Goto Kazumi, Hara Masahiko, Yamazaki Yoshiyuki, Urata Taihei, Shimizu Yuki, Shimizu Naofumi
Department of Orthopaedic Surgery, Toshiba Rinkan Hospital, Toshiba Rinkan Hospital, 7-9-1, Kamitsuruma, Minami-ku, Sagamihara-Shi, Kanagawa, 252-0385, Japan.
Japan Society of Clinical Research, Chuoh-ku, Tokyo, Japan.
Knee Surg Relat Res. 2020 Jul 8;32(1):34. doi: 10.1186/s43019-020-00052-5.
BACKGROUND/PURPOSE: Hamstring tendon autografts are commonly used for double-bundle anterior cruciate ligament reconstruction (DB-ACLR). If the volume of the semitendinosus (ST) tendon is insufficient, the gracilis (G) tendon is also harvested. Additional harvesting of the G autograft can affect patients' short-term postoperative outcome, such as muscle recovery; thus, preoperative information about whether an additional G autograft is needed would be useful. The purpose of this study was to investigate whether preoperative measurement of the ST tendon using ultrasonography could inform the intraoperative decision to harvest the G tendon.
We enrolled 20 patients (13 men and seven women) who underwent DB-ACLR between October 2017 and March 2019. The mean patient age was 28.5 years. The ipsilateral ST tendon was measured using ultrasonography before surgery. Measurements included the diameter and breadth of the short-axis image. The cross-sectional area (CSA) was calculated from these measurements. During surgery, when two grafts with diameters of ≥ 5.0 mm could not be made, the G tendon was also harvested. Patients were categorized into two groups: the ST group where only the ST tendon was harvested, and the semitendinosus gracilis tendon (STG) group where the ST and G tendons were both harvested. The CSA value was compared between the two groups, and the cutoff value was calculated.
In the ST group (n = 8), the mean diameter and breadth of the semitendinosus tendon were 4.21 and 2.34 mm, respectively. In the STG group (n = 12), the mean diameter and breadth of the ST tendon were 3.39 and 1.78 mm, respectively. The CSAs calculated for the ST group and the STG group were 7.74 mm and 4.79 mm, respectively. A cutoff value of 7.0 mm was found to correspond to a specificity and sensitivity to harvest the G tendon of 87.5% and 75.0%, respectively.
The preoperative CSA of the ST tendon determined using ultrasonography can, therefore, be informative for deciding whether to harvest the G tendon for DB-ACLR. The results of this study provide valuable information for graft selection in anterior cruciate ligament reconstruction.
IV (Retrospective case series design).
背景/目的：腘绳肌腱自体移植常用于双束前交叉韧带重建术（DB - ACLR）。如果半腱肌（ST）肌腱的体积不足，则也会采集股薄肌（G）肌腱。额外采集G肌腱自体移植物可能会影响患者术后短期恢复情况，如肌肉恢复；因此，术前了解是否需要额外采集G肌腱自体移植物将很有帮助。本研究的目的是调查术前使用超声测量ST肌腱是否能为术中采集G肌腱的决策提供依据。
我们纳入了20例在2017年10月至2019年3月期间接受DB - ACLR手术的患者（13例男性和7例女性）。患者的平均年龄为28.5岁。术前使用超声测量患侧的ST肌腱。测量包括短轴图像的直径和宽度。根据这些测量值计算横截面积（CSA）。在手术过程中，当无法制备两根直径≥5.0 mm的移植物时，也采集G肌腱。患者被分为两组：仅采集ST肌腱的ST组和同时采集ST和G肌腱的半腱肌股薄肌肌腱（STG）组。比较两组的CSA值，并计算临界值。
在ST组（n = 8）中，半腱肌肌腱的平均直径和宽度分别为4.21 mm和2.34 mm。在STG组（n = 12）中，ST肌腱的平均直径和宽度分别为3.39 mm和1.78 mm。ST组和STG组计算得到的CSA分别为7.74 mm²和4.79 mm²。发现临界值为7.0 mm时，采集G肌腱的特异性和敏感性分别为87.5%和75.0%。
因此，术前使用超声测定的ST肌腱CSA可为DB - ACLR手术中是否采集G肌腱提供参考信息。本研究结果为前交叉韧带重建术中移植物的选择提供了有价值的信息。
IV（回顾性病例系列设计）
