Pre-operative determination of the optimum graft length for anteriorcruciate ligament reconstruction
Year: 2015
Type: dissertation
Abstract: Purpose: \nAccurate knowledge of the anatomy of the anterior cruciate ligament (ACL) is crucial \nfor successful ACL reconstruction. Incorrect graft lengths and/or tunnel \nmisplacement have to be avoided. If the graft length is incorrect, the patient could \nrisk knee instability, loss of range of motion or failure of graft fixation. The success of \nACL reconstruction will be enhanced if the correct length of the graft ligament \nrequired, can be predicted in advance. Magnetic resonance imaging (MRI) is \ncurrently used for the evaluation of ACL injuries, but is not available to all patients. \nApart from examining the morphological properties of the ACL at macroscopic and \nmicroscopic levels, this study aimed to determine whether independent factors of an \nindividual can be used to predict native ACL length which could assist in preoperative \nplanning. \nMethods: \nNinety-one adult cadavers were studied. The patellar ligament (PL) length, ACL \nlength, ACL width and the maximum femoral epicondylar width (FECW) were \nmeasured. For the radiographic component, 52 patients were sourced to evaluate \nand compare ACL length, PL length and FECW, measured on both MRI and \nradiograph. Fresh ligaments were harvested (18 ACLs and 10 PLs) to evaluate the \nhistological composition of the ACL and PL. \nResults: \nThe morphology of the ACL and PL was determined. The morphology of the \nligaments compared well to the descriptions in previous literature. The ligaments \nproved to be compatible at histological level. The results revealed that FECW was \nthe most reliable predictor of ACL length. Linear regression formulas were developed \nin order to determine ACL length by measuring maximum FECW. It was also \ndetermined that either an MRI or radiograph can be used to assist in pre-operative \nplanning. \nConclusion: \nACL and PL morphology compared well with the descriptions found in previous \nstudies. It was also found that, contrary to previous studies, the maximum FECW is a \nmore reliable predictor of ACL length than the height of the patient. The results also \nshowed that both radiographs and MRI scans can be used to determine preoperative \nACL length. These results could improve the pre-operative planning of \nACL reconstruction and minimise the occurrence of graft mismatch.
Author: Reinette Ebersohn
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W1905917496