Department of Orthopedic Surgery, Tottori University, Yonago, Tottori, Japan.
J Knee Surg. 2021 Apr;34(5):546-551. doi: 10.1055/s-0039-1697625. Epub 2019 Sep 27.
The purpose of this study is to determine the influence of debridement in and around the bone tunnels on the prevalence of cyclops lesion (CL), after anterior cruciate ligament reconstruction (ACLR) with hamstring grafts. Our hypothesis was that bone tunnel debridement during ACLR would reduce the prevalence of CL. Methods for debridement in and around the bone tunnels after tunnel drilling were standardized and applied to 38 knees undergoing double-bundle ACLR between 2011 and 2014, Group A (debridement group). Group B (nondebridement group) included 56 knees in which bone tunnel debridement was not performed. Postoperative MRI was performed to evaluate the presence of CL and the following three criteria: (1) the intercondylar site of CL (grade 1-3), depending on its anterior extent along the femoral condyle; (2) posterior bowing of the ACL graft; and (3) the positional relationship between the frontmost fiber of ACL graft and Blumensaat's line. If CL caused loss of extension or pain or discomfort during knee extension, it was defined as symptomatic CL (SCL). CL was detected in 8 cases (21.1%) in Group A and 26 cases (46.4%) in Group B. The prevalence of CL was significantly lower in Group A than in Group B ( = 0.010), and the risk ratio of CL was 0.31 (95% confidence interval: 0.12-0.79). Furthermore, 10 patients in Group B had SCL, compared with none in Group A ( = 0.004). In Group A, the intercondylar site of CL was grade 1 in all cases, while in Group B, the CL grades were 1 ( = 17), 2 ( = 7), 3 ( = 2) ( = 0.008). There were no cases of posterior bowing of the ACL in Group A, but six cases in Group B ( = 0.023). Debridement in and around the bone tunnel is a simple and effective method of preventing CL and SCL after ACLR. The level of evidence for the study is 3.
本研究旨在确定在 ACLR 中对骨隧道内外进行清创是否会影响前交叉韧带重建（ACLR）后髁间窝病变（CL）的发生率。我们的假设是，在 ACLR 中对骨隧道进行清创会降低 CL 的发生率。在 2011 年至 2014 年间，对 38 例采用双束 ACLR 的患者（A 组，清创组）进行标准化的骨隧道内外清创，并对 56 例未进行骨隧道清创的患者（B 组）进行随访。术后 MRI 评估 CL 的存在，并采用以下三个标准进行评估：（1）CL 的髁间窝部位（根据其在股骨髁上的前伸程度分为 1-3 级）；（2）ACL 移植物的后弓；（3）ACL 移植物最前缘纤维与 Blumensaat 线的位置关系。如果 CL 导致膝关节伸直时出现伸直受限或疼痛或不适，则定义为有症状 CL（SCL）。A 组 8 例（21.1%）和 B 组 26 例（46.4%）发现 CL。A 组的 CL 发生率明显低于 B 组（ = 0.010），CL 的风险比为 0.31（95%置信区间：0.12-0.79）。此外，B 组有 10 例 SCL，而 A 组无 SCL（ = 0.004）。A 组的 CL 髁间窝部位均为 1 级，而 B 组的 CL 分级为 1 级（ = 17）、2 级（ = 7）、3 级（ = 2）（ = 0.008）。A 组无 ACL 后弓，B 组有 6 例（ = 0.023）。在骨隧道内外进行清创是预防 ACLR 后 CL 和 SCL 的一种简单有效的方法。本研究的证据水平为 3 级。
