Department of Orthopaedic and Trauma Surgery, Martin Luther Hospital, Berlin, Germany.
Arthroscopy. 2013 Sep;29(9):1514-24. doi: 10.1016/j.arthro.2013.06.002.
The purpose of this study was to compare the amount of postoperative bone tunnel enlargement after anatomic double-bundle (DB) and single-bundle (SB) anterior cruciate ligament (ACL) reconstruction 6 to 8 months after surgery.
Twenty-one consecutive patients undergoing anatomic 4-tunnel DB ACL reconstruction and 24 patients undergoing anatomic 2-tunnel SB ACL reconstruction were included in this study. In both groups a hybrid fixation technique with interference screw and extracortical fixation at the tibia and an extracortical fixation technique at the femur were used. Magnetic resonance imaging was performed on the second postoperative day and at a mean of 8 months' follow-up (range, 6.8 to 8.3 months) to assess intraoperative and postoperative bone tunnel enlargement. Tunnel widening was determined in different planes by digitally measuring the diameters of the bone tunnels. Tunnel position was measured and classified according to Harner et al. (femoral) and Stäubli et al. and Petersen et al. (tibial).
Magnetic resonance imaging showed that all bone tunnels were anatomically placed within the area of the original ACL insertion zone. Compared with the intraoperative drill diameter, we observed only a slight increase in tunnel diameter in both groups on the second postoperative day. At 8 months postoperatively, significant bone tunnel widening occurred in all bone tunnels (P < .001). However, no significant differences were found between tunnel enlargement in the DB group and tunnel enlargement in the SB group (P > .05), either on the tibial side or on the femoral side. In 2 cases tibial tunnel communication was noted at follow-up.
With the use of anatomic SB and DB ACL reconstruction techniques, the results of bone tunnel enlargement were comparable; no significant difference was observed between the tibial and femoral tunnels.
Level III, prospective comparative study.
本研究旨在比较解剖学双束（DB）和单束（SB）前交叉韧带（ACL）重建术后 6 至 8 个月时术后骨隧道扩大的程度。
本研究纳入 21 例连续接受解剖学 4 隧道 DB ACL 重建和 24 例接受解剖学 2 隧道 SB ACL 重建的患者。两组均采用混合固定技术（胫骨采用干扰螺钉和皮质外固定，股骨采用皮质外固定）。术后第 2 天和平均 8 个月（6.8 至 8.3 个月）时进行磁共振成像（MRI）检查，以评估术中及术后骨隧道扩大情况。通过数字测量骨隧道的直径，在不同平面上确定隧道增宽。根据 Harner 等人（股骨）和 Stäubli 等人以及 Petersen 等人（胫骨）的方法测量和分类隧道位置。
MRI 显示所有骨隧道均在 ACL 原始插入区域的解剖位置。与术中钻头直径相比，两组患者术后第 2 天仅观察到隧道直径略有增加。术后 8 个月，所有骨隧道均出现明显的骨隧道增宽（P <.001）。然而，在 DB 组和 SB 组之间，无论是在胫骨侧还是股骨侧，均未发现隧道扩大有显著差异（P >.05）。随访时发现 2 例胫骨隧道连通。
采用解剖学 SB 和 DB ACL 重建技术，骨隧道扩大的结果具有可比性；胫骨和股骨隧道之间未观察到显著差异。
III 级，前瞻性比较研究。
