Giorgio Nicola, Moretti Lorenzo, Pignataro Paolo, Carrozzo Massimiliano, Vicenti Giovanni, Moretti Biagio
Department of Basic Medical Sciences, Neurosciences and Sensory Organs, UO Orthopaedics and Traumatology, Azienda Ospe - daliero Universitaria "Policlinico di Bari", Bari, Italy.
UO University Diagnostic Radiology, Azienda Ospedaliero Universitaria "Policlinico di Bari", Bari, Italy.
Muscles Ligaments Tendons J. 2016 Feb 12;6(4):467-472. doi: 10.11138/mltj/2016.6.4.467. eCollection 2016 Oct-Dec.
Femoral and tibial tunnel widening (TW) after ACL reconstruction is a phenomenon increasing talk in the literature. It is underlying biological and mechanical causes.
The aim of this study was to evaluate the relationship between bone tunnel enlargement and two different ACL fixation systems.
40 patient underwent ACL reconstruction with hamstring; randomly divided into group A with 20 patients treated with stiff systems (femoral Rigidfix and tibial interference screw), and into group B, with 20 patients treated with morel elastic system (femoral and tibial Tight-rope). Evaluated postoperatively with knee MRI at 40 days, 3 months, 6 months to measure bone tunnel diameters widening.
At 40 days tunnel widening between two groups shows no statistically difference. At 3 months postoperatively, femoral bone tunnel widening amounted on average to 1.84 mm in middle of tunnel and 1 mm at the mouth in joint in group A, and respectively 3.2 mm and 2.5 mm in group B (p<0.05). Tibial tunnel widening was 1.24 mm at the mouth in joint and 1.3 mm in middle in group A and respectively 2.26 mm and 2.43 mm in group B (p<0.05). At 6 months femoral tunnel widening amounted on average to 2.45 mm in middle and 1.35 mm at the mouth in joint in group A and respectively 3.5 mm and 2.7 mm in group B (p<0.01). Tibial tunnel widening amounted on average to 1.27 at mouth in joint and 1 mm in middle of tunnel in group A and respectively 2.6 mm and 2.3 mm in group B (p<0.01).
This study results suggest elastic fixation system increases bone tunnel enlargement after ACL reconstruction with hamstring without correlation with worse clinical performance.
IV.
前交叉韧带（ACL）重建术后股骨和胫骨隧道增宽（TW）是文献中越来越受关注的现象。其存在生物学和力学方面的潜在原因。
本研究旨在评估骨隧道扩大与两种不同ACL固定系统之间的关系。
40例患者接受了腘绳肌肌腱ACL重建术；随机分为A组，20例患者采用刚性系统（股骨端Rigidfix和胫骨端干涉螺钉）治疗，B组，20例患者采用更具弹性的系统（股骨和胫骨端Tight - rope）治疗。术后40天、3个月、6个月通过膝关节MRI评估，测量骨隧道直径增宽情况。
40天时两组之间的隧道增宽无统计学差异。术后3个月，A组股骨骨隧道在隧道中部平均增宽1.84 mm，关节内开口处增宽1 mm，B组分别为3.2 mm和2.5 mm（p<0.05）。A组胫骨隧道在关节内开口处增宽1.24 mm，中部增宽1.3 mm，B组分别为2.26 mm和2.43 mm（p<0.05）。6个月时，A组股骨隧道中部平均增宽2.45 mm，关节内开口处增宽1.35 mm，B组分别为3.5 mm和2.7 mm（p<0.01）。A组胫骨隧道在关节内开口处平均增宽1.27 mm，隧道中部增宽1 mm，B组分别为2.6 mm和2.3 mm（p<0.01）。
本研究结果表明，在腘绳肌肌腱ACL重建术后，弹性固定系统会增加骨隧道扩大，且与较差的临床性能无关。
IV级。
