Buelow J-U, Siebold R, Ellermann A
64 View Terrace, East Fremantle 6158, Western Australia.
Knee Surg Sports Traumatol Arthrosc. 2002 Mar;10(2):80-5. doi: 10.1007/s00167-001-0267-6. Epub 2002 Feb 27.
Changes in the femoral and tibial bone tunnel were studied prospectively after arthroscopic ACL reconstruction with quadruple hamstring autograft. To determine whether tunnel enlargement can be decreased by fixing the graft close to the joint line having a stiffer fixation construct we compared "anatomical" (one absorbable interference screw femorally, and bicortical fixation with two absorbable interference screws tibially) and extracortical fixation techniques (Endobutton femorally, and two no. 6 Ethibond sutures over a suture washer tibially). Over a 2-year period we evaluated 60 patients clinically (IKDC scale, Cincinnati Knee Score, KT-1000) and radiographically (confirmed by MRI). The operated knee was radiographed immediately postoperatively and 6 and 24 months postoperatively. The femoral and tibial bone tunnel diameter was measured on anteroposterior and lateral images, and the tunnel area was calculated and compared to the initial area calculated from the perioperative drill size. In the "anatomical" group the immediately postoperative bone tunnel area was 75% larger than the initial tunnel area, after 6 months it was increased another 31%, and between 6 and 24 months it remained basically unchanged. In the "extracortical" group there was no significant enlargement immediately postoperatively, but after 6 months it was 65% larger than the initial area of drill and graft size, and between 6 and 24 months it decreased to 47%. There was no correlation between the amount of tunnel enlargement and clinical scores or KT-1000 measurement. Arthroscopic ACL reconstruction with quadruple hamstring autograft is associated with bone tunnel enlargement. Using a purely extracortical fixation technique thus significantly increased the tibial and femoral tunnel area during the first 6 postoperative months, while it decreased slightly thereafter. The insertion of large interference screws apparently not only compresses the graft in the bone tunnel but also significantly enlarges the bone tunnel itself. The immediate enlargement at the time of the operation is followed by a reduced further enlargement at 6 months and then stabilization. Tunnel widening did not influence clinical outcome over a 2-year period.
采用四股自体腘绳肌腱进行关节镜下前交叉韧带重建术后，对股骨和胫骨骨隧道的变化进行了前瞻性研究。为了确定通过将移植物固定在靠近关节线处并采用更坚固的固定结构是否可以减少隧道扩大，我们比较了“解剖学”固定技术（股骨端使用一枚可吸收挤压螺钉，胫骨端使用两枚可吸收挤压螺钉进行双皮质固定）和皮质外固定技术（股骨端使用Endobutton，胫骨端使用两根6号Ethibond缝线穿过缝线垫圈）。在2年的时间里，我们对60例患者进行了临床评估（IKDC评分、辛辛那提膝关节评分、KT-1000）和影像学评估（通过MRI确认）。术后即刻、术后6个月和24个月对患膝进行X线检查。在前后位和侧位图像上测量股骨和胫骨骨隧道直径，计算隧道面积，并与根据术前钻孔尺寸计算的初始面积进行比较。在“解剖学”组中，术后即刻骨隧道面积比初始隧道面积大75%，6个月后又增加了31%，6至24个月间基本保持不变。在“皮质外”组中，术后即刻无明显扩大，但6个月后比钻孔和移植物初始面积大65%，6至24个月间降至47%。隧道扩大量与临床评分或KT-1000测量值之间无相关性。采用四股自体腘绳肌腱进行关节镜下前交叉韧带重建与骨隧道扩大有关。因此，使用单纯的皮质外固定技术在术后最初6个月显著增加了胫骨和股骨隧道面积，此后略有减小。插入大型挤压螺钉显然不仅压缩了骨隧道内的移植物，还显著扩大了骨隧道本身。手术时的即刻扩大之后，6个月时进一步扩大减少，然后趋于稳定。在2年的时间里，隧道增宽并未影响临床结果。
