Jang Ki-Mo, Park Sung-Chul, Lee Dae-Hee
Department of Orthopedic Surgery, Korea University, College of Medicine, Anam Hospital, Seoul, Korea.
Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
Am J Sports Med. 2016 May;44(5):1269-75. doi: 10.1177/0363546515625046. Epub 2016 Feb 4.
To date, no in vivo 3-dimensional computed tomography (3D-CT) studies have compared graft bending angles at the femoral tunnel aperture and femoral tunnel length in patients who underwent posterior cruciate ligament (PCL) reconstruction with outside-in (OI) and inside-out (IO) techniques.
PURPOSE/HYPOTHESIS: This study used in vivo 3D-CT analysis to compare graft bending angles at the femoral tunnel aperture and femoral tunnel lengths after OI and IO femoral drilling techniques in single-bundle PCL reconstruction. It was hypothesized that the graft bending angle at the femoral tunnel aperture would be less acute with the OI compared with the IO technique, with no difference in femoral tunnel lengths.
Cross-sectional study; Level of evidence, 3.
Immediate postoperative in vivo 3D-CT and curved planar reformation were used to assess the graft bending angles and femoral tunnel lengths in the sagittal, axial, and coronal planes in 67 patients who underwent single-bundle PCL reconstruction with the OI (n = 37) and IO (n = 30) techniques.
The mean graft bending angles on the sagittal and axial planes were 8.2° more acute (23.5° vs 15.3°, P = .011) and 5.3° more acute (49.0° vs 43.7°, P = .013), respectively, with the IO compared with the OI technique, but the difference in the coronal plane was not statistically significant (25.3° vs 24.8°, P = .623). Femoral tunnel length was similar in the 2 groups.
The graft bending angles in single-bundle PCL reconstruction were more acute in the sagittal and axial planes with the IO compared with the OI technique, but there was no difference in the coronal plane. In addition, femoral tunnel lengths did not differ significantly in patients who underwent OI and IO single-bundle PCL reconstructions. Although further biomechanical studies are needed to evaluate the effect on graft failure of a <10° difference in graft bending angle, the small magnitude of this difference would likely have little adverse effect on graft survival.
迄今为止，尚无体内三维计算机断层扫描（3D-CT）研究比较采用由外向内（OI）和由内向外（IO）技术进行后交叉韧带（PCL）重建的患者在股骨隧道开口处的移植物弯曲角度和股骨隧道长度。
目的/假设：本研究采用体内3D-CT分析，比较单束PCL重建中OI和IO股骨钻孔技术后股骨隧道开口处的移植物弯曲角度和股骨隧道长度。假设与IO技术相比，OI技术在股骨隧道开口处的移植物弯曲角度不那么锐利，而股骨隧道长度无差异。
横断面研究；证据水平，3级。
对67例行单束PCL重建的患者（OI技术组n = 37，IO技术组n = 30），术后即刻采用体内3D-CT和曲面平面重组技术评估矢状面、轴位面和冠状面的移植物弯曲角度和股骨隧道长度。
与OI技术相比，IO技术在矢状面和轴位面的平均移植物弯曲角度分别更锐利8.2°（23.5°对15.3°，P = 0.011）和5.3°（49.0°对43.7°，P = 0.013），但在冠状面的差异无统计学意义（25.3°对24.8°，P = 0.623）。两组的股骨隧道长度相似。
与OI技术相比，IO技术在单束PCL重建中矢状面和轴位面的移植物弯曲角度更锐利，但在冠状面无差异。此外，接受OI和IO单束PCL重建的患者股骨隧道长度无显著差异。尽管需要进一步的生物力学研究来评估移植物弯曲角度相差<10°对移植物失败的影响，但这种差异的幅度较小，可能对移植物存活几乎没有不利影响。
