Mg. Clatworthy et al., Tunnel widening in anterior cruciate ligament reconstruction: a prospective evaluation of hamstring and patella tendon grafts, KNEE SURG S, 7(3), 1999, pp. 138-145
We report a prospective series evaluating the incidence and degree of tunne
l widening in a well-matched series of patients receiving a hamstring or pa
tella tendon graft for anterior cruciate ligament (ACL) deficiency. The cor
related tunnel widening with clinical factors, knee scores, KT-1000 and iso
kinetic muscle strength to determine the clinical significance of this find
ing. Seventy-three patients at least 12 months post-ACL reconstruction were
evaluated. Thirty-eight patients had received a doubled semitendinous and
gracilis graft and 35 a bone-patella tendon-bone graft. All patients underw
ent a similar endoscopic procedure and accelerated postoperative rehabilita
tion. Tunnel widening was determined using standardized anteroposterior (AP
) and lateral X-rays adjusted for magnification. A limited series of MRIs w
as performed to validate these measurements. There was a significant differ
ence in the degree of tunnel widening between the two groups. The mean incr
ease in femoral tunnel area in the hamstring group was 100.4% compared with
a decrease of 25% in the patella tendon group (P = <0.0001). In the tibial
tunnel the mean increase in the hamstring group was 73.9% compared with a
decrease of 2.1% in the patella tendon group (P = <0.0001). The MRIs valida
ted the plain film measurements. Tunnel widening did not correlate with the
clinical findings, knee scores. KT-1000 or isokinetic muscle strength. Tun
nel widening is marked in the hamstring group. Tunnel widening does not cor
relate with instability or a poor clinical outcome in the short term. The l
ong-term implications of this finding ale still to be determined.