Aga Cathrine, Wilson Katharine J, Johansen Steinar, Dornan Grant, La Prade Robert F, Engebretsen Lars
Martina Hansens Hospital, Pb 823, 1306, Sandvika, Norway.
Orthopaedic Department Oslo University Hospital, Faculty of Medicine, University of Oslo, Oslo, Norway.
Knee Surg Sports Traumatol Arthrosc. 2017 Apr;25(4):1316-1327. doi: 10.1007/s00167-016-4204-0. Epub 2016 Jun 21.
The consequence of tunnel widening after ACL reconstructions is foremost of importance in case of revision surgery. Tunnel expansion leads to bone loss close to the joint, and additional surgery with bone grafting prior to revision surgery might be necessary. The purpose of the study was to measure widening of the tunnels in single-bundle (SB) and double-bundle (DB) ACL reconstructed knees during the first year after surgery, detected by a novel, semi-automated 3D CT imaging modality. Our hypothesis was that there would be a difference between the initial tunnel size and the size measured one year post-operatively due to the tunnel widening process. Further, the purpose was to evaluate whether there were any differences in the amount of tunnel widening between the two surgical techniques.
Twenty patients who underwent DB ACL reconstruction, and 22 patients who underwent SB ACL reconstruction, performed a CT scan of the bony tunnels, during their first days after surgery and one year post-operatively. The CT scans were transformed into 3D CT reconstructions, and the tunnels were measured with the "best-fit cylinder" method, measurements at the level of tunnel aperture and 10.0 mm from the joint line.
All tunnels in the DB and SB ACL reconstructed knees exhibited widening during the first year after the operation (p < 0.001). The SB femoral tunnels showed more widening compared to the DB femoral AM tunnels (1.4 ± 0.9 vs. 0.5 ± 0.6 mm) (p < 0.001), and the SB tibial tunnels widened more compared to the DB tibial PL tunnels (1.0 ± 1.0 vs. 0.5 ± 0.6) (p < 0.043).
All tunnels widened during the first year after the ACL reconstruction with a larger amount of widening in the SB tunnels compared to the DB femoral AM tunnels and the DB tibial PL tunnels. This is the first study to detect tunnel widening in DB reconstructed knees through a semi-automated 3D CT imaging modality.
Prospective cohort study, Level III.
在翻修手术中，前交叉韧带（ACL）重建术后隧道扩大的后果至关重要。隧道扩张会导致关节周围骨质流失，可能需要在翻修手术前进行额外的骨移植手术。本研究的目的是通过一种新型的半自动三维CT成像方式，测量单束（SB）和双束（DB）ACL重建膝关节术后第一年隧道的扩大情况。我们的假设是，由于隧道扩大过程，初始隧道大小与术后一年测量的大小会存在差异。此外，目的是评估两种手术技术在隧道扩大量上是否存在差异。
20例行DB ACL重建的患者和22例行SB ACL重建的患者，在术后第一天和术后一年进行了骨隧道的CT扫描。CT扫描被转换为三维CT重建图像，采用“最佳拟合圆柱体”方法在隧道开口水平和距关节线10.0毫米处测量隧道。
DB和SB ACL重建膝关节的所有隧道在术后第一年均出现扩大（p<0.001）。与DB股骨前内侧（AM）隧道相比，SB股骨隧道扩大更明显（1.4±0.9对0.5±0.6毫米）（p<0.001），与DB胫骨后外侧（PL）隧道相比，SB胫骨隧道扩大更明显（1.0±1.0对0.5±0.6）（p<0.043）。
ACL重建术后第一年所有隧道均扩大，SB隧道的扩大量大于DB股骨AM隧道和DB胫骨PL隧道。这是第一项通过半自动三维CT成像方式检测DB重建膝关节隧道扩大的研究。
前瞻性队列研究，III级。
