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Relationship between bone plug position and morphological changes of tunnel aperture in anatomic rectangular tunnel
Ryohei Uchida1, Yoshiki Shiozaki2, Yoshinari Tanaka3
1Department of Orthopedic Sports Medicine, Seifu Hospital, 5-1-3, Shinkanaoka-cho, Sakai, 591-8021, Japan. uchida3847@gmail.com.
Summary
Deeper bone plug placement in anterior cruciate ligament reconstruction (ACL-R) using bone-patellar tendon-bone (BTB) grafts increases femoral tunnel enlargement. Accurate positioning of the tendon-bone junction at the aperture is crucial for optimal healing and minimizing tunnel changes.
Area of Science:
- Orthopedic Surgery
- Biomedical Engineering
- Radiology
Background:
- Graft healing after anterior cruciate ligament reconstruction (ACL-R) with bone-patellar tendon-bone (BTB) grafts is influenced by bone plug-tunnel wall interaction.
- Postoperative tunnel morphology changes may be linked to graft healing patterns, but the relationship between bone plug position and tunnel changes remains unstudied.
Purpose of the Study:
- To investigate the relationship between bone plug position within the femoral or tibial tunnel and the resulting morphological changes of each tunnel aperture following ACL-R using BTB grafts.
- To assess tunnel aperture enlargement and wall migration using computed tomography (CT).
Main Methods:
- Computed tomography (CT) scans of 30 patients (20.4 ± 5.4 years) who underwent primary ACL-R with BTB grafts were analyzed.
- Measurements included the distance from the tunnel aperture to the tendon-bone junction (TBJ) at 2 weeks postoperatively.
- Tunnel aperture enlargement and wall migration were evaluated between 2 weeks and 6 months postoperatively.
Main Results:
- The tendon-bone junction (TBJ) was typically located within 2 mm of the femoral tunnel aperture or within the tibial tunnel.
- Significant enlargement of the femoral tunnel aperture (17.0 ± 11.7%) occurred distally, and the tibial tunnel aperture (19.6 ± 12.5%) enlarged posterolaterally.
- A significant correlation was found between the distal position of the femoral bone plug and femoral tunnel aperture enlargement (r=0.454, p=0.0015).
Conclusions:
- Both femoral and tibial tunnel apertures significantly enlarged distally and posterolaterally by 6 months postoperatively.
- Deeper placement of the femoral bone plug is a risk factor for femoral tunnel enlargement.
- Accurate positioning of the TBJ at the femoral tunnel aperture is critical; adjusting the harvest site may optimize graft fit and minimize tunnel changes.
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