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Clinical implication of fibrin clot augmentation in anatomic anterior cruciate ligament reconstruction using soft tissue allograft related to tunnel enlargement
Arthrosc Orthop Sports Med 2024;11:30-35
Published online May 1, 2024;  https://doi.org/10.14517/aosm23020
© 2024 Korean Arthroscopy Society and Korean Orthopedic Society for Sports Medicine.

Ju Hong Lee, Sung Il Wang, Se Hwan Lee, Sang Hyun Jeon, Ki Bum Kim

Department of Orthopedic Surgery, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
Correspondence to: Ki Bum Kim, https://orcid.org/0000-0003-0990-4017
Departments of Orthopedic Surgery, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, 20 Geonjiro, Deokjin-gu, Jeonju 54907, Korea. Tel: +82-63-250-1760, Fax: +82-63-270-3053, E-mail: tibikim@naver.com
Received October 5, 2023; Revised October 29, 2023; Accepted October 30, 2023.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background: Tunnel enlargement is a frequently encountered complication following anterior cruciate ligament reconstruction (ACLR). This study investigated the effect of fibrin clot augmentation on tunnel enlargement after ACLR with tibialis posterior tendon allograft.
Methods: This study included 67 patients who consequently underwent anatomic single-bundle ACLR with tibialis posterior tendon allograft. We categorized the two groups according to fibrin clot usage (Group A [fibrin clot]: 36 knees and Group B [nonfibrin clot]: 31 knees). We compared the tunnel enlargement and clinical outcomes between the two groups. All patients underwent computed tomography scans at postoperative day 2 and 1-year follow-up. The difference in widest tunnel size in sagittal and coronal sections at both periods was used to calculate tunnel enlargement. Clinical outcomes, including the Lysholm and International Knee Documentation Committee scores, were compared between two groups at 1-year follow-up. Knee stability, evaluated by Lachman, pivot shift, and stress view tests, was compared between the two groups at 1-year follow-up.
Results: The coronal and sagittal planes revealed significantly less femoral and tibial tunnel widenings in Group A than Group B concerning amount and proportion (2.3 ± 1.5 mm vs. 2.8 ± 2.1 mm, 26.6% ± 17.2% vs. 30.2% ± 22.1%; 2.0 ± 1.6 mm vs. 2.4 ± 2.3 mm, 19.9% ± 16.5% vs. 24.7% ± 24.8%). However, clinical outcomes and knee stability demonstrated no significant differences between the two groups.
Conclusion: This study revealed that fibrin clot augmentation reduced tunnel enlargement compared to no augmentation regarding amount and proportion. Moreover, clinically meaningful tunnel enlargement did not show at 1 year after ACLR using posterior tibialis allograft with fibrin clot augmentation although not statistically significant. Further study of randomized and large sample sizes is required to confirm these results.
Keywords : Anterior cruciate ligament reconstruction; Allografts; Tunnel enlargement; Fibrin clot
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May 2024, 11 (1)