Morphological changes in the femoral and tibial bone tunnels after anatomic single-bundle anterior cruciate ligament reconstruction using a calcium phosphate-hybridized tendon graft in 2 years of follow-up - 09/03/19

Doi : 10.1016/j.otsr.2019.01.005

Hirotaka Mutsuzaki ^a,^⁎ , Tomonori Kinugasa ^b, Kotaro Ikeda ^b, Masataka Sakane ^c
^a Department of Orthopaedic Surgery, Ibaraki Prefectural University of Health Sciences, 4669-2 Ami Ami-machi, 300-0394 Inashiki-gun, Ibaraki, Japan
^b Department of Orthopaedic Surgery, Ichihara Hospital, 3681 Oozone, 300-3295 Tsukuba, Ibaraki, Japan
^c Department of Orthopaedic Surgery, Tsukuba Gakuen Hospital, 2573-1 Kamiyokoba, 305-0854 Tsukuba, Ibaraki, Japan

^⁎Corresponding author.

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Abstract

Introduction

A calcium phosphate (CaP)-hybridized tendon graft improves tendon-to-bone healing. The purpose of the study was to evaluate the progression of morphological changes in the femoral and tibial bone tunnels after anatomic single-bundle anterior cruciate ligament (ACL) reconstruction using the CaP-hybridized tendon graft versus an untreated tendon graft during 2 years of follow-up.

Hypothesis

We hypothesized that the CaP-hybridized tendon graft would prevent the progression of bone tunnel enlargement compared with the untreated tendon graft.

Patients and methods

The CaP group comprised 19 patients, while the conventional group comprised 18. Computed tomography was performed at postoperative 1 week, 1 year, and 2 years. The bone tunnel enlargement and tunnel translation at the aperture of the femoral and tibial tunnels were analyzed.

Results

In the CaP group, the femoral bone tunnel did not expand during 2 years of follow-up. In the conventional group, the femoral bone tunnel diameters at postoperative 1 year and 2 years were enlarged compared with postoperative 1 week, and the proximal and distal walls of the femoral bone tunnel shifted proximally and distally, respectively. The femoral bone tunnel in the CaP group was smaller than that in the conventional group at 1 year postoperatively. Although the tibial bone tunnels expanded for up to 1 year postoperatively in both groups, the expanded bone tunnel reduced during 2 years of follow-up only in the CaP group.

Discussion

In anatomic single-bundle ACL reconstruction, the femoral bone tunnel in the CaP group did not expand or progress with time compared with the conventional group, while the tibial bone tunnel in the CaP group expanded for up to 1 year postoperatively and then reduced for up to 2 years postoperatively. The CaP-hybridized tendon can prevent the progression of bone tunnel enlargement.

Level of evidence

Level II, Low-powered prospective randomized trial.

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Keywords : Anatomic single-bundle anterior cruciate ligament reconstruction, Calcium phosphate hybridization, Bone tunnel enlargement, Morphological change, Computed tomography