Clin Orthop Surg.  2014 Sep;6(3):290-297. 10.4055/cios.2014.6.3.290.

Volume and Contact Surface Area Analysis of Bony Tunnels in Single and Double Bundle Anterior Cruciate Ligament Reconstruction Using Autograft Tendons: In Vivo Three-Dimensional Imaging Analysis

• Yang JH
• Chang M
• Kwak DS
• Wang JH

• KMID: 1794710
• DOI: http://doi.org/10.4055/cios.2014.6.3.290

Abstract

BACKGROUND
Regarding reconstruction surgery of the anterior cruciate ligament (ACL), there is still a debate whether to perform a single bundle (SB) or double bundle (DB) reconstruction. The purpose of this study was to analyze and compare the volume and surface area of femoral and tibial tunnels during transtibial SB versus transportal DB ACL reconstruction.
METHODS
A consecutive series of 26 patients who underwent trantibial SB ACL reconstruction and 27 patients with transportal DB ACL reconstruction using hamstring autograft from January 2010 to October 2010 were included in this study. Three-dimensional computed tomography (3D-CT) was taken within one week after operation. The CT bone images were segmented with use of Mimics software v14.0. The obtained digital images were then imported in the commercial package Geomagic Studio v10.0 and SketchUp Pro v8.0 for processing. The femoral and tibial tunnel lengths, diameters, volumes and surface areas were evaluated. A comparison between the two groups was performed using the independent-samples t-test. A p-value less than the significance value of 5% (p < 0.05) was considered statistically significant.
RESULTS
Regarding femur tunnels, a significant difference was not found between the tunnel volume for SB technique (1,496.51 +/- 396.72 mm3) and the total tunnel volume for DB technique (1,593.81 +/- 469.42 mm3; p = 0.366). However, the total surface area for femoral tunnels was larger in DB technique (919.65 +/- 201.79 mm2) compared to SB technique (810.02 +/- 117.98 mm2; p = 0.004). For tibia tunnels, there was a significant difference between tunnel volume for the SB technique (2,070.43 +/- 565.07 mm3) and the total tunnel volume for the DB technique (2,681.93 +/- 668.09 mm3; p < or = 0.001). The tibial tunnel surface area for the SB technique (958.84 +/- 147.50 mm2) was smaller than the total tunnel surface area for the DB technique (1,493.31 +/- 220.79 mm2; p < or = 0.001).
CONCLUSIONS
Although the total femoral tunnel volume was similar between two techniques, the total surface area was larger in the DB technique. For the tibia, both total tunnel volume and the surface area were larger in DB technique.

Keyword

Anterior cruciate ligament reconstruction; Single bundle; Double bundle; Tunnel; Volume; Surface area

MeSH Terms

Adult
Anterior Cruciate Ligament/injuries/surgery
Anterior Cruciate Ligament Reconstruction/*methods
Autografts
Femur/*radiography/surgery
Humans
Imaging, Three-Dimensional
Male
Tendon Injuries/*radiography/rehabilitation/surgery
Tendons/transplantation
Tibia/*radiography/surgery

Figure

• 

  Fig. 1 Tunnel separation. (A) Transparent image obtained through three-dimensional digital reconstruction. (B) Removing parts other than the tunnel. (C) Sealing the tunnel for each volume measurement (black arrows). (D) Image processed for surface area measurement: (A-C) was processed in Geomagic Studio v10.0 and (D) was processed in SketchUp Pro v8.0.

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