Ma C Benjamin, Francis Kimberly, Towers Jeffrey, Irrgang Jay, Fu Freddie H, Harner Christopher H
Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Arthroscopy. 2004 Feb;20(2):122-8. doi: 10.1016/j.arthro.2003.11.007.
The purpose of this study was to evaluate hamstring anterior cruciate ligament (ACL) reconstruction using aperture fixation with bioabsorbable interference screw (BIS) and distant fixation using EndoButton (Smith & Nephew, Andover, MA) and screw-post (ENDO).
Prospective nonrandomized clinical outcome study.
Two groups of 15 patients who underwent autogenous hamstring ACL reconstruction with a minimum of 2 years' follow-up evaluation (mean 35 months) were included in the study. The BIS group underwent poly-L-lactic acid interference screw fixation at both femoral and tibial tunnels and the ENDO group underwent EndoButton fixation on the femoral side and screw-post fixation on the tibial side. Clinical evaluation included International Knee Documentation Committee (IKDC) and arthrometer measurements. Tunnel enlargement, screw integrity, graft integrity, and graft-tunnel interface were evaluated using radiographs and magnetic resonance imaging. Statistical analyses were performed using the Student t test, with significance set at 0.05.
All patients in both groups had functionally normal or near-normal IKDC scores. The average IKDC subjective knee form scores were 85 +/- 11 versus 81 +/- 17 (BIS v ENDO) and side-to-side KT differences were 3.2 +/- 2.6 mm versus 2.4 +/- 1.8 mm (P >.05). For both groups, tunnel enlargement was present on radiographs at both femoral and tibial sides (36% to 77%). Tunnel enlargement was more significant at the femoral tunnels (53% to 77%) than the tibial tunnels (36% to 42%). In the BIS group, magnetic resonance imaging revealed 9 partially degraded screws and 2 intact screws on the femoral side. On the tibial side, 4 partially degraded and 10 intact screws were seen. For both groups, the grafts have partial or complete incorporation at all tunnels. Tunnel enlargement measured on radiographs correlate well with measurements on magnetic resonance images.
Our results showed that rigid aperture fixation using BIS did not lead to significant differences in clinical outcome when compared with distant fixation using ENDO at 24 to 40 months follow-up evaluation. Significant tunnel enlargement was present in both groups, more pronounced on the femoral side. Magnetic resonance imaging findings showed that BIS were not degraded even at 2 to 4 years after surgery.
Level II.
本研究旨在评估使用生物可吸收干涉螺钉（BIS）进行骨隧道固定和使用EndoButton（史赛克公司，安多弗，马萨诸塞州）及螺钉柱（ENDO）进行远端固定的自体腘绳肌腱前交叉韧带（ACL）重建术。
前瞻性非随机临床结局研究。
本研究纳入两组患者，每组15例，均接受了自体腘绳肌腱ACL重建术，并至少进行了2年的随访评估（平均35个月）。BIS组在股骨和胫骨隧道均采用聚-L-乳酸干涉螺钉固定，ENDO组在股骨侧采用EndoButton固定，在胫骨侧采用螺钉柱固定。临床评估包括国际膝关节文献委员会（IKDC）评分和关节测径仪测量。使用X线片和磁共振成像评估隧道扩大情况、螺钉完整性、移植物完整性及移植物-隧道界面。采用学生t检验进行统计学分析，显著性水平设定为0.05。
两组所有患者的IKDC评分在功能上均正常或接近正常。IKDC主观膝关节形态评分的平均值在BIS组为85±11，在ENDO组为81±17（BIS组对比ENDO组）；两侧KT差值在BIS组为3.⒉±2.6mm，在ENDO组为2.4±1.8mm（P>.05）。两组患者的X线片均显示股骨和胫骨侧隧道均有扩大（36%至77%）。股骨隧道的扩大（53%至77%）比胫骨隧道（36%至42%）更显著。在BIS组，磁共振成像显示股骨侧9枚螺钉部分降解，2枚完整。在胫骨侧，可见4枚部分降解和10枚完整的螺钉。两组患者的移植物在所有隧道均有部分或完全融合。X线片测量的隧道扩大与磁共振成像测量结果相关性良好。
我们的结果表明，在24至40个月的随访评估中，与使用ENDO进行远端固定相比，使用BIS进行刚性骨隧道固定在临床结局上没有显著差异。两组均存在明显的隧道扩大，在股骨侧更明显。磁共振成像结果显示，即使在术后2至4年，BIS也未降解。
二级。
