Departamento de Cirugía Ortopédica y Traumatología, Clínica Universidad de Navarra, Pamplona, España.
Departamento de Cirugía Ortopédica y Traumatología, Clínica Universidad de Navarra, Pamplona, España.
Rev Esp Cir Ortop Traumatol (Engl Ed). 2020 Sep-Oct;64(5):310-317. doi: 10.1016/j.recot.2020.04.009. Epub 2020 Jun 16.
Currently, there is no stablished pre-operative model that helps the orthopaedic surgeon predict the final graft diameter in anterior cruciate ligament reconstruction (ACLR). The purpose of this study was to determine whether there is a correlation between semitendinosus (ST) and gracilis (GT) cross-sectional area (CSA) evaluated pre-operatively in mm using magnetic resonance imaging (MRI) and the final intra-operative ST-GT autograft diameter in mm.
A retrospective study was designed, 89 patients undergoing ACLR with hamstring autograft participated. We analysed ST-CSA (mm) and GT-CSA (mm) using pre-operative MRI, intra-operative autograft diameter, age, sex, side of the injury, weight, height and body mass index (BMI).
A moderate-strong correlation was identified between final autograft diameter and ST-GT CSA in MRI (Pearson correlation coefficient .6911 P<.001). We observed that, if the combination of ST-CSA and GT-STA is at least 19mm, the probability of obtaining an autograft with a diameter greater than or equal to 8mm is 91.8% or more. The ROC curve analysis demonstrated, in this model, that this predictive method on MRI correctly discriminates in over 95.6% of cases between achieving or otherwise an autograft greater than or equal to 8mm during surgery. Intra and interobserver concordance of the MRI measurements were excellent, as shown in the intraobserver intraclass correlation coefficient (CCI) of .79 and the interobserver CCI of .84 and .77 for the ST and GT respectively.
Preoperative determinations of ST-CSA and GT-CSA (mm) using MRI correlate with the final autograft diameter. This method represents a reliable and reproducible model to predict the hamstring autograft diameter in ACLR.
Retrospective cohort study, level IV.
A review of the available literature reveals a higher risk of ACL failure or re-rupture if the graft is smaller than 8mm in diameter. Despite being an important factor there is no established pre-operative model that predicts the final graft diameter. Knowing beforehand the possibilities of obtaining a hamstring autograft with a diameter greater than or equal to 8mm would help the orthopaedic surgeon to better plan the surgery and to anticipate the need for other graft options (such as bone-patellar-tendon-bone autograft or allografts, amongst other alternatives).
目前，尚无既定的术前模型可帮助骨科医生预测前交叉韧带重建（ACL）中最终移植物直径。本研究旨在确定使用磁共振成像（MRI）术前评估的半腱肌（ST）和股薄肌（GT）横截面积（CSA）与术中 ST-GT 自体移植物直径之间是否存在相关性。
设计了一项回顾性研究，共纳入 89 例接受腘绳肌腱自体移植的 ACLR 患者。我们使用术前 MRI 分析 ST-CSA（mm）和 GT-CSA（mm）、术中自体移植物直径、年龄、性别、损伤侧、体重、身高和体重指数（BMI）。
最终自体移植物直径与 MRI 中 ST-GT CSA 之间存在中度强相关性（Pearson 相关系数.6911，P<.001）。我们观察到，如果 ST-CSA 和 GT-STA 的组合至少为 19mm，则获得直径大于或等于 8mm 的自体移植物的可能性为 91.8%或更高。ROC 曲线分析表明，在该模型中，MRI 上的这种预测方法可正确区分 95.6%以上的病例在手术中是否获得或未获得直径大于或等于 8mm 的自体移植物。MRI 测量的内和观察者间一致性均很好，观察者内的组内相关系数（ICC）为.79，ST 和 GT 的观察者间 ICC 分别为.84 和.77。
使用 MRI 术前确定 ST-CSA 和 GT-CSA（mm）与最终自体移植物直径相关。该方法代表了一种可靠且可重复的模型，可预测 ACLR 中腘绳肌腱自体移植物的直径。
回顾性队列研究，IV 级。
对现有文献的回顾表明，如果移植物直径小于 8mm，则 ACL 失败或再断裂的风险更高。尽管这是一个重要因素，但尚无既定的术前模型可预测最终移植物直径。如果事先知道获得直径大于或等于 8mm 的腘绳肌腱自体移植物的可能性，将有助于骨科医生更好地计划手术并预测对其他移植物选择（如髌腱-骨-髌腱自体移植物或同种异体移植物等）的需求。
