Department of Orthopedic Surgery, Shimada Hospital, 100-1 Kashiyama, Habikino, 583-0875, Japan,
Knee Surg Sports Traumatol Arthrosc. 2014 Jul;22(7):1563-72. doi: 10.1007/s00167-013-2594-9. Epub 2013 Jul 11.
The purpose of this study is to assess the incidence of post-operative femoral bone tunnel communication after anterior cruciate ligament double-bundle reconstruction (ACL-DBR) with two drilling techniques by transparent 3-dimensional computed tomography (CT) and elucidate the factors associated with post-operative femoral bone tunnel communication.
Fifty-five patients underwent ACL-DBR using outside-in technique (Group A, 25 patients) and transportal technique (Group B, 30 patients) for the drilling of femoral tunnel. CT was taken at 1 week and 6 months post-operatively. The femoral and tibial bone tunnel orientation, position, the divergency and the distance of bone bridge between the tunnels were measured using reconstructed CT images. In order to identify the factors related to post-operative femoral bone tunnel communication, patients were divided into two groups depending on whether femoral bone tunnels communicated (Group F-C) or remained (Group F-R) at 6 months post-operatively.
Femoral bone tunnels in Group B were orientated horizontally and dorsally compared to those in Group A. Tunnel divergency between two femoral tunnels was greater in Group A (11.7°) than in Group B (10.0°). Average distance of bone bridge at 1 week post-operatively was 1.8 mm in Group A and 1.7 mm in Group B (n.s.). Post-operative femoral bone tunnel communication occurred in 16 patients (64 %) in Group A and in 18 patients (60 %) in Group B at 6 months after ACL-DBR, respectively (n.s.). Regarding tibial tunnels, there were no significant differences in tunnel orientation, position, divergency and incidence of post-operative tibial tunnel communication between Groups A and B. Mean distance of femoral bone bridge at 1 week in Group F-R (2.5 mm) was significantly greater than in Group F-C (1.3 mm) (p < 0.001).
There was no significant difference in the incidence of post-operative femoral tunnel communication between two techniques. To avoid post-operative femoral tunnel bone communication, more than 2 mm distance of bone bridge at surgery is recommended.
本研究旨在通过透明三维 CT 评估两种钻取技术行前交叉韧带双束重建（ACL-DBR）后股骨骨隧道术后的沟通发生率，并阐明与术后股骨骨隧道沟通相关的因素。
55 例患者采用经皮技术（A 组，25 例）和经隧道技术（B 组，30 例）行 ACL-DBR 股骨隧道钻取。术后 1 周和 6 个月行 CT 检查。采用重建 CT 图像测量股骨和胫骨骨隧道的方向、位置、发散度以及隧道之间骨桥的距离。为了确定与术后股骨骨隧道沟通相关的因素，根据术后 6 个月股骨骨隧道是否沟通（F-C 组）或未沟通（F-R 组）将患者分为两组。
B 组股骨隧道的方向为水平和背侧，而 A 组的方向为斜向和前侧。A 组的两个股骨隧道之间的隧道发散度较大（11.7°），B 组较小（10.0°）。术后 1 周，A 组骨桥的平均距离为 1.8mm，B 组为 1.7mm（无统计学差异）。术后 6 个月，A 组 16 例（64%）和 B 组 18 例（60%）患者发生 ACL-DBR 术后股骨骨隧道沟通（无统计学差异）。关于胫骨隧道，A 组和 B 组在隧道方向、位置、发散度和术后胫骨隧道沟通发生率方面无显著差异。F-R 组术后 1 周股骨骨桥的平均距离（2.5mm）显著大于 F-C 组（1.3mm）（p<0.001）。
两种技术术后股骨隧道沟通发生率无显著差异。为避免术后股骨隧道骨沟通，建议术中骨桥距离大于 2mm。
