Hamada Masayuki, Shino Konsei, Horibe Shuji, Mitsuoka Tomoki, Toritsuka Yukiyoshi, Nakamura Norimasa
Department of Orthopaedic Surgery, Hoshigaoka Koseinenkin Hospital, Osaka, Japan.
Arthroscopy. 2005 Aug;21(8):917-22. doi: 10.1016/j.arthro.2005.05.006.
To measure the cross-sectional area (CSA) of hamstring anterior cruciate ligament (ACL) grafts in humans up to 2 years postoperatively and to estimate the appropriate graft-notch distance (the distance between ACL graft and roof or wall of the notch) at surgery.
Case series.
Fifty-nine patients, who had consented to have a magnetic resonance imaging (MRI) evaluation postoperatively, underwent endoscopic ACL reconstruction using 3- to 5-strand autogenous hamstring tendons. Intraoperatively, the CSA of the graft was measured using a custom-made area micrometer. Postoperatively, 115 axial MRIs of the grafts (48 at 3 months, 44 at 12 months, and 23 at 24 months) were obtained. They were transmitted to a personal computer and the CSAs of the grafts' midsubstance were calculated. To evaluate the accuracy of the MRI measurement, another 15 patients who consented to have MRI 2 days after surgery were selected and intraoperative graft CSA measurements and graft axial MRI were performed 2 days after surgery.
The CSAs of the grafts measured by MRI 2 days after surgery were well correlated with those directly measured intraoperatively (gamma = 0.905). The CSA of the grafts measured intraoperatively was 43 +/- 5 mm2, and those estimated by MRI at 3, 12, and 24 months were 50 +/- 9 mm2, 54 +/- 9 mm2, and 48 +/- 12 mm2, respectively. The increase in graft diameter at 3, 12, and 24 months was 9% +/- 8%, 13% +/- 10%, and 7% +/- 12%, respectively.
In humans, the increase in CSA of the ACL graft was smaller compared with previous animal studies. The graft CSA increased up to 29% (13% in diameter) 12 months after surgery. When a 95% confidence interval was used, the percent increase in diameter of the reconstructed graft was estimated to be less than 32% in 95% of the cases. When the graft diameter was 7, 8, or 9 mm, a 1.1-, 1.3-, or 1.4-mm graft-notch distance, respectively, was suitable for impingement-free graft during postoperative periods with 95% of probability.
Level IIII.
测量人类腘绳肌前交叉韧带（ACL）移植物术后2年内的横截面积（CSA），并估计手术时合适的移植物-切迹距离（ACL移植物与切迹顶部或壁之间的距离）。
病例系列。
59例同意术后进行磁共振成像（MRI）评估的患者接受了使用3至5股自体腘绳肌腱的关节镜下ACL重建术。术中，使用定制的面积测微计测量移植物的CSA。术后，获取了115份移植物的轴向MRI（3个月时48份，12个月时44份，24个月时23份）。将它们传输到个人计算机并计算移植物中间部分的CSA。为了评估MRI测量的准确性，选择了另外15例同意术后2天进行MRI检查的患者，并在术后2天进行术中移植物CSA测量和移植物轴向MRI检查。
术后2天通过MRI测量的移植物CSA与术中直接测量的结果高度相关（γ = 0.905）。术中测量的移植物CSA为43±5mm²，MRI在3个月、12个月和24个月时估计的移植物CSA分别为50±9mm²、54±9mm²和48±12mm²。3个月、12个月和24个月时移植物直径的增加分别为9%±8%、13%±10%和7%±12%。
在人类中，与先前的动物研究相比，ACL移植物CSA的增加较小。术后12个月移植物CSA增加高达29%（直径增加13%）。当使用95%置信区间时，估计95%的病例中重建移植物直径的增加百分比小于32%。当移植物直径为7mm、8mm或9mm时，分别有1.1mm、1.3mm或1.4mm的移植物-切迹距离适合在术后期间以95%的概率实现无撞击的移植物。
III级。
