Does retrograde tibial tunnel drilling decrease subchondral bone lesions during ACL reconstruction? A prospective trial comparing retrograde to antegrade technique
Abstract Background The main goal of this study was to assess iatrogenic subchondral bone lesions following three different anterior cruciate ligament (ACL) reconstruction techniques and their association with early postoperative pain. Methods A multicenter prospective comparative study was conducte...
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| Veröffentlicht in: | The knee 2016-01, Vol.23 (1), p.111-115 |
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| creator | Lopes, Ronny Klouche, Shahnaz Odri, Guillaume Grimaud, Olivier Lanternier, Hubert Hardy, Philippe |
| description | Abstract Background The main goal of this study was to assess iatrogenic subchondral bone lesions following three different anterior cruciate ligament (ACL) reconstruction techniques and their association with early postoperative pain. Methods A multicenter prospective comparative study was conducted in 2012. Each center performed a specific ligamentoplasty technique: two used retrograde and the other antegrade tibial tunnel drilling. Peri- and postoperative analgesia and systematic early postoperative magnetic resonance imaging (MRI) protocols were standardized. The main assessment criterion was tibial subchondral lesions (microfractures or bone oedema) on MRI during the first postoperative week. Secondary criteria were the assessment of postoperative pain for two days using a Visual Analogical Scale (VAS 0–10) and consumption of analgesics. Results Forty-three patients were included in three centers, 15 in the “antegrade group” and 28 in the “retrograde group”, mean age is 32.5 ± 9.1 years, 14 women/29 men. All included patients underwent postoperative MRI. There were no subchondral tibial microfractures, but oedema was significantly more frequent in the antegrade group (p = 0.0001). Tibial subchondral oedema was correlated to greater early postoperative pain (p = 0.01). Multivariate analysis identified tibial tunnel diameter as an independent factor of early postoperative pain. The smaller the tibial tunnel diameter, the greater the mean early postoperative pain (≤ 8 mm (18 patients) 3.4 ± 1.5 vs. > 8 mm (25 patients) 1.8 ± 1.7, p = 0.004) and the more frequent the presence of edemas (10/18 vs. 2/25, p = 0.001). Conclusion The present clinical study confirmed the benefit of retrograde tibial tunnel drilling for tibial subchondral bone lesions and showed a correlation between these lesions and early postoperative pain. Level of evidence II; therapeutic study — prospective cohort study. |
| doi_str_mv | 10.1016/j.knee.2015.09.010 |
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A prospective trial comparing retrograde to antegrade technique</title><source>MEDLINE</source><source>Access via ScienceDirect (Elsevier)</source><creator>Lopes, Ronny ; Klouche, Shahnaz ; Odri, Guillaume ; Grimaud, Olivier ; Lanternier, Hubert ; Hardy, Philippe</creator><creatorcontrib>Lopes, Ronny ; Klouche, Shahnaz ; Odri, Guillaume ; Grimaud, Olivier ; Lanternier, Hubert ; Hardy, Philippe</creatorcontrib><description>Abstract Background The main goal of this study was to assess iatrogenic subchondral bone lesions following three different anterior cruciate ligament (ACL) reconstruction techniques and their association with early postoperative pain. Methods A multicenter prospective comparative study was conducted in 2012. Each center performed a specific ligamentoplasty technique: two used retrograde and the other antegrade tibial tunnel drilling. Peri- and postoperative analgesia and systematic early postoperative magnetic resonance imaging (MRI) protocols were standardized. The main assessment criterion was tibial subchondral lesions (microfractures or bone oedema) on MRI during the first postoperative week. Secondary criteria were the assessment of postoperative pain for two days using a Visual Analogical Scale (VAS 0–10) and consumption of analgesics. Results Forty-three patients were included in three centers, 15 in the “antegrade group” and 28 in the “retrograde group”, mean age is 32.5 ± 9.1 years, 14 women/29 men. All included patients underwent postoperative MRI. There were no subchondral tibial microfractures, but oedema was significantly more frequent in the antegrade group (p = 0.0001). Tibial subchondral oedema was correlated to greater early postoperative pain (p = 0.01). Multivariate analysis identified tibial tunnel diameter as an independent factor of early postoperative pain. The smaller the tibial tunnel diameter, the greater the mean early postoperative pain (≤ 8 mm (18 patients) 3.4 ± 1.5 vs. > 8 mm (25 patients) 1.8 ± 1.7, p = 0.004) and the more frequent the presence of edemas (10/18 vs. 2/25, p = 0.001). Conclusion The present clinical study confirmed the benefit of retrograde tibial tunnel drilling for tibial subchondral bone lesions and showed a correlation between these lesions and early postoperative pain. Level of evidence II; therapeutic study — prospective cohort study.</description><identifier>ISSN: 0968-0160</identifier><identifier>EISSN: 1873-5800</identifier><identifier>DOI: 10.1016/j.knee.2015.09.010</identifier><identifier>PMID: 26775256</identifier><language>eng</language><publisher>Netherlands: Elsevier B.V</publisher><subject>ACL reconstruction ; Adolescent ; Adult ; Agreements ; Analgesics ; Antegrade ; Anterior Cruciate Ligament - diagnostic imaging ; Anterior Cruciate Ligament - surgery ; Anterior Cruciate Ligament Injuries - diagnosis ; Anterior Cruciate Ligament Injuries - surgery ; Anterior Cruciate Ligament Reconstruction - methods ; Bone bruises ; Bone surgery ; Conflicts of interest ; Drilling ; Edema ; Female ; Femur - diagnostic imaging ; Femur - surgery ; Follow-Up Studies ; Humans ; Knee ; Ligaments ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Multivariate analysis ; Orthopedics ; Patients ; Postoperative pain ; Prospective Studies ; Retrograde ; Skin & tissue grafts ; Subchondral microfractures ; Tendons ; Tibia - diagnostic imaging ; Tibia - surgery ; Tomography, X-Ray Computed ; Trauma ; Treatment Outcome ; Young Adult</subject><ispartof>The knee, 2016-01, Vol.23 (1), p.111-115</ispartof><rights>Elsevier B.V.</rights><rights>2015 Elsevier B.V.</rights><rights>Copyright © 2015 Elsevier B.V. All rights reserved.</rights><rights>Copyright Elsevier Limited Jan 2016</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c568t-c24e69f28d6af7b3eee352aa38f68b202390c802514e99ef993246e957db2b283</citedby><cites>FETCH-LOGICAL-c568t-c24e69f28d6af7b3eee352aa38f68b202390c802514e99ef993246e957db2b283</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.knee.2015.09.010$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26775256$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lopes, Ronny</creatorcontrib><creatorcontrib>Klouche, Shahnaz</creatorcontrib><creatorcontrib>Odri, Guillaume</creatorcontrib><creatorcontrib>Grimaud, Olivier</creatorcontrib><creatorcontrib>Lanternier, Hubert</creatorcontrib><creatorcontrib>Hardy, Philippe</creatorcontrib><title>Does retrograde tibial tunnel drilling decrease subchondral bone lesions during ACL reconstruction? A prospective trial comparing retrograde to antegrade technique</title><title>The knee</title><addtitle>Knee</addtitle><description>Abstract Background The main goal of this study was to assess iatrogenic subchondral bone lesions following three different anterior cruciate ligament (ACL) reconstruction techniques and their association with early postoperative pain. Methods A multicenter prospective comparative study was conducted in 2012. Each center performed a specific ligamentoplasty technique: two used retrograde and the other antegrade tibial tunnel drilling. Peri- and postoperative analgesia and systematic early postoperative magnetic resonance imaging (MRI) protocols were standardized. The main assessment criterion was tibial subchondral lesions (microfractures or bone oedema) on MRI during the first postoperative week. Secondary criteria were the assessment of postoperative pain for two days using a Visual Analogical Scale (VAS 0–10) and consumption of analgesics. Results Forty-three patients were included in three centers, 15 in the “antegrade group” and 28 in the “retrograde group”, mean age is 32.5 ± 9.1 years, 14 women/29 men. All included patients underwent postoperative MRI. There were no subchondral tibial microfractures, but oedema was significantly more frequent in the antegrade group (p = 0.0001). Tibial subchondral oedema was correlated to greater early postoperative pain (p = 0.01). Multivariate analysis identified tibial tunnel diameter as an independent factor of early postoperative pain. The smaller the tibial tunnel diameter, the greater the mean early postoperative pain (≤ 8 mm (18 patients) 3.4 ± 1.5 vs. > 8 mm (25 patients) 1.8 ± 1.7, p = 0.004) and the more frequent the presence of edemas (10/18 vs. 2/25, p = 0.001). Conclusion The present clinical study confirmed the benefit of retrograde tibial tunnel drilling for tibial subchondral bone lesions and showed a correlation between these lesions and early postoperative pain. Level of evidence II; therapeutic study — prospective cohort study.</description><subject>ACL reconstruction</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Agreements</subject><subject>Analgesics</subject><subject>Antegrade</subject><subject>Anterior Cruciate Ligament - diagnostic imaging</subject><subject>Anterior Cruciate Ligament - surgery</subject><subject>Anterior Cruciate Ligament Injuries - diagnosis</subject><subject>Anterior Cruciate Ligament Injuries - surgery</subject><subject>Anterior Cruciate Ligament Reconstruction - methods</subject><subject>Bone bruises</subject><subject>Bone surgery</subject><subject>Conflicts of interest</subject><subject>Drilling</subject><subject>Edema</subject><subject>Female</subject><subject>Femur - diagnostic imaging</subject><subject>Femur - surgery</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Knee</subject><subject>Ligaments</subject><subject>Magnetic Resonance Imaging</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Multivariate analysis</subject><subject>Orthopedics</subject><subject>Patients</subject><subject>Postoperative pain</subject><subject>Prospective Studies</subject><subject>Retrograde</subject><subject>Skin & tissue grafts</subject><subject>Subchondral microfractures</subject><subject>Tendons</subject><subject>Tibia - diagnostic imaging</subject><subject>Tibia - surgery</subject><subject>Tomography, X-Ray Computed</subject><subject>Trauma</subject><subject>Treatment Outcome</subject><subject>Young Adult</subject><issn>0968-0160</issn><issn>1873-5800</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkk1v1DAQhiMEokvhD3BAlrhwSRg7sWNLCLRaPqWVOABny3EmrbdZe7GTSv09_FGc7vKhHuBkjf3MvJ55pyieUqgoUPFyV115xIoB5RWoCijcK1ZUtnXJJcD9YgVKyDKTcFY8SmkHAEI1_GFxxkTbcsbFqvjxNmAiEacYLqLpkUyuc2Yk0-w9jqSPbhydvyA92ogmIUlzZy-D72OGuuCRjJhc8In0c1zA9Waby9l8M8XZTvnpDVmTQwzpgDm8zgpxEbBhfzC3GX-LB2L8hKcA7aV332d8XDwYzJjwyek8L769f_d187Hcfv7wabPelpYLOZWWNSjUwGQvzNB2NSLWnBlTy0HIjgGrFVgJjNMGlcJBqZo1AhVv-451TNbnxYtj3fzbLJsmvXfJ4jgaj2FOOo-WScYbSv-PtqIVjCm-oM_voLswR58bWSjBlWhuKXakbJ5UijjoQ3R7E280Bb24rXd6cVsvbmtQOrudk56dSs_dHvvfKb_szcCrI4B5bNcOo07WobfYu-zRpPvg_l3_9Z10m5fBWTNe4Q2mP33oxDToL8u-LetGOQBjUNc_AQBC0qw</recordid><startdate>20160101</startdate><enddate>20160101</enddate><creator>Lopes, Ronny</creator><creator>Klouche, Shahnaz</creator><creator>Odri, Guillaume</creator><creator>Grimaud, Olivier</creator><creator>Lanternier, Hubert</creator><creator>Hardy, Philippe</creator><general>Elsevier B.V</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope></search><sort><creationdate>20160101</creationdate><title>Does retrograde tibial tunnel drilling decrease subchondral bone lesions during ACL reconstruction? A prospective trial comparing retrograde to antegrade technique</title><author>Lopes, Ronny ; Klouche, Shahnaz ; Odri, Guillaume ; Grimaud, Olivier ; Lanternier, Hubert ; Hardy, Philippe</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c568t-c24e69f28d6af7b3eee352aa38f68b202390c802514e99ef993246e957db2b283</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>ACL reconstruction</topic><topic>Adolescent</topic><topic>Adult</topic><topic>Agreements</topic><topic>Analgesics</topic><topic>Antegrade</topic><topic>Anterior Cruciate Ligament - diagnostic imaging</topic><topic>Anterior Cruciate Ligament - surgery</topic><topic>Anterior Cruciate Ligament Injuries - diagnosis</topic><topic>Anterior Cruciate Ligament Injuries - surgery</topic><topic>Anterior Cruciate Ligament Reconstruction - methods</topic><topic>Bone bruises</topic><topic>Bone surgery</topic><topic>Conflicts of interest</topic><topic>Drilling</topic><topic>Edema</topic><topic>Female</topic><topic>Femur - diagnostic imaging</topic><topic>Femur - surgery</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Knee</topic><topic>Ligaments</topic><topic>Magnetic Resonance Imaging</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Multivariate analysis</topic><topic>Orthopedics</topic><topic>Patients</topic><topic>Postoperative pain</topic><topic>Prospective Studies</topic><topic>Retrograde</topic><topic>Skin & tissue grafts</topic><topic>Subchondral microfractures</topic><topic>Tendons</topic><topic>Tibia - diagnostic imaging</topic><topic>Tibia - surgery</topic><topic>Tomography, X-Ray Computed</topic><topic>Trauma</topic><topic>Treatment Outcome</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lopes, Ronny</creatorcontrib><creatorcontrib>Klouche, Shahnaz</creatorcontrib><creatorcontrib>Odri, Guillaume</creatorcontrib><creatorcontrib>Grimaud, Olivier</creatorcontrib><creatorcontrib>Lanternier, Hubert</creatorcontrib><creatorcontrib>Hardy, Philippe</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>The knee</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lopes, Ronny</au><au>Klouche, Shahnaz</au><au>Odri, Guillaume</au><au>Grimaud, Olivier</au><au>Lanternier, Hubert</au><au>Hardy, Philippe</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Does retrograde tibial tunnel drilling decrease subchondral bone lesions during ACL reconstruction? A prospective trial comparing retrograde to antegrade technique</atitle><jtitle>The knee</jtitle><addtitle>Knee</addtitle><date>2016-01-01</date><risdate>2016</risdate><volume>23</volume><issue>1</issue><spage>111</spage><epage>115</epage><pages>111-115</pages><issn>0968-0160</issn><eissn>1873-5800</eissn><abstract>Abstract Background The main goal of this study was to assess iatrogenic subchondral bone lesions following three different anterior cruciate ligament (ACL) reconstruction techniques and their association with early postoperative pain. Methods A multicenter prospective comparative study was conducted in 2012. Each center performed a specific ligamentoplasty technique: two used retrograde and the other antegrade tibial tunnel drilling. Peri- and postoperative analgesia and systematic early postoperative magnetic resonance imaging (MRI) protocols were standardized. The main assessment criterion was tibial subchondral lesions (microfractures or bone oedema) on MRI during the first postoperative week. Secondary criteria were the assessment of postoperative pain for two days using a Visual Analogical Scale (VAS 0–10) and consumption of analgesics. Results Forty-three patients were included in three centers, 15 in the “antegrade group” and 28 in the “retrograde group”, mean age is 32.5 ± 9.1 years, 14 women/29 men. All included patients underwent postoperative MRI. There were no subchondral tibial microfractures, but oedema was significantly more frequent in the antegrade group (p = 0.0001). Tibial subchondral oedema was correlated to greater early postoperative pain (p = 0.01). Multivariate analysis identified tibial tunnel diameter as an independent factor of early postoperative pain. The smaller the tibial tunnel diameter, the greater the mean early postoperative pain (≤ 8 mm (18 patients) 3.4 ± 1.5 vs. > 8 mm (25 patients) 1.8 ± 1.7, p = 0.004) and the more frequent the presence of edemas (10/18 vs. 2/25, p = 0.001). Conclusion The present clinical study confirmed the benefit of retrograde tibial tunnel drilling for tibial subchondral bone lesions and showed a correlation between these lesions and early postoperative pain. Level of evidence II; therapeutic study — prospective cohort study.</abstract><cop>Netherlands</cop><pub>Elsevier B.V</pub><pmid>26775256</pmid><doi>10.1016/j.knee.2015.09.010</doi><tpages>5</tpages></addata></record> |
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| subjects | ACL reconstruction Adolescent Adult Agreements Analgesics Antegrade Anterior Cruciate Ligament - diagnostic imaging Anterior Cruciate Ligament - surgery Anterior Cruciate Ligament Injuries - diagnosis Anterior Cruciate Ligament Injuries - surgery Anterior Cruciate Ligament Reconstruction - methods Bone bruises Bone surgery Conflicts of interest Drilling Edema Female Femur - diagnostic imaging Femur - surgery Follow-Up Studies Humans Knee Ligaments Magnetic Resonance Imaging Male Middle Aged Multivariate analysis Orthopedics Patients Postoperative pain Prospective Studies Retrograde Skin & tissue grafts Subchondral microfractures Tendons Tibia - diagnostic imaging Tibia - surgery Tomography, X-Ray Computed Trauma Treatment Outcome Young Adult |
| title | Does retrograde tibial tunnel drilling decrease subchondral bone lesions during ACL reconstruction? A prospective trial comparing retrograde to antegrade technique |
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