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Review
. 2017 Sep 18;7(2):230-239.
doi: 10.11138/mltj/2017.7.2.230. eCollection 2017 Apr-Jun.

How to evaluate bone tunnel widening after ACL reconstruction - a critical review

Arjan de Beus  1 , Jonathan Ej Koch  1 , Anna Hirschmann  1 , Michael T Hirschmann  1
Affiliations
Review

How to evaluate bone tunnel widening after ACL reconstruction - a critical review

Arjan de Beus et al. Muscles Ligaments Tendons J. .

Abstract

Background: Comparing different imaging modalities and methods for assessment tunnel widening after ACL reconstruction and providing a detailed evidence-based literature overview.

Methods: PubMed was searched from 1970 to 2016 using the terms "ACL reconstruction" and "tunnel" and "imaging" or "CT" or "computerized tomography" or "MRI" or "magnetic resonance imaging" or "radiographs". 647 studies were found. 575 articles were excluded due to absence of specific radiological measurement methods of tunnel widening and 40 due to repetition of a previously published radiological measurement method. 32 articles were included reporting interand intraobserver reliabilities of tunnel measurement methods after ACL reconstruction.

Results: A variety of different algorithms and measurement methods using radiographs, magnetic resonance imaging, computed tomography or SPECT/CT evaluating tunnel position and bone tunnel enlargement have been described. Tunnel delination restricts an exact analysis using X-ray. Measurements using CT or MR were mostly obtained perpendicular to the tunnel axis or using specialized software for tunnel volume calculation in 3D.Based on the review the width of the femoral and tibial tunnels should be assessed perpendicular to the tunnel axis at different levels in relation to the joint. At least one measurement should be performed at the tunnel entrance, exit and midpoint of the tunnel.

Conclusion: CT should be considered the gold standard assessing tunnel widening in patients after ACL reconstruction. If specialized software is available calculating the tunnel volume, measurements should be preferably performed in 3D CT.

Level of evidence: II.

Keywords: ACL reconstruction; computed tomography; magnetic resonance imaging; tunnel widening.

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Conflict of interest statement

Conflict of interest The Authors have no conflict of interest to be reported with regards to this paper.

Figures

Figure 1
Figure 1
Flow chart of inclusion and exclusion criteria.
Figure 2 a–c
Figure 2 a–c
Illustration of different measurement methods on anterior-posterior and lateral knee radiographs. a) Peyrache et al. measured both tunnels at three different hights in two projections. b) Fauno and Kaalund measured the femoral tunnel width 1 cm above the tunnel entrance and the tibial tunnel width 1 cm below the entrance. c) Nebelung et al. measured both tunnel widths at the entrance and additionally the tibial tunnel widths at the exit.
Figure 3 a–c
Figure 3 a–c
Illustration of different measurement methods of the tibial tunnel on coronal, sagittal and axial CT images. a) Fink et al. measured the tibial tunnel widths at five different levels with equal distances between each other. b) Sabat et al. measured the tibial tunnel width at three different levels, the entrance, the exit and the widest part. c) Webster et al. measured the tibial tunnel width at the widest distance.
Figure 4 a–c
Figure 4 a–c
Illustration of different measurement methods for the tibial tunnel on MRI (oblique coronal, sagittal and axial images). a) Buelow et al. measured the tibial tunnel width 1 cm distal to the ACL insertion. b) Järvelä et al. measured the tibial tunnel width 2 cm apart from the entrance. c) Frosch et al. divided the tibial tunnel into three parts and measured the largest tunnel widths at each of the three parts.
See this image and copyright information in PMC

References

    1. Araki D, Kuroda R, Matsumoto T, et al. Three-Dimensional Analysis of Bone Tunnel Changes After Anatomic Double- Bundle Anterior Cruciate Ligament Reconstruction Using Multidetector- Row Computed Tomography. Am J Sports Med. 2014;42(9):2234–2241. - PubMed
    1. Baumfeld JA, Diduch DR, Rubino LJ, et al. Tunnel widening following anterior cruciate ligament reconstruction using hamstring autograft: a comparison between double cross-pin and suspensory graft fixation. Knee Surg Sports Traumatol Arthrosc. 2008;16(12):1108–1113. - PubMed
    1. Buelow J-U, Siebold R, Ellermann A. A prospective evaluation of tunnel enlargement in anterior cruciate ligament reconstruction with hamstrings: extracortical versus anatomical fixation. Knee Surg Sports Traumatol Arthrosc. 2002;10(2):80–85. - PubMed
    1. Clatworthy M, Annear P, Bulow J-U, Bartlett R. Tunnel widening in anterior cruciate ligament reconstruction: a prospective evaluation of hamstring and patella tendon grafts. Knee Surg Sports Traumatol Arthrosc. 1999;7(3):138–145. - PubMed
    1. Fahey M, Indelicato PA. Bone tunnel enlargement after anterior cruciate ligament replacement. Am J Sports Med. 1994;22(3):410–414. - PubMed

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