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Arthroscopy. 2014 Jun;30(6):739-46. doi: 10.1016/j.arthro.2014.02.024. Epub 2014 Apr 13.

The effect of notchplasty on tunnel widening in anterior cruciate ligament reconstruction.

Author information

  • 1Department of Orthopedic Surgery, Hallym University Medical Center, Dongtan, South Korea.
  • 2Department of Orthopedic Surgery, Hallym University Medical Center, Dongtan, South Korea. Electronic address: ybw1999@gmail.com.
  • 3HiLab, Korea University of Technology and Education, Cheonan, South Korea.
  • 4Department of Orthopedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A.

Abstract

PURPOSE:

To investigate changes in femoral tunnel diameter, dimension, and volume after anterior cruciate ligament reconstruction with notchplasty.

METHODS:

Porcine knee specimens were divided into 2 groups of 10 specimens each. Group A did not receive notchplasty. A 2-mm notchplasty was conducted in group B. Seven-millimeter-diameter femoral tunnels were drilled and a doubled flexor digitorum profundus tendon was inserted and fixed with an EndoButton (Smith & Nephew, Andover, MA) in each knee specimen. Samples were mounted on a materials testing machine. Each group was preloaded at 10 N and subjected to 20 loading cycles (between 0 and 40 N), followed by 1,000 loading cycles in the elastic region (between 10 and 150 N). High-resolution computed tomography with 1.0-mm slices was conducted with all samples before and after testing. A 3-dimensional model was constructed to evaluate the degree of the tunnel change.

RESULTS:

In group B the mean longest diameter and dimension of the femoral tunnel significantly increased after the test (P = .005 and P = .001, respectively). The volumetric loss of bony structure after the test in group B was significantly greater than that in group A (P = .039). Meanwhile, no significant difference was found before and after the test in terms of tunnel diameter, dimension, and volumetric loss around the tunnel in group A.

CONCLUSIONS:

The intra-articular orifice of the femoral tunnel was enlarged after the uniaxial cyclic loading test after notchplasty. An enlarged tunnel orifice may lead to a discrepancy between the tunnel and the graft at the tunnel aperture.

CLINICAL RELEVANCE:

The data may have an implication that suspensory fixation with a notchplasty has a negative effect on the full graft accommodation at the tunnel aperture. Aperture widening may affect graft positioning, leading to subtle changes in graft biomechanics and laxity.

PMID:
24725985
DOI:
10.1016/j.arthro.2014.02.024
[PubMed - indexed for MEDLINE]
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