Medical college, Ningbo University, Ningbo, Zhejiang, People's Republic of China.
Department of Repair and Reconstruction Surgery, Ningbo First hospital, 247 Renmin Road, Ningbo, Zhejiang, People's Republic of China.
Knee Surg Sports Traumatol Arthrosc. 2018 Oct;26(10):3048-3054. doi: 10.1007/s00167-018-4910-x. Epub 2018 Mar 24.
The aim of this study was to clarify the association of the anterior cruciate ligament (ACL) graft bending angle and graft maturity of autograft and allograft tendons using high-resolution MRI.
Patients with unilateral ACL reconstruction were invited to participate in this study, and they were examined using a 3.0-T MRI scan at 3, 6 and 12 months after the operation. Anatomic single-bundle ACL reconstruction was performed on 48 patients using the trans-portal technique, including 28 with autograft hamstring tendons and 20 with allograft tendons. To evaluate graft healing, the signal/noise quotient (SNQ) was measured in four regions of interest (ROIs) of the femoral tunnel, proximal, midsubstance and distal ACL grafts. The graft bending angle was defined as the angle between the femoral bone tunnel and the line connecting the femoral and tibial tunnel apertures. Graft SNQ and graft bending angle were assessed at 3, 6 and 12 months postoperatively, and the association between SNQ and the average graft bending angle was analyzed.
Generally, the mean graft bending angle of this cohort increased gradually with time. The SNQ value of each graft region increased from 3 to 6 months and then decreased from 6 to 12 months. In the whole cohort, the graft bending angle had a significant positive association with graft SNQ in the femoral tunnel or proximal site. In the allograft subgroup, the graft bending angle had a significant positive association with the graft SNQ in the femoral tunnel or proximal site at 6 months after surgery, while there was no association between the graft bending angle and SNQ at 12 months. In the autograft subgroup, the graft bending angle had a significant positive association with graft SNQ in the femoral tunnel or proximal site at 12 months after surgery.
Generally, the graft bending angle was correlated with a high signal intensity of the proximal graft in the early postoperative period for allograft tendons and in the late postoperative period for allograft tendons. This suggests that the biomechanical effect from the graft bending angle on graft healing may be different for allografts and autografts after ACL reconstruction.
III.
本研究旨在使用高分辨率 MRI 明确前交叉韧带（ACL）移植物弯曲角度与自体和同种异体肌腱移植物成熟度的相关性。
邀请单侧 ACL 重建患者参与本研究，并在术后 3、6 和 12 个月使用 3.0-T MRI 扫描进行检查。48 例患者采用经皮隧道技术行解剖单束 ACL 重建，其中 28 例使用自体腘绳肌腱，20 例使用同种异体肌腱。为评估移植物愈合情况，在股骨隧道、近端、中体和 ACL 移植物的 4 个感兴趣区（ROI）测量信噪比（SNQ）。定义移植物弯曲角度为股骨骨隧道与连接股骨和胫骨隧道开口的线之间的角度。术后 3、6 和 12 个月评估移植物 SNQ 和移植物弯曲角度，并分析 SNQ 与平均移植物弯曲角度之间的相关性。
总体而言，该队列的平均移植物弯曲角度随时间逐渐增加。各移植物区域的 SNQ 值从 3 个月增加到 6 个月，然后从 6 个月减少到 12 个月。在整个队列中，移植物弯曲角度与股骨隧道或近端的移植物 SNQ 呈显著正相关。在同种异体移植物亚组中，术后 6 个月时，移植物弯曲角度与股骨隧道或近端的移植物 SNQ 呈显著正相关，而术后 12 个月时两者之间无相关性。在自体移植物亚组中，术后 12 个月时，移植物弯曲角度与股骨隧道或近端的移植物 SNQ 呈显著正相关。
总体而言，同种异体肌腱在术后早期，自体肌腱在术后晚期，移植物弯曲角度与近端移植物高信号强度相关。这表明 ACL 重建后同种异体和自体移植物的移植物弯曲角度对移植物愈合的生物力学影响可能不同。
III 级。
