Mann O, Al-Dadah O. Anterior cruciate ligament reconstruction: Effect of graft tunnel position on early to mid-term clinical outcomes. World J Orthop 2024; 15(8): 744-753 [PMID: 39165872 DOI: 10.5312/wjo.v15.i8.744]
Corresponding Author of This Article
Oliver Mann, Master’s Student, Research Fellow, The Medical School, Newcastle University, Framlington Place, Newcastle upon Tyne NE2 4HH, United Kingdom. oliver.mann1@nhs.net
Research Domain of This Article
Orthopedics
Article-Type of This Article
Observational Study
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Mann O, Al-Dadah O. Anterior cruciate ligament reconstruction: Effect of graft tunnel position on early to mid-term clinical outcomes. World J Orthop 2024; 15(8): 744-753 [PMID: 39165872 DOI: 10.5312/wjo.v15.i8.744]
World J Orthop. Aug 18, 2024; 15(8): 744-753 Published online Aug 18, 2024. doi: 10.5312/wjo.v15.i8.744
Anterior cruciate ligament reconstruction: Effect of graft tunnel position on early to mid-term clinical outcomes
Oliver Mann, Oday Al-Dadah
Oliver Mann, The Medical School, Newcastle University, Newcastle upon Tyne NE2 4HH, United Kingdom
Oday Al-Dadah, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE2 4HH, United Kingdom
Oday Al-Dadah, Department of Trauma and Orthopaedic Surgery, South Tyneside District Hospital, Harton Lane, South Tyneside NE34 0PL, United Kingdom
Author contributions: Mann O contributed to conceptualization, investigation, writing-original draft, writing-review and editing, and visualization; Al-Dadah O contributed to conceptualization, methodology, validation, formal analysis, resources, writing-review and editing, supervision, and project administration.
Institutional review board statement: This was reviewed and approved by the Institution’s Clinical Effectiveness Department at South Tyneside District Hospital (Approval No. CA10358).
Informed consent statement: All patients included in this study signed informed consent forms to have their data included (anonymously) for the purpose of research. It forms part of their standard of care treatment consent forms. Due to our hospitals Data Protection policy, we cannot send out all the patients signed consent forms to a third party.
Conflict-of-interest statement: We confirm that all authors have no conflicts of interest.
Data sharing statement: Not applicable.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Corresponding author: Oliver Mann, Master’s Student, Research Fellow, The Medical School, Newcastle University, Framlington Place, Newcastle upon Tyne NE2 4HH, United Kingdom. oliver.mann1@nhs.net
Received: January 18, 2024 Revised: May 30, 2024 Accepted: July 9, 2024 Published online: August 18, 2024 Processing time: 207 Days and 15.6 Hours
Abstract
BACKGROUND
Patient reported outcome measures (PROMs) can be used to assess knee function following anterior cruciate ligament (ACL) reconstruction. Intra-operatively, femoral and tibial tunnels are created to accommodate the new ACL graft. It is postulated that there is an optimum position and orientation of these tunnels and that outcomes from this procedure are affected by their position.
AIM
To evaluate the influence of graft tunnel position on early to mid-term clinical outcomes following ACL reconstruction.
METHODS
Six PROMs were collected following ACL reconstruction which included the Knee Injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee, Lysholm, Tegner, EuroQol-5 Dimension-5 level, and Short Form 12-item Health Survey. A total of 8 radiological parameters were measured from post-operative X-rays relating to graft tunnel positions. This data was analysed to assess for any correlations between graft tunnel position and post-operative PROMs.
RESULTS
A total of 87 patients were included in the study with a mean post-operative follow-up of 2.3 years (range 1 to 7 years). Posterior position of tibial tunnel was associated with improved KOOS quality of life (rho = 0.43, P = 0.002) and EQ-5D VAS (rho = 0.36, P = 0.010). Anterior position of EndoButton femoral tunnel was associated with an improved EQ-5D index (rho = -0.38, P = 0.028). There were no other significant correlations between any of the other radiological parameters and PROM scores.
CONCLUSION
Overall, graft tunnel position had very little correlation with clinical outcomes following ACL reconstruction. A few (posterior) tibial tunnel and (anterior) EndoButton femoral tunnel measurements were associated with better PROMs.
Core Tip: This is an observational cross-sectional study investigating the effect of graft tunnel position following anterior cruciate ligament reconstruction and its association with patient reported outcome measures (PROMs). PROMs were collected before and at a minimum of 12 months following surgery. The results of these questionnaires were analysed to determine whether radiological measurements of graft tunnel position had a significant impact on early to mid-term clinical outcomes. If significance is found, it is important to determine the most optimal position for the tunnels to improve patients’ function following these procedures.
