Tunnel Widening after Anterior Cruciate Ligament Reconstruction: An Experimental Study in Sheep
Background A common clinical concern after anterior cruciate ligament reconstruction is the expansion of the bone tunnels as seen radiographically. The etiology and clinical relevance of this phenomenon remain unclear. Hypothesis Tunnel widening results in an increased anteroposterior translation, a...
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| Veröffentlicht in: | The American journal of sports medicine 2009-08, Vol.37 (8), p.1609-1617 |
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| container_title | The American journal of sports medicine |
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| creator | Neddermann, Alexandra Willbold, Elmar Witte, Frank Hurschler, Christof Hankemeier, Stefan Stübig, Timo Hesse, Eric Fehr, Michael Krettek, Christian Meller, Rupert |
| description | Background
A common clinical concern after anterior cruciate ligament reconstruction is the expansion of the bone tunnels as seen radiographically. The etiology and clinical relevance of this phenomenon remain unclear.
Hypothesis
Tunnel widening results in an increased anteroposterior translation, and there are specific histologic changes due to osteoclastic bone resorption associated with this phenomenon.
Study Design
Controlled laboratory study.
Methods
Thirty sheep (age, 4 months) underwent an anterior cruciate ligament reconstruction using a soft tissue graft. Graft fixation was achieved using the EndoButton and Suture Washer. Six animals each were sacrificed at 0, 3, 6, 12, and 24 weeks after surgery. Each anterior cruciate ligament–reconstructed knee was examined by computed tomography. Anteroposterior translation was determined using a universal force-moment sensor robot. The bone surrounding the tunnel was evaluated histologically.
Results
The prevalence of tunnel enlargement on the femoral side was 77.3%. Animals with tunnel widening did not demonstrate increased anteroposterior translation. Widening of the femoral tunnel was significantly associated with a higher stiffness of the graft (P |
| doi_str_mv | 10.1177/0363546509332251 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_744582004</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sage_id>10.1177_0363546509332251</sage_id><sourcerecordid>67524838</sourcerecordid><originalsourceid>FETCH-LOGICAL-c377t-723f6ff25079f7b835d689906d6aa2e8111cecd2dd91243eae964943e23b19de3</originalsourceid><addsrcrecordid>eNp90UtLAzEQAOAgiq3VuydZBPW0msfmdZJSfEFBkIrHJc3OlpRttia7B_-9KS0WBL0kIfNlJskgdE7wLSFS3mEmGC8Ex5oxSjk5QEPCOc0ZE_wQDTfhfBMfoJMYlxhjIoU6RgOiGdVS4yG6n_XeQ5N9uAq884vM1B2EbOzT6NqQTUJvnekgm7qFWYHvsjewrY9d2u9c60_RUW2aCGe7eYTeHx9mk-d8-vr0MhlPc8uk7HJJWS3qmnIsdS3nivFKKK2xqIQxFBQhxIKtaFVpQgsGBrQodFpQNie6AjZCN9u869B-9hC7cuWihaYxHto-lrIouKIYF0le_yuF5LRQTCV4-Qsu2z749IqSEoklTS4hvEU2tDEGqMt1cCsTvkqCy00Pyt89SEcudnn7-Qqq_YHdpydwtQMmWtPUwXjr4o-jRGGt-KZ2vnXRLGB_uT8LfwMQGJkp</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>217072524</pqid></control><display><type>article</type><title>Tunnel Widening after Anterior Cruciate Ligament Reconstruction: An Experimental Study in Sheep</title><source>Access via SAGE</source><source>MEDLINE</source><source>Alma/SFX Local Collection</source><creator>Neddermann, Alexandra ; Willbold, Elmar ; Witte, Frank ; Hurschler, Christof ; Hankemeier, Stefan ; Stübig, Timo ; Hesse, Eric ; Fehr, Michael ; Krettek, Christian ; Meller, Rupert</creator><creatorcontrib>Neddermann, Alexandra ; Willbold, Elmar ; Witte, Frank ; Hurschler, Christof ; Hankemeier, Stefan ; Stübig, Timo ; Hesse, Eric ; Fehr, Michael ; Krettek, Christian ; Meller, Rupert</creatorcontrib><description>Background
A common clinical concern after anterior cruciate ligament reconstruction is the expansion of the bone tunnels as seen radiographically. The etiology and clinical relevance of this phenomenon remain unclear.
Hypothesis
Tunnel widening results in an increased anteroposterior translation, and there are specific histologic changes due to osteoclastic bone resorption associated with this phenomenon.
Study Design
Controlled laboratory study.
Methods
Thirty sheep (age, 4 months) underwent an anterior cruciate ligament reconstruction using a soft tissue graft. Graft fixation was achieved using the EndoButton and Suture Washer. Six animals each were sacrificed at 0, 3, 6, 12, and 24 weeks after surgery. Each anterior cruciate ligament–reconstructed knee was examined by computed tomography. Anteroposterior translation was determined using a universal force-moment sensor robot. The bone surrounding the tunnel was evaluated histologically.
Results
The prevalence of tunnel enlargement on the femoral side was 77.3%. Animals with tunnel widening did not demonstrate increased anteroposterior translation. Widening of the femoral tunnel was significantly associated with a higher stiffness of the graft (P <. 05) and hypertrophy of the graft throughout the remodeling process. The histologic evaluation of the bone tunnel walls demonstrated an increase of bone volume in animals with tunnel enlargement. No statistically significant correlation could be found between the number of osteoclasts and the presence of tunnel widening.
Conclusion
In this large animal model of anterior cruciate ligament reconstruction, animals with significant tunnel widening did not suffer increased anteroposterior translation. Tunnel widening was associated with a high stiffness of the graft, graft hypertrophy, and an increase in bone volume of the tunnel wall.
Clinical Relevance
The present data correspond to the current opinion in humans that tunnel widening is not associated with knee instability. Further research is needed to understand the role of graft stiffness, graft hypertrophy, and the increase in bone volume in this phenomenon.</description><identifier>ISSN: 0363-5465</identifier><identifier>EISSN: 1552-3365</identifier><identifier>DOI: 10.1177/0363546509332251</identifier><identifier>PMID: 19329790</identifier><identifier>CODEN: AJSMDO</identifier><language>eng</language><publisher>Los Angeles, CA: SAGE Publications</publisher><subject>Animals ; Anterior Cruciate Ligament - surgery ; Biological and medical sciences ; Biomechanical Phenomena ; Biomechanics ; Biomechanics. Biorheology ; Bones ; Diseases of the osteoarticular system ; Fundamental and applied biological sciences. Psychology ; Joint replacement surgery ; Knee Joint - anatomy & histology ; Knee Joint - surgery ; Ligaments ; Medical sciences ; Orthopedic Procedures - methods ; Sheep ; Skin & tissue grafts ; Tissues, organs and organisms biophysics</subject><ispartof>The American journal of sports medicine, 2009-08, Vol.37 (8), p.1609-1617</ispartof><rights>2009 American Orthopaedic Society for Sports Medicine</rights><rights>2009 INIST-CNRS</rights><rights>Copyright Sage Publications Ltd. Aug 2009</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c377t-723f6ff25079f7b835d689906d6aa2e8111cecd2dd91243eae964943e23b19de3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/0363546509332251$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/0363546509332251$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,780,784,21819,27924,27925,43621,43622</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=21809854$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19329790$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Neddermann, Alexandra</creatorcontrib><creatorcontrib>Willbold, Elmar</creatorcontrib><creatorcontrib>Witte, Frank</creatorcontrib><creatorcontrib>Hurschler, Christof</creatorcontrib><creatorcontrib>Hankemeier, Stefan</creatorcontrib><creatorcontrib>Stübig, Timo</creatorcontrib><creatorcontrib>Hesse, Eric</creatorcontrib><creatorcontrib>Fehr, Michael</creatorcontrib><creatorcontrib>Krettek, Christian</creatorcontrib><creatorcontrib>Meller, Rupert</creatorcontrib><title>Tunnel Widening after Anterior Cruciate Ligament Reconstruction: An Experimental Study in Sheep</title><title>The American journal of sports medicine</title><addtitle>Am J Sports Med</addtitle><description>Background
A common clinical concern after anterior cruciate ligament reconstruction is the expansion of the bone tunnels as seen radiographically. The etiology and clinical relevance of this phenomenon remain unclear.
Hypothesis
Tunnel widening results in an increased anteroposterior translation, and there are specific histologic changes due to osteoclastic bone resorption associated with this phenomenon.
Study Design
Controlled laboratory study.
Methods
Thirty sheep (age, 4 months) underwent an anterior cruciate ligament reconstruction using a soft tissue graft. Graft fixation was achieved using the EndoButton and Suture Washer. Six animals each were sacrificed at 0, 3, 6, 12, and 24 weeks after surgery. Each anterior cruciate ligament–reconstructed knee was examined by computed tomography. Anteroposterior translation was determined using a universal force-moment sensor robot. The bone surrounding the tunnel was evaluated histologically.
Results
The prevalence of tunnel enlargement on the femoral side was 77.3%. Animals with tunnel widening did not demonstrate increased anteroposterior translation. Widening of the femoral tunnel was significantly associated with a higher stiffness of the graft (P <. 05) and hypertrophy of the graft throughout the remodeling process. The histologic evaluation of the bone tunnel walls demonstrated an increase of bone volume in animals with tunnel enlargement. No statistically significant correlation could be found between the number of osteoclasts and the presence of tunnel widening.
Conclusion
In this large animal model of anterior cruciate ligament reconstruction, animals with significant tunnel widening did not suffer increased anteroposterior translation. Tunnel widening was associated with a high stiffness of the graft, graft hypertrophy, and an increase in bone volume of the tunnel wall.
Clinical Relevance
The present data correspond to the current opinion in humans that tunnel widening is not associated with knee instability. Further research is needed to understand the role of graft stiffness, graft hypertrophy, and the increase in bone volume in this phenomenon.</description><subject>Animals</subject><subject>Anterior Cruciate Ligament - surgery</subject><subject>Biological and medical sciences</subject><subject>Biomechanical Phenomena</subject><subject>Biomechanics</subject><subject>Biomechanics. Biorheology</subject><subject>Bones</subject><subject>Diseases of the osteoarticular system</subject><subject>Fundamental and applied biological sciences. Psychology</subject><subject>Joint replacement surgery</subject><subject>Knee Joint - anatomy & histology</subject><subject>Knee Joint - surgery</subject><subject>Ligaments</subject><subject>Medical sciences</subject><subject>Orthopedic Procedures - methods</subject><subject>Sheep</subject><subject>Skin & tissue grafts</subject><subject>Tissues, organs and organisms biophysics</subject><issn>0363-5465</issn><issn>1552-3365</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp90UtLAzEQAOAgiq3VuydZBPW0msfmdZJSfEFBkIrHJc3OlpRttia7B_-9KS0WBL0kIfNlJskgdE7wLSFS3mEmGC8Ex5oxSjk5QEPCOc0ZE_wQDTfhfBMfoJMYlxhjIoU6RgOiGdVS4yG6n_XeQ5N9uAq884vM1B2EbOzT6NqQTUJvnekgm7qFWYHvsjewrY9d2u9c60_RUW2aCGe7eYTeHx9mk-d8-vr0MhlPc8uk7HJJWS3qmnIsdS3nivFKKK2xqIQxFBQhxIKtaFVpQgsGBrQodFpQNie6AjZCN9u869B-9hC7cuWihaYxHto-lrIouKIYF0le_yuF5LRQTCV4-Qsu2z749IqSEoklTS4hvEU2tDEGqMt1cCsTvkqCy00Pyt89SEcudnn7-Qqq_YHdpydwtQMmWtPUwXjr4o-jRGGt-KZ2vnXRLGB_uT8LfwMQGJkp</recordid><startdate>20090801</startdate><enddate>20090801</enddate><creator>Neddermann, Alexandra</creator><creator>Willbold, Elmar</creator><creator>Witte, Frank</creator><creator>Hurschler, Christof</creator><creator>Hankemeier, Stefan</creator><creator>Stübig, Timo</creator><creator>Hesse, Eric</creator><creator>Fehr, Michael</creator><creator>Krettek, Christian</creator><creator>Meller, Rupert</creator><general>SAGE Publications</general><general>Sage Publications</general><general>Sage Publications Ltd</general><scope>IQODW</scope><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>7TS</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>U9A</scope><scope>7X8</scope></search><sort><creationdate>20090801</creationdate><title>Tunnel Widening after Anterior Cruciate Ligament Reconstruction</title><author>Neddermann, Alexandra ; Willbold, Elmar ; Witte, Frank ; Hurschler, Christof ; Hankemeier, Stefan ; Stübig, Timo ; Hesse, Eric ; Fehr, Michael ; Krettek, Christian ; Meller, Rupert</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c377t-723f6ff25079f7b835d689906d6aa2e8111cecd2dd91243eae964943e23b19de3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Animals</topic><topic>Anterior Cruciate Ligament - surgery</topic><topic>Biological and medical sciences</topic><topic>Biomechanical Phenomena</topic><topic>Biomechanics</topic><topic>Biomechanics. Biorheology</topic><topic>Bones</topic><topic>Diseases of the osteoarticular system</topic><topic>Fundamental and applied biological sciences. Psychology</topic><topic>Joint replacement surgery</topic><topic>Knee Joint - anatomy & histology</topic><topic>Knee Joint - surgery</topic><topic>Ligaments</topic><topic>Medical sciences</topic><topic>Orthopedic Procedures - methods</topic><topic>Sheep</topic><topic>Skin & tissue grafts</topic><topic>Tissues, organs and organisms biophysics</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Neddermann, Alexandra</creatorcontrib><creatorcontrib>Willbold, Elmar</creatorcontrib><creatorcontrib>Witte, Frank</creatorcontrib><creatorcontrib>Hurschler, Christof</creatorcontrib><creatorcontrib>Hankemeier, Stefan</creatorcontrib><creatorcontrib>Stübig, Timo</creatorcontrib><creatorcontrib>Hesse, Eric</creatorcontrib><creatorcontrib>Fehr, Michael</creatorcontrib><creatorcontrib>Krettek, Christian</creatorcontrib><creatorcontrib>Meller, Rupert</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Physical Education Index</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of sports medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Neddermann, Alexandra</au><au>Willbold, Elmar</au><au>Witte, Frank</au><au>Hurschler, Christof</au><au>Hankemeier, Stefan</au><au>Stübig, Timo</au><au>Hesse, Eric</au><au>Fehr, Michael</au><au>Krettek, Christian</au><au>Meller, Rupert</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Tunnel Widening after Anterior Cruciate Ligament Reconstruction: An Experimental Study in Sheep</atitle><jtitle>The American journal of sports medicine</jtitle><addtitle>Am J Sports Med</addtitle><date>2009-08-01</date><risdate>2009</risdate><volume>37</volume><issue>8</issue><spage>1609</spage><epage>1617</epage><pages>1609-1617</pages><issn>0363-5465</issn><eissn>1552-3365</eissn><coden>AJSMDO</coden><abstract>Background
A common clinical concern after anterior cruciate ligament reconstruction is the expansion of the bone tunnels as seen radiographically. The etiology and clinical relevance of this phenomenon remain unclear.
Hypothesis
Tunnel widening results in an increased anteroposterior translation, and there are specific histologic changes due to osteoclastic bone resorption associated with this phenomenon.
Study Design
Controlled laboratory study.
Methods
Thirty sheep (age, 4 months) underwent an anterior cruciate ligament reconstruction using a soft tissue graft. Graft fixation was achieved using the EndoButton and Suture Washer. Six animals each were sacrificed at 0, 3, 6, 12, and 24 weeks after surgery. Each anterior cruciate ligament–reconstructed knee was examined by computed tomography. Anteroposterior translation was determined using a universal force-moment sensor robot. The bone surrounding the tunnel was evaluated histologically.
Results
The prevalence of tunnel enlargement on the femoral side was 77.3%. Animals with tunnel widening did not demonstrate increased anteroposterior translation. Widening of the femoral tunnel was significantly associated with a higher stiffness of the graft (P <. 05) and hypertrophy of the graft throughout the remodeling process. The histologic evaluation of the bone tunnel walls demonstrated an increase of bone volume in animals with tunnel enlargement. No statistically significant correlation could be found between the number of osteoclasts and the presence of tunnel widening.
Conclusion
In this large animal model of anterior cruciate ligament reconstruction, animals with significant tunnel widening did not suffer increased anteroposterior translation. Tunnel widening was associated with a high stiffness of the graft, graft hypertrophy, and an increase in bone volume of the tunnel wall.
Clinical Relevance
The present data correspond to the current opinion in humans that tunnel widening is not associated with knee instability. Further research is needed to understand the role of graft stiffness, graft hypertrophy, and the increase in bone volume in this phenomenon.</abstract><cop>Los Angeles, CA</cop><pub>SAGE Publications</pub><pmid>19329790</pmid><doi>10.1177/0363546509332251</doi><tpages>9</tpages></addata></record> |
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| subjects | Animals Anterior Cruciate Ligament - surgery Biological and medical sciences Biomechanical Phenomena Biomechanics Biomechanics. Biorheology Bones Diseases of the osteoarticular system Fundamental and applied biological sciences. Psychology Joint replacement surgery Knee Joint - anatomy & histology Knee Joint - surgery Ligaments Medical sciences Orthopedic Procedures - methods Sheep Skin & tissue grafts Tissues, organs and organisms biophysics |
| title | Tunnel Widening after Anterior Cruciate Ligament Reconstruction: An Experimental Study in Sheep |
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