Bone-to-bone integrations were complete within 5 months after anatomical rectangular tunnel anterior cruciate ligament reconstruction using a bone–patellar tendon–bone graft
- 141 Downloads
Anterior cruciate ligament (ACL) reconstruction using a bone–patellar tendon–bone (BTB) graft is known to provide secure fixation due to the direct bone-to-bone integration of the bone plug and bone tunnel. It is important to know the time required for bone integration when designing the postoperative rehabilitation protocol or deciding when the patient can return to competition-level activity, especially if the patient is an athlete. However, because reports are scarce, the period necessary for bone-to-bone integration after ACL reconstruction using a BTB graft remains unclear. The purpose of this study was to clarify this issue. It was hypothesised that ACL reconstruction using a BTB graft via an anatomical rectangular tunnel would help in the integration between bone plugs and bone tunnels on both the femoral and tibial sides after at least 6 months, at which point basic exercises similar to pre-injury sporting activity levels can be resumed.
This study included 40 knees treated with ACL reconstruction using a BTB graft via anatomical rectangular tunnel reconstruction between 2013 and 2014 in a single institute. The integration between bone plugs and bone tunnels was evaluated using multi-slice tomosynthesis, which is a technique for producing slice images using conventional radiographic systems, at 1, 3, and 5 months postoperatively. All procedures were performed by two experienced surgeons. Bone integration was evaluated by two orthopaedic doctors.
The rates of integration of the bone plug and femoral bone tunnel on tomosynthesis at 1, 3, and 5 months postoperatively were 0, 55, and 100%, respectively. On the tibial side, the corresponding rates were 0, 75, and 100%, respectively. The rate of integration on the tibial side was significantly higher than that on the femoral side at 3 months postoperatively (p = 0.031).
Bone-to-bone integration on the femoral and tibial sides was complete within 5 months after surgery in all cases. Since the time required for bone integration is important in designing the postoperative rehabilitation approach, these results will serve as a useful guideline for planning rehabilitation protocols.
Level of evidence
KeywordsACL reconstruction Anatomical rectangular tunnel Bone–patellar tendon–bone graft EndoButton
Anterior cruciate ligament
Bone–patellar tendon–bone graft
Double spiked plate
Author contribution statement
HM and TN made substantial contributions to conception and design, acquisition of data, analysis and interpretation of data, and drafting the manuscript or revising it critically for important intellectual content. ST, HI, NS, NN, and ST agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. HK gave final approval of the version to be published. All authors read and approved the final manuscript.
No funding was provided to the article.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no competing interests.
The institutional review board of Teikyo University in Tokyo, Japan approved this study (ID17036).
All patients were informed about the procedure and provided consent for participation in the study and for the publication of their data.
- 13.Hayashi H, Kurosaka D, Saito M, Ikeda R, Kijima E, Yamashita Y et al (2017) Anterior cruciate ligament reconstruction with bone–patellar tendon–bone graft through a rectangular bone tunnel made with a rectangular retro-dilator: an operative technique. Arthrosc Tech 6:e1057–e1062CrossRefPubMedPubMedCentralGoogle Scholar
- 22.Mascarenhas R, Tranovich MJ, Kropf EJ, Fu FH, Harner CD (2012) Bone–patellar tendon–bone autograft versus hamstring autograft anterior cruciate ligament reconstruction in the young athlete: a retrospective matched analysis with 2–10 year follow-up. Knee Surg Sports Traumatol Arthrosc 20:1520–1527CrossRefPubMedGoogle Scholar
- 24.Nye DD, Mitchell WR, Liu W, Ostrander RV (2017) Biomechanical comparison of fixed-loop and adjustable-loop cortical suspensory devices for metaphyseal femoral-sided soft tissue graft fixation in anatomic anterior cruciate Ligament reconstruction using a porcine model. Arthroscopy 33:1225–1232 (e1221) CrossRefPubMedGoogle Scholar
- 29.Shino K, Nakata K, Nakamura N, Toritsuka Y, Nakagawa S, Horibe S (2005) Anatomically oriented anterior cruciate ligament reconstruction with a bone–patellar tendon–bone graft via rectangular socket and tunnel: a snug-fit and impingement-free grafting technique. Arthroscopy 21:1402CrossRefPubMedGoogle Scholar
- 30.Suzuki T, Shino K, Nakagawa S, Nakata K, Iwahashi T, Kinugasa K et al (2011) Early integration of a bone plug in the femoral tunnel in rectangular tunnel ACL reconstruction with a bone–patellar tendon–bone graft: a prospective computed tomography analysis. Knee Surg Sports Traumatol Arthrosc 19(Suppl 1):S29–S35CrossRefPubMedGoogle Scholar
- 33.Taketomi S, Inui H, Yamagami R, Shirakawa N, Kawaguchi K, Nakagawa T et al. (2017) Bone–patellar tendon–bone autograft versus hamstring tendon autograft for anatomical anterior cruciate ligament reconstruction with three-dimensional validation of femoral and tibial tunnel positions. J Knee Surg. https://doi.org/10.1055/s-0037-1615813 PubMedGoogle Scholar
- 34.Thompson SM, Salmon LJ, Waller A, Linklater J, Roe JP, Pinczewski LA (2016) Twenty-year outcome of a longitudinal prospective evaluation of isolated endoscopic anterior cruciate ligament reconstruction with patellar tendon or hamstring autograft. Am J Sports Med 44:3083–3094CrossRefPubMedGoogle Scholar
- 35.Thrush C, Porter TJ, Devitt BM (2018) No evidence for the most appropriate postoperative rehabilitation protocol following anterior cruciate ligament reconstruction with concomitant articular cartilage lesions: a systematic review. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-018-4882-x PubMedGoogle Scholar
- 37.Weiler A, Peine R, Pashmineh-Azar A, Abel C, Südkamp NP, Hoffmann RF (2002) Tendon healing in a bone tunnel. Part I: biomechanical results after biodegradable interference fit fixation in a model of anterior cruciate ligament reconstruction in sheep. Arthroscopy 18:113–123CrossRefPubMedGoogle Scholar