Cobanoglu Mutlu, Ozgezmez Ferit Tufan, Omurlu Imran Kurt, Ozkan Ilhan, Savk Sevki Oner, Cullu Emre
Department of Orthopedics and Traumatology, Adnan Menderes University Faculty of Medicine, Aydın, Turkey.
Department of Biostatistics, Adnan Menderes University Faculty of Medicine, Aydın, Turkey.
Indian J Orthop. 2016 Sep;50(5):499-504. doi: 10.4103/0019-5413.189612.
Anterior cruciate ligament (ACL) reconstruction with ST autograft is sometimes unsuccessful because of harvested thin graft. Magnetic resonance imaging (MRI) can be a useful tool to evaluate the thickness of the graft. This study is performed to evaluate whether there is any correlation between diameters and cross-sectional area (CSA) of the semitendinosus tendon (ST) on the preoperative magnetic MRI and the diameter of the 4-stranded ST autograft in ACL reconstruction.
Seventy patients who underwent single-bundle ACL reconstruction with 4-stranded ST for full-thickness ACL ruptures were included in this study. Anteroposterior (AP) and mediolateral (ML) diameters of ST at the levels of the joint line (JL) and femoral physeal line (PL), and also CSA at these levels were measured on T2-weighted fat-suppressed MRI examinations. The data obtained were compared with intraoperatively measured diameters of 4-stranded ST autograft. Correlations between variables were evaluated using Spearman's rho. Receiver operating characteristic and area under the curve statistics were used to evaluate the cut-off value for the correlation between 4-stranded ST graft diameter of 8 mm and CSA (mm) on MRI.
On MRI measurements, no correlation was found between AP diameters at the level of the JL and 4-stranded ST diameter ( = 0.180). However, correlations were found between diameter of 4-stranded ST and ML diameter at the level of JL ( = 0.003) and PL ( = 0.002), AP diameter at the level of the PL ( = 0.009), CSA at the level of the JL ( < 0.001) and at the level of PL ( < 0.001). Correlation between the diameter of 4-stranded ST and CSA at both levels was more significant than that between AP-ML diameters of ST and diameter of autograft. The cut-off value for the 8 mm diameter CSA of 4-stranded ST was 5.9 mm at the JL and 8.99 mm at the PL.
Preoperative MRI evaluation of CSA at the JL of the ST is a reliable parameter to predict graft size. Other graft alternatives should better be considered if the CSA of ST is <5.9 mm at the level of the JL.
采用半腱肌（ST）自体移植物进行前交叉韧带（ACL）重建有时会因获取的移植物过薄而失败。磁共振成像（MRI）可作为评估移植物厚度的有用工具。本研究旨在评估术前MRI上半腱肌肌腱（ST）的直径和横截面积（CSA）与ACL重建中4股ST自体移植物直径之间是否存在相关性。
本研究纳入70例因全层ACL断裂接受单束ACL重建并使用4股ST的患者。在T2加权脂肪抑制MRI检查中测量关节线（JL）和股骨骨骺线（PL）水平处ST的前后径（AP）和内外径（ML），以及这些水平处的CSA。将获得的数据与术中测量的4股ST自体移植物直径进行比较。使用Spearman等级相关系数评估变量之间的相关性。采用受试者工作特征曲线和曲线下面积统计来评估MRI上4股ST移植物直径8 mm与CSA（mm）之间相关性的截断值。
在MRI测量中，未发现JL水平处的AP直径与4股ST直径之间存在相关性（ = 0.180）。然而，发现4股ST直径与JL水平（ = 0.003）和PL水平（ = 0.002）的ML直径、PL水平的AP直径（ = 0.009）、JL水平（ < 0.001）和PL水平（ < 0.001）的CSA之间存在相关性。4股ST直径与两个水平处CSA之间的相关性比ST的AP-ML直径与自体移植物直径之间的相关性更显著。4股ST直径8 mm时，JL水平处CSA的截断值为5.9 mm，PL水平处为8.99 mm。
术前MRI评估ST在JL处的CSA是预测移植物大小的可靠参数。如果ST在JL水平处的CSA < 5.9 mm，则应更好地考虑其他移植物选择。
