Orthopaedic Unit and "Kirk Kilgour" Sports Injury Centre, S. Andrea Hospital, "Sapienza" University of Rome, Rome, Italy.
Eur Rev Med Pharmacol Sci. 2013 Nov;17(21):2956-61.
Bone tunnel enlargement after anterior cruciate ligament (ACL) reconstruction is well documented in the literature. The cause of this tunnel enlargement is unclear, but is thought to be multifactorial, with mechanical and biological factors playing a role.
The aim of this prospective study was to evaluate how the different techniques may affect the bone tunnel enlargement and clinical outcome.
Forty-five consecutive patients undergoing ACL reconstruction with autologous doubled semitendinosus and gracilis tendons entered this study. They were randomly assigned to enter group A (In-Out technique, with cortical fixation and Interference screw) and group B (Out-In technique, metal cortical fixation on the femour and tibia). At a mean follow-up of 10 months, all the patients underwent CT scan exam to evaluate the post-operative diameters of both femoral and they underwent tibial tunnels clinical examination after 24 months.
The mean femoral tunnel diameter increased significantly from 9.05±0.3 mm to 10.01±2.3 mm in group A and from 9.04±0.8 mm to 9.3±1.12 mm in group B. The mean increase in femoral tunnel diameters observed in group A was significantly higher than that observed in group B (p < 0.05) The mean tibial tunnel diameter increased significantly from 9.03±0.04 mm to 10.68±2.5 mm in group A and from 9.04±0.03 mm to 10.±0.78 mm in group B. The mean increase in tibial tunnel diameters observed in group A was significantly higher than that observed in group B (p < 0.05). No clinical differences were found between two groups and no correlations between clinical and radiological results were found in any patients of both groups.
Results of the study suggest that different mechanical fixation devices could influence tunnel widening. The lower stiffness of the fixation devices is probably responsible of the tunnel widening through the fixation devices's micromotions in the femoral and tibial tunnels.
前交叉韧带（ACL）重建后骨隧道扩大在文献中有充分的记载。这种隧道扩大的原因尚不清楚，但被认为是多因素的，机械和生物因素都起作用。
本前瞻性研究旨在评估不同技术可能如何影响骨隧道扩大和临床结果。
45 例连续接受自体双半腱肌腱和股薄肌腱重建 ACL 的患者进入本研究。他们被随机分配到 A 组（In-Out 技术，皮质固定和 Interference 螺钉）和 B 组（Out-In 技术，股骨和胫骨金属皮质固定）。在平均 10 个月的随访时，所有患者都接受了 CT 扫描检查，以评估术后股骨隧道的直径；24 个月后，对胫骨隧道进行临床检查。
A 组的股骨隧道直径从 9.05±0.3mm 显著增加到 10.01±2.3mm，B 组从 9.04±0.8mm 增加到 9.3±1.12mm。A 组观察到的股骨隧道直径增加明显高于 B 组（p<0.05）。A 组的胫骨隧道直径从 9.03±0.04mm 显著增加到 10.68±2.5mm，B 组从 9.04±0.03mm 增加到 10.0±0.78mm。A 组观察到的胫骨隧道直径增加明显高于 B 组（p<0.05）。两组之间没有发现临床差异，两组患者的临床和影像学结果之间也没有发现相关性。
研究结果表明，不同的机械固定装置可能会影响隧道扩大。固定装置的较低刚度可能是通过固定装置在股骨和胫骨隧道中的微运动导致隧道扩大的原因。
