagnostic 3DCT reconstruction images.
Collapse
Affiliation(s)
- Amir Monir Ali
- Department of Radiodiagnosis, Faculty of Medicine, Mansoura University, Egypt.,Department of Medical Imaging, Sultan Bin Abdulaziz Humanitarian City, Riyadh 13571-6262, Kingdom of Saudi Arabia
| |
Collapse
|
|
9
|
Anterior cruciate ligament fixation devices: Expected imaging appearance and common complications. Eur J Radiol 2018; 99:17-27. [DOI: 10.1016/j.ejrad.2017.12.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 10/23/2017] [Accepted: 12/08/2017] [Indexed: 11/21/2022]
|
|
10
|
Hu Y, Pan S, Zhao X, Guo W, He M, Guo Q. Value and Clinical Application of Orthopedic Metal Artifact Reduction Algorithm in CT Scans after Orthopedic Metal Implantation. Korean J Radiol 2017; 18:526-535. [PMID: 28458605 PMCID: PMC5390622 DOI: 10.3348/kjr.2017.18.3.526] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 12/18/2016] [Indexed: 11/30/2022] Open
Abstract
Objective To evaluate orthopedic metal artifact reduction algorithm (O-MAR) in CT orthopedic metal artifact reduction at different tube voltages, identify an appropriate low tube voltage for clinical practice, and investigate its clinical application. Materials and Methods The institutional ethical committee approved all the animal procedures. A stainless-steel plate and four screws were implanted into the femurs of three Japanese white rabbits. Preoperative CT was performed at 120 kVp without O-MAR reconstruction, and postoperative CT was performed at 80–140 kVp with O-MAR. Muscular CT attenuation, artifact index (AI) and signal-to-noise ratio (SNR) were compared between preoperative and postoperative images (unpaired t test), between paired O-MAR and non-O-MAR images (paired Student t test) and among different kVp settings (repeated measures ANOVA). Artifacts' severity, muscular homogeneity, visibility of inter-muscular space and definition of bony structures were subjectively evaluated and compared (Wilcoxon rank-sum test). In the clinical study, 20 patients undertook CT scan at low kVp with O-MAR with informed consent. The diagnostic satisfaction of clinical images was subjectively assessed. Results Animal experiments showed that the use of O-MAR resulted in accurate CT attenuation, lower AI, better SNR, and higher subjective scores (p < 0.010) at all tube voltages. O-MAR images at 100 kVp had almost the same AI and SNR as non-O-MAR images at 140 kVp. All O-MAR images were scored ≥ 3. In addition, 95% of clinical CT images performed at 100 kVp were considered satisfactory. Conclusion O-MAR can effectively reduce orthopedic metal artifacts at different tube voltages, and facilitates low-tube-voltage CT for patients with orthopedic metal implants.
Collapse
Affiliation(s)
- Yi Hu
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province 110004, China
| | - Shinong Pan
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province 110004, China
| | - Xudong Zhao
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province 110004, China
| | - Wenli Guo
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province 110004, China
| | - Ming He
- Department of Orthopedics, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province 110004, China
| | - Qiyong Guo
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province 110004, China
| |
Collapse
|