Clatworthy M G, Annear P, Bulow J U, Bartlett R J
Warringal Private Hospital, Melbourne, Australia.
Knee Surg Sports Traumatol Arthrosc. 1999;7(3):138-45. doi: 10.1007/s001670050138.
We report a prospective series evaluating the incidence and degree of tunnel widening in a well-matched series of patients receiving a hamstring or patella tendon graft for anterior cruciate ligament (ACL) deficiency. We correlated tunnel widening with clinical factors, knee scores, KT-1000 and isokinetic muscle strength to determine the clinical significance of this finding. 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 underwent a similar endoscopic procedure and accelerated postoperative rehabilitation. Tunnel widening was determined using standardized anteroposterior (AP) and lateral X-rays adjusted for magnification. A limited series of MRIs was performed to validate these measurements. There was a significant difference in the degree of tunnel widening between the two groups. The mean increase 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 validated the plain film measurements. Tunnel widening did not correlate with the clinical findings, knee scores, KT-1000 or isokinetic muscle strength. Tunnel widening is marked in the hamstring group. Tunnel widening does not correlate with instability or a poor clinical outcome in the short term. The long-term implications of this finding are still to be determined.
我们报告了一项前瞻性研究系列，评估了一系列匹配良好的因前交叉韧带（ACL）损伤而接受绳肌或髌腱移植的患者中隧道增宽的发生率和程度。我们将隧道增宽与临床因素、膝关节评分、KT-1000和等速肌力进行关联，以确定这一发现的临床意义。对73例ACL重建术后至少12个月的患者进行了评估。38例患者接受了双股半腱肌和股薄肌移植，35例接受了骨-髌腱-骨移植。所有患者均接受了类似的关节镜手术并进行了加速术后康复。使用标准化的前后位（AP）和侧位X线片并校正放大倍数来确定隧道增宽情况。进行了有限系列的MRI检查以验证这些测量结果。两组之间隧道增宽程度存在显著差异。绳肌组股骨隧道面积平均增加100.4%，而髌腱组减少25%（P = < 0.0001）。在胫骨隧道中，绳肌组平均增加73.9%，而髌腱组减少2.1%（P = < 0.0001）。MRI检查验证了平片测量结果。隧道增宽与临床发现、膝关节评分、KT-1000或等速肌力无关。绳肌组的隧道增宽明显。短期内，隧道增宽与不稳定或不良临床结果无关。这一发现的长期影响仍有待确定。
