Matsumoto Akio, Howell Stephen M, Liu-Barba David
Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
Arthroscopy. 2006 Aug;22(8):855-60. doi: 10.1016/j.arthro.2006.04.092.
Extensive tunnel expansion in hamstring anterior cruciate ligament (ACL) reconstruction can complicate revision surgery. The purpose of this study was to examine our hypothesis that compaction of a bone dowel into the tibial tunnel reduces the cross-sectional area of the tunnel on the day of surgery and limits tunnel expansion to that of the cross-sectional area of the reamer at 4 months and 1 to 2 years.
A bone dowel averaging 23 mm in length and 7 mm in diameter was harvested from the tibial tunnel in 10 patients undergoing hamstring ACL reconstruction. The tibial tunnel was dilated, and the bone dowel was compacted anterior to the tendon graft. The cross-sectional area of the tibial tunnel was calculated on the day of surgery and at 4 months and 1 to 2 years postoperatively from computed tomography scans.
On the day of surgery, the cross-sectional area of the tibial tunnel was 34% smaller than the 50-mm2 cross-sectional area of the 8-mm reamer used to drill the tunnel (P < .001). At 1 to 2 years, the cross-sectional area of the tibial tunnel was smaller than that of the reamer in 6 subjects, was slightly larger (53 to 56 mm2) in 3 subjects, and was substantially larger (80 mm2) in 1 subject.
A surgeon who compacts an autogenous bone dowel into the tibial tunnel alongside a hamstring graft can expect little to no tunnel expansion in 90% of patients at 1 to 2 years. To our knowledge, the limitation of tunnel expansion to that of the cross-sectional area of the reamer has not been shown with other tibial fixation techniques.
Level IV, therapeutic case series.
在腘绳肌前交叉韧带（ACL）重建术中广泛的隧道扩张会使翻修手术变得复杂。本研究的目的是检验我们的假设，即向胫骨隧道内植入骨栓会在手术当天减小隧道的横截面积，并将隧道扩张限制在4个月以及1至2年后扩孔钻横截面积的水平。
从10例接受腘绳肌ACL重建术的患者的胫骨隧道中获取平均长度为23 mm、直径为7 mm的骨栓。扩张胫骨隧道，将骨栓植入肌腱移植物前方并压实。根据计算机断层扫描计算手术当天以及术后4个月和1至2年时胫骨隧道的横截面积。
手术当天，胫骨隧道的横截面积比用于钻隧道的8 mm扩孔钻的50 mm²横截面积小34%（P <.001）。在1至2年时，6例患者的胫骨隧道横截面积小于扩孔钻，3例患者的横截面积略大（53至56 mm²），1例患者的横截面积显著增大（80 mm²）。
在腘绳肌移植物旁向胫骨隧道内植入自体骨栓的外科医生可以预期，在1至2年时90%的患者隧道几乎不会扩张。据我们所知，其他胫骨固定技术尚未显示出将隧道扩张限制在扩孔钻横截面积水平的效果。
IV级，治疗性病例系列。
