Department of Orthopaedic Surgery, Teikyo University, Kaga 2-11-1, Itabashi-ku, Tokyo, 117-0003, Japan.
Department of Orthopaedic Surgery, Tokyo University, Tokyo, Japan.
Knee Surg Sports Traumatol Arthrosc. 2018 Dec;26(12):3660-3666. doi: 10.1007/s00167-018-4938-y. Epub 2018 Apr 16.
Anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone (BTB) graft is known to provide secure fixation due to the direct bone-to-bone integration of the bone plug and bone tunnel. It is important to know the time required for bone integration when designing the postoperative rehabilitation protocol or deciding when the patient can return to competition-level activity, especially if the patient is an athlete. However, because reports are scarce, the period necessary for bone-to-bone integration after ACL reconstruction using a BTB graft remains unclear. The purpose of this study was to clarify this issue. It was hypothesised that ACL reconstruction using a BTB graft via an anatomical rectangular tunnel would help in the integration between bone plugs and bone tunnels on both the femoral and tibial sides after at least 6 months, at which point basic exercises similar to pre-injury sporting activity levels can be resumed.
This study included 40 knees treated with ACL reconstruction using a BTB graft via anatomical rectangular tunnel reconstruction between 2013 and 2014 in a single institute. The integration between bone plugs and bone tunnels was evaluated using multi-slice tomosynthesis, which is a technique for producing slice images using conventional radiographic systems, at 1, 3, and 5 months postoperatively. All procedures were performed by two experienced surgeons. Bone integration was evaluated by two orthopaedic doctors.
The rates of integration of the bone plug and femoral bone tunnel on tomosynthesis at 1, 3, and 5 months postoperatively were 0, 55, and 100%, respectively. On the tibial side, the corresponding rates were 0, 75, and 100%, respectively. The rate of integration on the tibial side was significantly higher than that on the femoral side at 3 months postoperatively (p = 0.031).
Bone-to-bone integration on the femoral and tibial sides was complete within 5 months after surgery in all cases. Since the time required for bone integration is important in designing the postoperative rehabilitation approach, these results will serve as a useful guideline for planning rehabilitation protocols.
IV.
前交叉韧带（ACL）重建使用骨-髌腱-骨（BTB）移植物，由于骨栓和骨隧道之间直接的骨-骨整合，被认为可以提供可靠的固定。在设计术后康复方案或决定患者何时可以恢复竞技水平活动时，了解骨整合所需的时间非常重要，尤其是当患者是运动员时。然而，由于报告很少，使用 BTB 移植物进行 ACL 重建后的骨-骨整合所需的时间仍然不清楚。本研究的目的是阐明这个问题。假设使用解剖学矩形隧道进行 BTB 移植物 ACL 重建，至少在 6 个月后，在股骨和胫骨两侧的骨栓和骨隧道之间有助于整合，此时可以恢复类似于受伤前运动水平的基本运动。
本研究纳入了 2013 年至 2014 年在一家医院接受解剖学矩形隧道重建的 40 例 ACL 重建使用 BTB 移植物的膝关节。术后 1、3 和 5 个月，使用多层断层合成术（一种使用传统放射系统生成切片图像的技术）评估骨栓和骨隧道之间的整合情况。所有手术均由两名经验丰富的外科医生完成。骨整合由两名骨科医生进行评估。
术后 1、3 和 5 个月时，骨栓和股骨骨隧道在断层合成图像上的整合率分别为 0、55 和 100%。胫骨侧的相应比例分别为 0、75 和 100%。术后 3 个月时，胫骨侧的整合率明显高于股骨侧（p=0.031）。
所有病例术后 5 个月内，股骨和胫骨侧均完全实现骨-骨整合。由于骨整合所需的时间对于设计术后康复方法很重要，因此这些结果将为制定康复方案提供有用的指导。
IV。
