Department of Orthopedic Surgery, Seoul Medical Center, Seoul, South Korea.
Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, South Korea.
Arthroscopy. 2021 Jan;37(1):209-221. doi: 10.1016/j.arthro.2020.08.035. Epub 2020 Nov 19.
To compare the clinical, second-look arthroscopic, magnetic resonance imaging (MRI), and dynamic-contrast-enhanced MRI (DCE-MRI) findings between remnant-tensioning single-bundle (RT-SB) and double-bundle (DB) anterior cruciate ligament reconstruction (ACLR).
Sixty-seven patients with acute or subacute anterior cruciate ligament (ACL) injury were randomized to undergo RT-SB or DB ACLR. Twenty-six patients in the RT-SB group and 28 in the DB group were evaluated using stability tests (Lachman test, pivot-shift test, and KT-2000 arthrometer) and multiple clinical scores. One year postoperatively, all 54 patients underwent MRI for evaluation of graft continuity and graft signal/noise quotient and DCE-MRI for the calculation of normalized area under the curve (nAUC) as a marker of graft vascularity. Among them, 41 patients underwent second-look arthroscopy for the evaluation of graft continuity, graft tension, and synovialization. The results were compared between the 2 groups.
At the minimum 2-year follow-up (28.7 ± 6.4 months), the stability tests, clinical scores, second-look arthroscopic findings, and MRI findings were not significantly different between the groups. However, the mean nAUC values on DCE-MRI for the ACL graft were significantly higher in the RT-SB group than those in the DB group in all 3 zones (nAUC, P = .005; nAUC, P = .021; nAUC, P = .027; and nAUC, P = .008).
For acute or subacute ACL injury, the RT-SB ACLR showed an outcome comparable to that of DB ACLR in terms of knee stability, clinical scores, MRI findings, and second-look arthroscopic findings. Moreover, RT-SB ACLR showed better graft vascularity 1 year postoperatively than DB ACLR using DCE-MRI.
II, prospective randomized controlled trial.
比较残余张力单束（RT-SB）和双束（DB）前交叉韧带重建（ACLR）的临床、二次关节镜检查、磁共振成像（MRI）和动态对比增强 MRI（DCE-MRI）表现。
67 例急性或亚急性前交叉韧带（ACL）损伤患者随机分为 RT-SB 或 DB ACLR 组。26 例 RT-SB 组和 28 例 DB 组患者进行稳定性试验（Lachman 试验、枢轴移位试验和 KT-2000 关节测量仪）和多项临床评分评估。术后 1 年，所有 54 例患者接受 MRI 评估移植物连续性和移植物信号/噪声比，DCE-MRI 计算归一化曲线下面积（nAUC）作为移植物血管生成的标志物。其中，41 例患者接受二次关节镜检查评估移植物连续性、移植物张力和滑膜化。比较两组间的结果。
在最低 2 年随访（28.7 ± 6.4 个月）时，两组间的稳定性试验、临床评分、二次关节镜检查结果和 MRI 结果无显著差异。然而，DCE-MRI 上 ACL 移植物的平均 nAUC 值在 RT-SB 组中均显著高于 DB 组，在所有 3 个区域中（nAUC，P =.005；nAUC，P =.021；nAUC，P =.027；nAUC，P =.008）。
对于急性或亚急性 ACL 损伤，RT-SB ACLR 在膝关节稳定性、临床评分、MRI 表现和二次关节镜检查结果方面与 DB ACLR 具有可比性。此外，与 DB ACLR 相比，RT-SB ACLR 在术后 1 年时使用 DCE-MRI 显示出更好的移植物血管生成。
II 级，前瞻性随机对照试验。
