Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, TU Munich, Ismaninger Str. 22, 81675, Munich, Germany.
Department of Orthopaedic and Trauma Surgery, Policlinico San Pietro, Ponte St. Pietro, Italy.
Knee Surg Sports Traumatol Arthrosc. 2018 Feb;26(2):462-467. doi: 10.1007/s00167-017-4555-1. Epub 2017 Apr 24.
The purpose of this study was to evaluate tunnel position and width in failed primary single-bundle (SB) anterior cruciate ligament (ACL) reconstructions. It was hypothesized that both femoral and tibial bone tunnels are frequently malplaced in terms of a partially anatomic position in the setting of failed SB ACL reconstruction.
Patients with recurrent instability following isolated SB ACL reconstruction using hamstring tendon autografts, undergoing revision ACL surgery, were retrospectively included. Further inclusion criteria were age >18 years and availability of preoperative computed tomography (CT) scans and radiographs of the affected knee. Patients with multiligamentous instabilities as well as incomplete or poor radiographs were excluded. Tunnel position was evaluated according to the method described by Harner et al. and Stäubli and Rauschning. Tunnel width was determined on CT scans perpendicular to the bone tunnel axis at three different heights of each bone tunnel.
Eighty-two patients met the inclusion criteria and were considered for radiological analysis. Femoral tunnels were graded as anatomic in 60% (49 of 82) of all cases. In the remaining 40% (33/82), 27% of the tunnels were placed partially anatomic and 13% were graded as non-anatomic. Tibial tunnel placement was found to be anatomic in 54% (44/82) of all cases, partially anatomic in 45% and non-anatomic in 1% of the cases. No statistically significant difference between anatomic or partially anatomic tunnel position and tunnel diameter, neither for the femoral nor for the tibial side, was observed (n.s.).
The present study demonstrates that there is a high incidence of partially anatomic placed tunnels in failed SB ACL reconstruction. Tunnel width was not associated with tunnel position. Clinically, partially anatomic bone tunnels frequently require a staged procedure with bone grafting and subsequent ACL revision surgery. Thus, surgeons should carefully analyse tunnel position and width preoperatively to properly plan ACL revision surgery.
本研究旨在评估初次单束（SB）前交叉韧带（ACL）重建失败后隧道的位置和宽度。假设在 SB ACL 重建失败的情况下，股骨和胫骨隧道的位置都经常不正确，部分位于解剖位置。
回顾性纳入接受腘绳肌腱自体移植物行孤立性 SB ACL 重建后出现复发性不稳定且接受 ACL 翻修手术的患者。进一步的纳入标准为年龄＞18 岁，且有受累膝关节的术前计算机断层扫描（CT）和 X 线片。排除多韧带不稳定以及 X 线片不完整或质量较差的患者。根据 Harner 等人和 Stäubli 和 Rauschning 描述的方法评估隧道位置。在每个骨隧道的三个不同高度，垂直于骨隧道轴在 CT 扫描上确定隧道宽度。
82 例患者符合纳入标准并进行了影像学分析。在所有病例中，60%（49/82）的股骨隧道被评为解剖学位置。在其余 40%（33/82）的病例中，27%的隧道被部分评为解剖学位置，13%的隧道被评为非解剖学位置。在所有病例中，54%（44/82）的胫骨隧道被评为解剖学位置，45%的隧道被部分评为解剖学位置，1%的隧道被评为非解剖学位置。无论是股骨侧还是胫骨侧，解剖学或部分解剖学隧道位置与隧道直径之间均无统计学显著差异（n.s.）。
本研究表明，SB ACL 重建失败后存在较高比例的部分解剖学隧道。隧道宽度与隧道位置无关。临床上，部分解剖学骨隧道常需要分期手术，包括植骨和随后的 ACL 翻修手术。因此，外科医生应在术前仔细分析隧道位置和宽度，以便正确计划 ACL 翻修手术。
