• Knee surgery & related research
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• v.30 no.4
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• pp.341-347
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• 2018

Purpose: Tunnel widening following anterior cruciate ligament (ACL) reconstruction is commonly observed. Graft micromotion is an important contributing factor. Unlike fixed-loop devices that require a turning space, adjustable-loop devices fit the graft snugly in the tunnel. The purpose of this study is to compare tunnel widening between these devices. Our hypothesis is that the adjustable-loop device will create lesser tunnel widening. Materials and Methods: Ninety-eight patients underwent ACL reconstruction from January 2013 to December 2014. An adjustable-loop device was used in 54 patients (group 1) and a fixed-loop device was used in 44 patients (group 2). Maximum tunnel widening at 1 year was measured by the L'Insalata's method. Functional outcome was measured at 2-year follow-up. Results: The mean widening was 4.37 mm (standard deviation [SD], 2.01) in group 1 and 4.09 mm (SD, 1.98) in group 2 (p=0.511). The average International Knee Documentation Committee score was 78.40 (SD, 9.99) in group 1 and 77.11 (SD, 12.31) in group 2 (p=0.563). The average Tegner-Lysholm score was 87.25 (SD, 3.97) in group 1 and 87.29 in group 2 (SD, 4.36) (p=0.987). There was no significant difference in tunnel widening and functional outcome between the groups. Conclusions: The adjustable-loop device did not decrease the amount of tunnel widening when compared to the fixed-loop device. There was no significant difference in outcome between the two fixation devices. Level of Evidence: Level 3, Retrospective Cohort.

• 대한관절경학회:학술대회논문집
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• 2009.10a
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• pp.153-153
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• 2009

The purpose of this study was to evaluate tibial tunnel widening prospectively after anterior cruciate ligament (ACL) reconstruction with hamstring tendon grafts using Rigidfix (DePuy Mitek, Raynham, MA) femoral fixation and Intrafix (DePuy Mitek) tibial fixation. 56 consecutive patients who underwent ACL reconstruction with a minimum of 2 years' postoperative evaluation were reviewed. On the anterior-posterior (AP) and lateral radiographs, the diameter of the tibial tunnel was measured at proximal, middle, and distal positions and the shape of the tibial tunnels were classified. Tunnel widening was defined as widening of greater than 2 mm. Group I was defined as cases with no tunnel widening and group II defined as cases with tunnel widening. Postoperative laxity evaluations were performed using Lachman test, pivot-shift test, and Instrumented laxity testing using the KT-1000 arthrometer. On the AP radiographs, the average diameter of the tibial tunnel increased 8.8% at 6 months and 8.5% at 12 months postoperatively compared to the immediate postoperative day. On the lateral radiographs, the average diameter of the tibial tunnel increased 7.2% at 6 months and 8.1% at 12 months year postoperatively compared to the immediate postoperative day. The tunnel shape evaluation revealed predominantly linear type in 53 patients (95%). Group I was 42 patients (75%) and group II was 14 (25%). The average KT-1000 measurement was 1.0~1.8 mm in group I and 2.1~2.8 mm in group II (p>0.05) The Lachman and pivot-shift showed tests no significant differences between the two groups. In conclusion, hamstring ACL reconstruction using Rigidfix and Intrafix fixation showed less widening of the tibial tunnels than observed in previously published studies.

• Clinics in Shoulder and Elbow
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• v.8 no.2
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• pp.131-134
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• 2005

Distal clavicle tunnel widening was observed in coracoclavicular ligament reconstruction with semitendinous tendon autografts in a patient with acromioclavicular joint injury. Acromioclavicular joint separation, in a 44 years-old man was treated by coracoclavicular ligament reconstruction. We have performed x-ray evaluation on 2years 10months after surgery. The immediate postoperative tunnel size was measured 4.5mm in diameter. At postoperative 2years 10month the tunnel diameter was from 9.3 to 11.4mm. But the weightbearing clavicle view showed no significant acromioclavicular joint separation. Moreover the patient complained only minor intermittent shoulder discomfort.

• Journal of Korean Tunnelling and Underground Space Association
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• v.22 no.4
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• pp.451-468
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• 2020

Aging tunnels with small cross-sections can cause chronic traffic jams. This problem can be solved by widening the tunnel. In general, when the tunnel is expanded, the outer portion of the existing tunnel is excavated through a mechanical or blasting method. Such excavation affects not only the surrounding ground but also the existing tunnel. The application of the pre-cutting method can be a solution to these problems effectively. Therefore, if the widening of tunnel is performed by applying pre-cutting method, analysis of the impact of this method must be performed. In this study, in order to analyze the effect of applying pre-cutting in tunnel widening, numerical analysis is performed at six ground grades, from grade I to weathered rock. The analysis is performed with the expanding lane and the excavation length of pre-cutting as variables. In addition, the analysis is focused on the displacement of crown of the existing tunnel and the enlarged tunnel. As a result, the crown displacement of the enlarged tunnel is confirmed to converge at the same value regardless of the excavation length of the pre-cutting when the tunnel widening is completed. In the case of existing tunnels, uplift of crown occurs within 5 m of the front of the tunnel surface, and the shorter the excavation length of pre-cutting is found to be effective in preventing the occurrence of uplift.

• Journal of Korean Tunnelling and Underground Space Association
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• v.22 no.4
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• pp.435-450
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• 2020

The divergence section of a double-deck tunnel can be divided into a 'widening pre-divergence section', a large cross-section with a cap shape and a 'post-divergence section' where the separation between the main and the branch tunnel is made. Since the cross-section of the widening pre-divergence section is considerably larger than that of the post-divergence section, the influence of excavation due to the different sizes and shapes in the cross-section should be considered in the examination of the tunnel stability. In this study, the effect of the preceding excavation, that is the excavation of the widening pre-divergence section, on excavation stability of the post-divergence section was examined by varying the excavation methods and bench lengths through 3D finite element analysis. The results showed that although the effects of the excavation methods and the bench lengths are not significant on the variation of principal stresses, the preceding excavation causes a relatively large variation on the stresses which may have an impact on the stability of the post-divergence section from the comparison of Stress-Strength Ratio (SSR) between the cases with and without the consideration of the preceding excavation effect by 2D finite element analysis.

• Journal of the Korean Arthroscopy Society
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• v.10 no.2
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• pp.165-172
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• 2006

Purpose: The purpose of this study is to evaluate the effects of intratunnel fixation in the tibial side on the arthroscopic ACL reconstruction with quadruple hamstring tendon at the second look arthroscopy. Materials and Method: From Dec 1999 to May 2005, we arthroscopically reexamined 32 cases who had been done arthroscopic ACL reconstruction with quadruple hamstring tendons. Hamstring tendons of all cases were fixed at femoral side with RigidfixTM. At the tibial side hamstring tendons were fixed only Post-tie (Group I) or Post-tie combined with IntrafixTM (Group II). At the time of second look arthroscopy mean age of cases was 30 years and mean duration for second look arthroscopy was 21.3 months. We analyzed the results with IKDC score, KT-1000 arthrometer under anesthesia, Telos stress radiography, tibial tunnel widening on the radiography and second look arthroscopic findings. Results: Group II had more superior than group I at side to side differences with KT-1000 and Telos stress radiograph, IKDC score, but the differences were insignificant. At arthroscopic evaluation, Group ll also had more superior than group I at graft tension and graft appearance, graft synovialization, but the differences were insignificant. Tibial tunnel widening in the knee AP radiograph was 2.3 mm in Group I and 1.7 mm in Group II and the difference was significant. (P=0.042) Conclusions: Additional procedure of tibial intratunnel fixation in arthroscopic ACL reconstruction with autogenous hamstring tendon significantly prohibited from tibial tunnel widening but clinical results, radiologic joint stability, findings in second look arthroscopy were insignificantly different. We concluded that Post-tie itself induced satisfactory clinical results, joint stability and graft maturation and that tibial tunnel widening did not affect the results.

• Proceedings of the Korean Geotechical Society Conference
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• 2010.09a
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• pp.1328-1332
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• 2010

The enlargement of existing tunnels is required to cope with problems related to traffic congestion. Sometimes, the tunnel traffic must be maintained through existing tunnels during their reconstruction due to non-availability of detours. And excavation by drill and blasting is desired for widening a hard rock tunnel. In this case, the road must be closed for some period for blasting through analyzing of traffic volume. In this paper, a case study on some traffic countermeasures for tunnel enlargement by blasting was performed. And the traffic flow characteristics of some tunnels in domestic main city were analyzed.

• Journal of Korean Tunnelling and Underground Space Association
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• v.13 no.1
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• pp.33-50
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• 2011

Recently interest in enlargement of existing tunnel located in downtown or mountain area have been considerably increased along with requirements and discussion on the road-widening. Therefore, it is necessary to study the construction method and stability of tunnel to enlarge the existing tunnel in design. In this study, the design concept on the alignment, excavation method, reinforcement to enlarge the existing tunnel is described on the basis of the enlargement of 2-lane road tunnel under construction. This paper suggests a proper design method for the enlargement of an existing tunnel in useful practice.

• Journal of the Korean Arthroscopy Society
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• v.5 no.2
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• pp.69-73
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• 2001

Purpose : To evaluate the clinical results and widening of bony tunnel after anterior cruciate ligament(ACL) reconstruction using hamstring tendon with Ligament Anchor(LA) screw, which is newly designed fur fixation of graft into femur. Materials and Methods : Fifty eight patients who were followed up at least more than 2 years after ACL reconstruction with four strands of Hamstring tendon were included in this study. The graft was fixed with LA screw at femoral tunnel and with bioabsorbable interference screw at tibial tunnel. The average period of follow-up was 28 months. The clinical results such as physical examination and Lysholm knee score and radiological results. widening of bony tunnel and instrumented anterior laxity test with $Telos^{\circledR}$(Telos stress device; Austin & Associates, Inc., Polston, US) were evaluated. Results . The Lysholm knee score was 60.0 in average preoperatively and improved to 94.0 in average at follow up. On the Lachman test, there were mild(+) instability in 16 cases, moderate(++) in 24, severe(+++) in 18 preoperatively. 50 cases were converted to negative and 8 to mild instability at follow up. On instrumented anterior laxity test with $Telos^{\circledR}$, side to side difference in 20 lb was 12.9mm in average preoperatively, and was decreased to 3.1mm in average follow-up. The femoral tunnel was widened from 10.6mm postoperatively to 12.7mm$(21.1\%)$ at follow up on antero-posterior plane and from 10.7mm to 12.4mm$(16.5\%)$ on lateral plane. Tibial tunnels was also widened from 9.8mm to 11.8mm$(20.7\%)$ on antero-posterior plane and from 9.9mm to 11.7mm$(18.9\%)$ in lateral plane. Conclusion : ACL reconstruction with hamstring tendon and LA screw was one of the choice of grafts and fixatives in restoring knee stability and in improving clinical results with little complications such as excessive widening of bony tunnel.

• Tunnel and Underground Space
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• v.28 no.6
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• pp.620-634
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• 2018

The NTR(New Tubular Roof) method was used to secure the stability of the tunnel and minimize the subsidence of the road. The tunnel was constructed at about 7.5 meters deep below the highway. with a width of about 21 meters. Following the NTR method, 13 steel pipes with a diameter of 2.3 meters were digged and pushed in longitudinally along the tunnel profile and cut out sides of pipes to connect to adjacent pipes, then filled the inside of pipes and the connected space between pipes with concrete to complete the lining of the tunnel to be excavated. As the steel pipes were digged in sequentially, the area of relaxation was connected to each other and behaves like a gradually widening tunnel. When the steel pipes were digged in to the widest points of the tunnel, the settlement rate of the road surface was increasing to the maximum as 2.2 mm and the total settlement until the lining construction was approximately 7.7 mm. After that, by excavating a tunnel inside the pre-installed lining, an additional settlement of about 4.3 mm was occurred, resulting in the total settlement of about 11.8 mm after completing of tunnel construction.