Department of Sports Medicine, Huashan Hospital, Shanghai, China.
Department of Radiology, Huashan Hospital, Shanghai, China.
Am J Sports Med. 2018 Apr;46(5):1143-1149. doi: 10.1177/0363546517752918. Epub 2018 Feb 14.
The hamstring tendons are commonly harvested for anterior cruciate ligament (ACL) reconstruction with detachment of the tibial insertion. Retaining the insertion may help to preserve vascularity and viability of the graft and bypass the stages of avascular necrosis and revascularization, which might be beneficial to graft maturity.
To investigate and compare graft maturity by magnetic resonance imaging (MRI) after ACL reconstruction with preservation or detachment of hamstring tendon tibial insertion at up to 2 years.
Randomized controlled trial; Level of evidence, 2.
Forty-five patients (age range, 18-45 years) undergoing isolated ACL reconstruction with hamstring tendon were enrolled and randomized to 2 groups. The tibial insertion of the hamstring tendon was preserved in the study group (n = 21) and detached in the control group (n = 24). Patients had follow-up at 3, 6, 12, and 24 months, which consisted of the following: (1) clinical examination and (2) MRI evaluation of graft signal intensity based on signal/noise quotient (SNQ) values. Finally, 18 patients in the study group and 19 in the control group received full follow-up evaluation (ie, at all 4 time points).
All knees acquired full range of motion at 24 months without significant laxity. At each time point, the KT-1000 arthrometer revealed no significant difference between groups; the clinical scores significantly improved in both groups, although the difference between groups was not significant. In the control group, the SNQ value increased from 3 months, peaked at 6 months, and then decreased (3 months, 21.4 ± 12.7; 6 months, 25.6 ± 12; 12 months, 18.3 ± 7.7; 24 months, 15.3 ± 6.3). However, the insertion-preserved graft in the study group maintained relatively lower and unchanged signal intensity throughout all time points (3 months, 15.0 ± 11.2; 6 months, 14.9 ± 6.3; 12 months, 12.6 ± 7.0; 24 months, 14.6 ± 7.0). Between groups, there was no significant difference at 3 or 24 months ( P = .11 and .75, respectively), while the SNQ values were significantly lower in the study group versus the control group at 6 and 12 months ( P = .002 and .02, respectively).
The insertion-detached hamstring tendon grafts underwent a significantly increasing change in signal intensity during the first 2 years after ACL reconstruction, while the insertion-preserved grafts kept a relatively lower and unchanged signal intensity. The difference was most significant at 6 and 12 months postoperatively.
在进行前交叉韧带（ACL）重建时，通常会切除腘绳肌腱的胫骨止点来获取肌腱。保留胫骨止点可能有助于保持移植物的血管化和活力，并绕过无血管坏死和再血管化阶段，这可能有利于移植物成熟。
通过 MRI 对比 ACL 重建中保留与不保留腘绳肌腱胫骨止点在 2 年时的移植物成熟度。
随机对照试验；证据等级，2 级。
45 例（年龄 18-45 岁）接受 ACL 重建的患者随机分为 2 组，其中 21 例患者（研究组）保留了腘绳肌腱的胫骨止点，24 例患者（对照组）切除了胫骨止点。所有患者在术后 3、6、12 和 24 个月时接受随访，包括：（1）临床检查和（2）基于信噪比（SNQ）值的 MRI 评估。最后，研究组有 18 例患者和对照组有 19 例患者接受了完整的随访评估（即在所有 4 个时间点）。
所有膝关节在 24 个月时均获得了全范围的活动度，且无明显松弛。在每个时间点，KT-1000 关节测量仪均显示组间无显著差异；两组的临床评分均显著改善，尽管组间差异无统计学意义。对照组的 SNQ 值从 3 个月开始增加，在 6 个月时达到峰值，然后下降（3 个月时为 21.4±12.7，6 个月时为 25.6±12，12 个月时为 18.3±7.7，24 个月时为 15.3±6.3）。然而，研究组中保留了胫骨止点的移植物在所有时间点的信号强度均保持相对较低且不变（3 个月时为 15.0±11.2，6 个月时为 14.9±6.3，12 个月时为 12.6±7.0，24 个月时为 14.6±7.0）。组间在 3 个月或 24 个月时无显著差异（P=0.11 和 0.75），而在 6 个月和 12 个月时研究组的 SNQ 值明显低于对照组（P=0.002 和 0.02）。
在 ACL 重建后 2 年内，附着点分离的腘绳肌腱移植物的信号强度显著增加，而附着点保留的移植物的信号强度保持相对较低且不变。术后 6 个月和 12 个月时差异最显著。
