Chronicity of Anterior Cruciate Ligament Deficiency, Part 1: Effects on the Tibiofemoral Relationship Before and Immediately After Anatomic ACL Reconstruction With Autologous Hamstring Grafts

Yoshinari Tanaka; Keisuke Kita; Rikio Takao; Hiroshi Amano; Ryohei Uchida; Yoshiki Shiozaki; Yasukazu Yonetani; Kazutaka Kinugasa; Tatsuo Mae; Shuji Horibe

doi:10.1177/2325967117750813

Chronicity of Anterior Cruciate Ligament Deficiency, Part 1: Effects on the Tibiofemoral Relationship Before and Immediately After Anatomic ACL Reconstruction With Autologous Hamstring Grafts

Orthop J Sports Med. 2018 Jan 22;6(1):2325967117750813. doi: 10.1177/2325967117750813. eCollection 2018 Jan.

Authors

Affiliations

¹ Department of Sports Orthopedics, Osaka Rosai Hospital, Sakai, Japan.
² Faculty of Comprehensive Rehabilitation, Osaka Prefecture University, Habikino, Japan.
³ Department of Orthopedic Surgery, Seifu Hospital, Sakai, Japan.
⁴ Department of Orthopedic Surgery, Hoshigaoka Medical Center, Hirakata, Japan.
⁵ Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Japan.

Abstract

Background: It remains unclear whether the tibiofemoral relationship in the sagittal plane is restored after anatomic anterior cruciate ligament (ACL) reconstruction, particularly in cases of chronic ACL deficiency (ACLD).

Hypothesis: Patients with long-term ACLD will exhibit an anteriorly subluxed tibia both preoperatively and immediately postoperatively, even after anatomic reconstruction.

Study design: Cohort study; Level of evidence, 2.

Methods: In total, 358 patients who had undergone anatomic ACL reconstruction with autologous semitendinosus grafts were divided into 5 groups based on chronicity of ACLD: (1) 0 to 6 months, (2) 6 months to 1 year, (3) 1 to 2 years, (4) 2 to 5 years, and (5) longer than 5 years. Preoperatively and immediately postoperatively, all patients underwent lateral radiography in extension to evaluate the tibiofemoral relationship, specifically with regard to anterior tibial subluxation (ATS), space for the ACL (sACL), and extension angle. Demographic and radiographic factors were compared among the 5 groups.

Results: Preoperative ATS values in groups 4 (mean ± SD, 2.9 ± 2.1 mm) and 5 (2.6 ± 1.9 mm) were significantly greater than in group 1 (1.6 ± 1.9 mm). Postoperatively, the tibia was posteriorly overconstrained in all groups, and there was no difference in immediately postoperative ATS among the 5 groups. Further evaluation of the tibiofemoral relationship in the sagittal plane revealed that the mean preoperative side-to-side difference in sACL (sACL-SSD) was greater in groups 4 (2.5 ± 1.6 mm) and 5 (2.2 ± 1.7 mm) than in group 1 (1.2 ± 1.5 mm). Immediately after ACL reconstruction, however, there were no group-dependent differences in sACL-SSD. No significant group-dependent differences were found for extension deficit.

Conclusion: Chronicity of ACLD had an effect on the preoperative tibiofemoral relationship in the sagittal plane, including ATS and sACL-SSD, especially in patients with ACLD longer than 2 years. However, preoperative extension deficit was not influenced by chronicity. Immediately postoperatively, chronicity did not affect the ability of anatomic ACL reconstruction to reduce subluxation.

Keywords: ACL; anterior tibial subluxation; chronicity of ACL deficiency; space for the ACL.