J Korean Orthop Assoc.  2010 Feb;45(1):1-9. 10.4055/jkoa.2010.45.1.1.

Rotary Instability after Anterior Cruciate Ligament Reconstruction with Single BTB Tendon

• Kim MK
• Bae JH
• Jung JH

• KMID: 2185587
• DOI: http://doi.org/10.4055/jkoa.2010.45.1.1

Abstract

PURPOSE
To analyze both the functional restoration and recovery of rotational and anterior-posterior stability after a single bundle ACL reconstruction using a BTB tendon.
MATERIALS AND METHODS
A total of 52 patients were evaluated with an average follow up period of 32 months. A Lachman test, KT-2000 arthrometer, and Pivot shift test were performed to analyze the AP and rotational stability of the patients. The IKDC and Lysholm score was then used to evaluate the clinical results of the patients. The correlation between femoral tunnel angle and recovery of rotational stability was evaluated to determine the association between the two variables. This study also evaluated how the recovery of rotational stability affects the functional recovery of the patients.
RESULTS
At the final follow up, the results indicated significant improvement according to the negative Lachman tests in 40 cases (76%), with an average of 2.92 mm anterior translation in the KT-2000 arthrometer and negative Pivot shift tests in 41 cases (79%)(p<0.05). The Lysholm and IKDC scores also showed significant improvement (p<0.05). Throughout the study, Group A was designated as those with <5 mm anterior translation and a negative Pivot shift test whereas Group B had positive test results. In Group A, the results showed 35 normal (85%), and 6 near normal (15%) cases in the IKDC score system, whereas Group B showed 2 normal (25%) and 5 near normal (62.5%) cases. Group A had an average of 89.3 in the Lysholm score system whereas Group B had a score of 60.5. On the knee tunnel view, Group A showed an average femoral tunnel angle of 49.2degrees, whereas Group B showed 63.5degrees.
CONCLUSION
Decreasing the inclination of the BTB tendon using a transtibial femoral tunnel angle at either 10'30 or 1'30 will result in an excellent clinical outcome by achieving both anterior and rotational stability when operating a single bundle ACL reconstruction.

Keyword

rotational stability; single bundle ACL reconstruction; femoral tunnel; BTB tendon

MeSH Terms

Anterior Cruciate Ligament
Anterior Cruciate Ligament Reconstruction
Follow-Up Studies
Humans
Knee
Tendons

Figure

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  Figure 1 This picture shows that we preserved tibial remnant of ACL as possible.

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  Figure 2 (A, B) Figures show that our tibial tunnel starting point (arrow) is more medial than standard ACL tibial tunnel (X) (X: Midway of superfiical medial collateral ligament and tibial tubercle, Arrow: Point at junction of MCL and pes anserinus).

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  Figure 3 We reproduce normal lateral twist of the ACL with 90° of lateral rotation of the tibial bone plug (Painted fiber indicate anteromedial bundle and remains are posteromedial bundle).

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  Figure 4 Relationship between result of KT-2000 arthrometer (AP stability) and Pivot shift test (Rotational stability).

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  Figure 5 The comparison of IKDC score between Group A and B (Goup A: tibial translation was within 5 mm on KT 2000 arthrometer with negative Pivot shift test, Group B: tibial translation was within 5 mm on KT 2000 arthrometer with positive Pivot shift test).

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  Figure 6 The comparison of lysholm score between Group A and B.

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  Figure 7 Group A shows more oblique placement of femoral tunnel than Group B.

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