Anterior cruciate ligament reconstruction: Effect of graft tunnel position on early to mid-term clinical outcomes

doi:10.5312/wjo.v15.i8.744

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World Journal of Orthopedics

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2218-5836

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Observational Study

World J Orthop. Aug 18, 2024; 15(8): 744-753
Published online Aug 18, 2024. doi: 10.5312/wjo.v15.i8.744

Table 1 Patient demographics

Item	n = 87
Age (years), mean (range)	31.5 (12.0-62.0)
Sex (male:female)	60:27
Laterality (left:right)	44:43
Graft type (hamstring:BTB)	60:27
Height (cm), mean ± SD	174.3 ± 8.8
Weight (kg), mean ± SD	84.1 ± 18.0
BMI (kg/m²), mean ± SD	27.5 ± 5.4

BTB: Bone-patella tendon-bone; BMI: Body mass index.

Table 2 Post-operative radiological parameters

Item	Median (inter-quartile range)
Coronal position tibial tunnel (%)	46.3 (42.7-49.6)
Coronal angle tibial tunnel (º)	70.8 (66.7-76.4)
Coronal angle femoral tunnel (º)	45.7 (39.8-52.0)
Sagittal position tibial tunnel (%)	44.8 (38.4-54.5)
Transplant orientation to joint (º)	68.3 (60.7-72.7)
Position along Blumensaat’s line (%)	47.2 (36.3-53.8)
Angle of femoral tunnel to femur (º)	38.9 (35.2-43.7)

Table 3 Post-operative patient reported outcome measures data

Item	Median (inter-quartile range)
KOOS pain	89 (78-97)
KOOS symptom	79 (68-86)
KOOS ADL	97 (90-100)
KOOS sport/rec	75 (60-85)
KOOS QoL	63 (44-75)
KOOS overall	81 (70-87)
IKDC	75 (64-86)
Lysholm	87 (76-91)
Tegner	5 (4-7)
EQ-5D index	0.837 (0.728-1.000)
EQ-5D VAS	85 (70-90)
SF-12 MCS	53 (45-58)
SF-12 PCS	54 (47-57)

PROM: Patient reported outcome measures; IQR: Inter-quartile range; KOOS: Knee injury and Osteoarthritis Outcome Score; ADL: Activities of daily living; Sport/rec: Sport and recreation function; QoL: Quality of life; IKDC: International Knee Documentation Score; SF-12: Short Form 12; MCS: Mental component summary; PCS: Physical component summary; EQ-5D: EuroQol-5D; VAS: Visual analogue score.

Table 4 Comparison of post-operative patient reported outcome measures with EndoButton position

	Anterior, median (IQR)	Middle, median (IQR)	Posterior, median (IQR)	P value¹	H
KOOS pain	88 (73-97)	85 (67-95)	88 (82-91)	0.748	0.6
KOOS symptom	79 (68-89)	79 (57-83)	83 (68-88)	0.612	1.0
KOOS ADL	98 (87-100)	92 (71-97)	95 (92-96)	0.227	3.0
KOOS sport/rec	78 (61-85)	73 (45-75)	73 (51-75)	0.393	1.9
KOOS QoL	57 (25-80)	56 (31-65)	57 (40-69)	0.820	0.4
KOOS overall	81 (64-85)	77 (59-82)	79 (67-83)	0.440	1.6
IKDC	75 (53-77)	69 (56-77)	71 (64-72)	0.664	0.8
Lysholm	88 (71-94)	85 (74-89)	83 (74-89)	0.722	0.7
Tegner	5 (3-7)	5 (3-7)	4 (2-5)	0.454	1.6
EQ-5D index	1 (0.746-1.000)	0.750 (0.657-0.919)	0.704 (0.668-0.810)	0.097	4.7
EQ-5D VAS	74 (61-84)	88 (64-91)	73 (70-86)	0.161	3.6
SF-12 MCS	51 (47-59)	54 (40-59)	54 (37-58)	0.964	0.1
SF-12 PCS	55 (50-57)	52 (35-56)	46 (44-47)	0.266	2.7

¹Kruskal Wallis H test.

No statistically significant results. IQR: Inter-quartile range; PROM: Patient reported outcome measures; KOOS: Knee injury and Osteoarthritis Outcome Score; ADL: Activities of daily living; Sport/Rec: Sport and recreation function; QoL: Quality of life; IKDC: International Knee Documentation Score; SF-12: Short form 12; MCS: Mental component summary; PCS: Physical component summary; EQ-5D: EuroQol-5D; VAS: Visual analogue score.

Table 5 Correlation between post-operative patient reported outcome measures and radiological parameters¹

		Coronal position TT	Coronal angle TT	Coronal angle FT	Sagittal position TT	TOJ	Position along Blumensaat’s line	Angle of FT to femur	EndoButton position
KOOS pain	rho	0.150	-0.160	0.040	0.200	0.030	0.370	0.090	-0.090
	P value	0.297	0.251	0.801	0.158	0.809	0.109	0.603	0.621
KOOS symptom	rho	0.030	-0.150	-0.030	0.210	-0.050	-0.050	0.060	-0.050
	P value	0.828	0.285	0.818	0.127	0.709	0.823	0.736	0.778
KOOS ADL	rho	0.093	-0.140	0.190	0.200	-0.060	0.140	-0.150	-0.240
	P value	0.507	0.317	0.178	0.150	0.688	0.548	0.410	0.170
KOOS sport/rec	rho	0.110	-0.040	0.200	0.120	0.010	0.320	0.030	-0.220
	P value	0.436	0.771	0.166	0.410	0.944	0.190	0.864	0.220
KOOS QoL	rho	0.230	-0.110	0.200	0.430	-0.200	0.080	0.010	-0.020
	P value	0.097	0.441	0.147	0.002^a	0.157	0.735	0.956	0.928
KOOS overall	rho	0.170	-0.040	0.160	0.250	-0.090	0.230	0.020	-0.140
	P value	0.220	0.757	0.255	0.080	0.551	0.344	0.919	0.423
IKDC	rho	0.180	-0.100	0.150	0.260	0.070	0.260	0.170	-0.160
	P value	0.202	0.517	0.288	0.060	0.635	0.268	0.358	0.381
Lysholm	rho	0.010	-0.210	-0.110	0.200	-0.020	0.290	0.290	-0.140
	P value	0.921	0.139	0.446	0.166	0.898	0.232	0.105	0.453
Tegner	rho	-0.040	0.200	-0.020	0.200	0.140	0.130	0.130	-0.180
	P value	0.766	0.178	0.913	0.900	0.333	0.582	0.500	0.355
EQ-5D index	rho	0.060	-0.150	-0.010	0.260	-0.100	0.310	0.070	-0.380
	P value	0.659	0.285	0.933	0.068	0.491	0.192	0.698	0.028^a
EQ-5D VAS	rho	0.030	0.020	-0.080	0.360	-0.180	0.010	0.130	0.240
	P value	0.820	0.891	0.566	0.010^a	0.213	0.962	0.461	0.174
SF-12 MCS	rho	0.000	-0.140	-0.070	0.110	-0.010	0.110	0.040	0.050
	P value	0.999	0.339	0.650	0.459	0.956	0.641	0.822	0.797
SF-12 PCS	rho	0.170	-0.110	0.120	0.220	-0.100	0.290	-0.070	-0.280
	P value	0.244	0.467	0.405	0.144	0.524	0.223	0.732	0.129

¹Spearman’s rank correlation test.

^aP < 0.05.

rho: Correlation coefficient; PROM: Patient reported outcome measures; KOOS: Knee injury and Osteoarthritis Outcome Score; ADL: Activities of daily living; Sport/rec: Sport and recreation function; QoL: Quality of life; IKDC: International Knee Documentation Score; SF-12: Short Form 12; MCS: Mental component summary; PCS: Physical component summary; EQ-5D: EuroQol-5D; VAS: Visual analogue score; TT: Tibial tunnel; FT: Femoral tunnel; TOJ: Transplant orientation to joint angle.

Citation: 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
URL: https://www.wjgnet.com/2218-5836/full/v15/i8/744.htm
DOI: https://dx.doi.org/10.5312/wjo.v15.i8.744