Struewer Johannes, Efe Turgay, Frangen Thomas Manfred, Schwarting Tim, Buecking Benjamin, Ruchholtz Steffen, Schüttler Karl Friedrich, Ziring Ewgeni
Department of Trauma, Hand and Reconstructive Surgery and.
Orthop Rev (Pavia). 2012 May 9;4(2):e21. doi: 10.4081/or.2012.e21. Epub 2012 Jun 21.
The aim of the present study was to evaluate incidence, degree and impact of tibial tunnel widening (TW) on patient-reported long-term clinical outcome, knee joint stability and prevalence of osteoarthritis (OA) after isolated anterior cruciate ligament (ACL) reconstruction. On average, 13.5 years after ACL reconstruction via patella-bone-tendon-bone autograft, 73 patients have been re-evaluated. Inclusion criteria consisted of an isolated anterior cruciate ligament rupture and reconstruction, a minimum of 10-year follow-up and no previous anterior cruciate ligament repair or associated intra-articular lesions. Clinical evaluation was performed via the International Knee Documentation Committee (IKDC) score and the Tegner and Lysholm scores. Instrumental anterior laxity testing was carried out with the KT-1000™ arthrometer. The degree of degenerative changes and the prevalence of osteoarthritis were assessed with the Kellgren-Lawrence score. Tibial tunnel enlargement was radiographically evaluated on both antero-posterior and lateral views under establishment of 4 degrees of tibial tunnel widening by measuring the actual tunnel diameters in mm on the sclerotic margins of the inserted tunnels on 3 different points (T1-T3). Afterwards, a conversion of the absolute values in mm into a 4 staged ratio, based on the comparison to the results of the initial drill-width, should provide a better quantification and statistical analysis. Evaluation was performed postoperatively as well as on 2 year follow-up and 13 years after ACL reconstruction. Minimum follow-up was 10 years. 75% of patients were graded A or B according to IKDC score. The mean Lysholm score was 90.2±4.8 (25-100). Radiological assessment on long-term follow-up showed in 45% a grade I, in 24% a grade II, in 17% a grade III and in additional 12% a grade IV enlargement of the tibial tunnel. No evident progression of TW was found in comparison to the 2 year results. Radiological evaluation revealed degenerative changes in sense of a grade II OA in 54% of patients. Prevalence of a grade III or grade IV OA was found in 20%. Correlation analysis showed no significant relationship between the amount of tibial tunnel enlargement (P>0.05), long-term clinical results, anterior joint laxity or prevalence of osteoarthritis. Tunnel widening remains a radiological phenomenon which is most commonly observed within the short to midterm intervals after anterior cruciate ligament reconstruction and subsequently stabilises on mid and long- term follow-up. It does not adversely affect long-term clinical outcome and stability. Furthermore, tunnel widening doesn't constitute an increasing prevalence of osteoarthritis.
本研究的目的是评估胫骨隧道扩大（TW）的发生率、程度及其对患者报告的长期临床结果、膝关节稳定性和单纯前交叉韧带（ACL）重建术后骨关节炎（OA）患病率的影响。平均而言，在通过髌腱骨自体移植进行ACL重建13.5年后，对73例患者进行了重新评估。纳入标准包括单纯前交叉韧带断裂和重建、至少10年的随访以及既往无前交叉韧带修复或相关关节内病变。通过国际膝关节文献委员会（IKDC）评分以及Tegner和Lysholm评分进行临床评估。使用KT-1000™关节测量仪进行仪器化前侧松弛测试。用Kellgren-Lawrence评分评估退变改变的程度和骨关节炎的患病率。通过在前后位和侧位X线片上测量植入隧道硬化边缘上3个不同点（T1-T3）的实际隧道直径（以毫米为单位），在确定4度胫骨隧道扩大的情况下对胫骨隧道扩大进行影像学评估。之后，基于与初始钻孔宽度结果的比较，将毫米绝对值转换为4级比率，应能提供更好的量化和统计分析。在ACL重建术后、2年随访时以及13年时进行评估。最短随访时间为10年。根据IKDC评分，75%的患者为A或B级。Lysholm评分的平均值为90.2±4.8（25-100）。长期随访的影像学评估显示，45%的患者胫骨隧道扩大为I级，24%为II级，17%为III级，另有12%为IV级。与2年结果相比，未发现TW有明显进展。影像学评估显示，54%的患者存在II级OA意义上的退变改变。发现III级或IV级OA的患病率为20%。相关性分析显示，胫骨隧道扩大的程度（P>0.05）、长期临床结果、前侧关节松弛或骨关节炎患病率之间无显著关系。隧道扩大仍然是一种影像学现象，最常见于前交叉韧带重建后的短期至中期，随后在中长期随访中趋于稳定。它不会对长期临床结果和稳定性产生不利影响。此外，隧道扩大并不构成骨关节炎患病率的增加。
