Computed tomography based evaluation of the bone mineral density around the fixation area during knee ligament reconstructions: Clinical relevance in the choice of fixation method

Introduction: This study examined the bone density around the fixation area during knee ligament reconstructions and assessed how this clinical relevance can be applied to a firm construction for a reconstructed ligament. Materials and methods: Fifty consecutive patients (25 healthy men and 25 healthy women) were enrolled in this study. A quantitative computed tomography was used to determine the trabecular bone density at the 7 clinically relevant areas (anteromedial area of proximal tibia, anterolateral area of proximal tibia, posteromedial area of the proximal tibia, posterocentral area of the proximal tibia, posterolateral area of the proximal tibia, near femoral tunnel entrance of the ACL, near the femoral funnel entrance of the PCL). The means and standard deviations of the areas of interest were measured using a 10 mm diameter circle and the bone density was compared. Results: A comparison of the fixation areas in the proximal tibia, anteromedial area of proximal tibia showed the highest bone density and posterocentral area showed the lowest bone density. A comparison of the PCL tibial fixation with interference screws or trans-condylar fixation revealed the posterocentral area to have the lowest bone density. A comparison of the femoral fixation areas in the ACL and PCL reconstruction revealed no differences in bone density. Conclusion: The anteromedial area of the proximal tibia was most acceptable in the interference screw fixation and the posterocentral area had the lowest bone density in the proximal tibia. There were no differences in the femoral fixation areas in the ACL and PCL reconstruction. (C) 2012 Elsevier B.V. All rights reserved.