Cavaignac Etienne, Marot Vincent, Faruch Marie, Reina Nicolas, Murgier Jérôme, Accadbled Franck, Berard Emilie, Chiron Philippe
Department of Orthopedic Surgery and Trauma, Hôpital Pierre-Paul Riquet, Toulouse, France.
Department of Radiology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.
Am J Sports Med. 2018 Feb;46(2):348-356. doi: 10.1177/0363546517733472. Epub 2017 Oct 24.
Anterior cruciate ligament (ACL) reconstruction with a quadrupled semitendinosus (ST4) graft is an evolution of the standard technique with 2 hamstring tendons (semitendinosus + gracilis [STG]). However, there is no published comparison of how well these 2 types of hamstring grafts are incorporated into the bone tunnels. Because the ST4 graft is shorter, there is less graft material inside the tunnels.
To use magnetic resonance imaging (MRI) to compare graft incorporation in the tibial bone tunnels 1 year after ACL reconstruction with either an STG graft or ST4 graft.
Cohort study; Level of evidence, 2.
Sixty-two patients who underwent ACL reconstruction were enrolled prospectively: 31 with an ST4 graft and 31 with an STG graft. The same surgical technique, fixation method, and postoperative protocol were used in both groups. Graft incorporation and ligamentization were evaluated with MRI after 1 year of follow-up. The following parameters were evaluated: signal-to-noise quotient (SNQ), tibial tunnel enlargement, signal intensity at the bone-graft interface, and graft signal according to the Howell scale. The number of participants needed to show that the mean SNQ did not differ between the 2 techniques was 31 in each group (with a 1-sided alpha of 2.5% and a 1-sided beta of 10.0%). The Student t test was used to compare the distribution of continuous secondary endpoints.
The mean SNQ was 5.2 ± 4.5 for the STG group and 5.9 ± 3.7 for the ST4 group ( P = .5100). The mean tibial tunnel widening was 93.7% ± 51.7% for the STG group versus 80.0% ± 42.9% for the ST4 group ( P = .2605). The groups did not differ in signal intensity at the bone-graft interface ( P = .7502) or in graft signal according to the Howell scale ( P = .4544).
At the 1-year postoperative follow-up, incorporation and ligamentization of the STG and ST4 grafts were the same based on MRI analysis. The results were at least as good with the ST4 technique as with the standard STG technique in terms of incorporation and ligamentization.
采用四股半腱肌（ST4）移植物进行前交叉韧带（ACL）重建是标准的双股腘绳肌腱（半腱肌+股薄肌[STG]）技术的改进。然而，尚无关于这两种类型的腘绳肌移植物在骨隧道中整合情况的比较报道。由于ST4移植物较短，隧道内的移植物材料较少。
使用磁共振成像（MRI）比较ACL重建术后1年，STG移植物和ST4移植物在胫骨骨隧道中的移植物整合情况。
队列研究；证据等级，2级。
前瞻性纳入62例行ACL重建的患者：31例使用ST4移植物，31例使用STG移植物。两组采用相同的手术技术、固定方法和术后方案。随访1年后，通过MRI评估移植物整合和韧带化情况。评估以下参数：信噪比（SNQ）、胫骨隧道扩大情况、骨-移植物界面的信号强度以及根据豪厄尔量表评估的移植物信号。要证明两种技术的平均SNQ无差异，每组所需的参与者数量为31例（单侧α为2.5%，单侧β为10.0%）。采用Student t检验比较连续次要终点的分布。
STG组的平均SNQ为5.2±4.5，ST4组为5.9±3.7（P = 0.5100）。STG组胫骨隧道平均增宽93.7%±51.7%，ST4组为80.0%±42.9%（P = 0.2605）。两组在骨-移植物界面的信号强度（P = 0.7502）或根据豪厄尔量表评估的移植物信号方面无差异（P = 0.4544）。
术后1年随访时，根据MRI分析，STG和ST4移植物的整合和韧带化情况相同。就整合和韧带化而言，ST4技术的结果至少与标准STG技术一样好。
