患者年龄作为术前因素与使用自体腘绳肌腱的双束前交叉韧带重建后隧道扩大有关。
Patient age as a preoperative factor associated with tunnel enlargement following double-bundle anterior cruciate ligament reconstruction using hamstring tendon autografts.
机构信息
Zensyukai Hospital Gunma Sports Medicine Research Center, 54-1 Utsuboi-machi, Maebashi, Gunma, 379-2115, Japan.
Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-15 Showa-machi, Maebashi, Gunma, Japan.
出版信息
Knee Surg Sports Traumatol Arthrosc. 2018 Apr;26(4):1230-1236. doi: 10.1007/s00167-017-4611-x. Epub 2017 Jun 22.
PURPOSE
A few studies have detected associations of post-operative tunnel enlargement with sex, age, and the timing of anterior cruciate ligament reconstruction (ACLR). The aim of the present study was to investigate the correlation between post-operative tunnel enlargement following ACLR using hamstring tendon autografts and preoperative factors. The authors hypothesized that tunnel enlargement is associated with age in patients undergoing ACLR.
METHODS
One hundred and six patients (male, n = 57; female, n = 49; mean age, 26.9 years) who underwent double-bundle ACL reconstruction were included in the present study. The time between injury and surgery was 26.3 ± 71.4 weeks. Computed tomographic scans of the operated knee were obtained at 2 weeks and 6 months after surgery. The area of the tunnel aperture was measured for the femoral anteromedial tunnel (FAMT), femoral posterolateral tunnel (FPLT), tibial anteromedial tunnel (TAMT), and tibial posterolateral tunnel. The percentage of tunnel area enlargement was defined as the area at 2 weeks after ACLR subtracted from the area at 6 months after ACLR and then divided by the area at 2 weeks after ACLR. Spearman's correlation coefficient was calculated for each factor. The patients were divided into two groups based on age. Patients aged <40 and ≥40 years were assigned to Groups A and B, respectively. The differences in the outcomes and characteristics of the two groups were evaluated.
RESULTS
The percentage of enlargement of the FAMT, FPLT, and TAMT was correlated with patient age (r = 0.31, p = 0.001; r = 0.24, p = 0.012; and r = 0.30, p = 0.002, respectively). In total, 87 and 19 knees were classified into Groups A and B, respectively, based on patient age. The percentage of enlargement of the FAMT was significantly higher in Group B than A (78 vs. 60%, respectively; p = 0.01). The percentage of enlargement of the TAMT was significantly higher in Group B than A (53 vs. 36%, respectively; p = 0.03).
CONCLUSION
The percentage of enlargement of the FAMT and TAMT was associated with patient age. These findings suggest the need to consider the possibility of tunnel enlargement when double-bundle ACLR is performed for patients aged >40 years. Age was a preoperative factor associated with tunnel enlargement.
LEVEL OF EVIDENCE
III.
目的
有几项研究发现，术后隧道扩大与性别、年龄和前交叉韧带重建（ACL）的时间有关。本研究的目的是探讨使用自体腘绳肌腱进行 ACLR 后术后隧道扩大与术前因素之间的相关性。作者假设在接受 ACLR 的患者中，年龄与隧道扩大有关。
方法
本研究纳入了 106 名患者（男性 n=57；女性 n=49；平均年龄 26.9 岁），均接受了双束 ACL 重建。损伤与手术之间的时间为 26.3±71.4 周。术后 2 周和 6 个月对手术膝关节进行计算机断层扫描。测量股骨前内侧隧道（FAMT）、股骨后外侧隧道（FPLT）、胫骨前内侧隧道（TAMT）和胫骨后外侧隧道的隧道孔径面积。隧道面积扩大百分比定义为 ACLR 后 2 周的面积减去 ACLR 后 6 个月的面积，然后除以 ACLR 后 2 周的面积。对每个因素进行 Spearman 相关系数计算。根据年龄将患者分为两组。<40 岁和≥40 岁的患者分别归入 A 组和 B 组。评估两组之间的结果和特征差异。
结果
FAMT、FPLT 和 TAMT 的扩大百分比与患者年龄相关（r=0.31，p=0.001；r=0.24，p=0.012；r=0.30，p=0.002）。总共根据患者年龄将 87 个和 19 个膝关节分别归入 A 组和 B 组。B 组 FAMT 的扩大百分比明显高于 A 组（分别为 78%和 60%；p=0.01）。B 组 TAMT 的扩大百分比明显高于 A 组（分别为 53%和 36%；p=0.03）。
结论
FAMT 和 TAMT 的扩大百分比与患者年龄相关。这些发现表明，对于年龄>40 岁的患者进行双束 ACLR 时，需要考虑隧道扩大的可能性。年龄是与隧道扩大相关的术前因素。
证据水平
III 级。
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