外侧关节外肌腱固定术对前交叉韧带移植物整合的影响。
Effect of Lateral Extra-articular Tenodesis on Anterior Cruciate Ligament Graft Incorporation.
作者信息
Cavaignac Etienne, Mesnier Timothée, Marot Vincent, Fernandez Andrea, Faruch Marie, Berard Emilie, Sonnery-Cottet Bertrand
机构信息
Department of Orthopedic Surgery and Trauma, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.
I2R, Institut de Recherche Riquet, Toulouse, France.
出版信息
Orthop J Sports Med. 2020 Nov 30;8(11):2325967120960097. doi: 10.1177/2325967120960097. eCollection 2020 Nov.
BACKGROUND
It has been shown that adding lateral extra-articular tenodesis (LET) to standard anterior cruciate ligament (ACL) reconstruction significantly decreases the loads on the ACL composite graft. To date, the possible effect of LET on ACL graft incorporation is not known.
PURPOSE
To compare the incorporation in tibial bone tunnels of a standard quadrupled semitendinosus (ST4) graft to an ST4 graft plus LET at 1 year postoperatively using magnetic resonance imaging (MRI).
STUDY DESIGN
Cohort study; Level of evidence, 3.
METHODS
A total of 62 patients who underwent ACL reconstruction were enrolled prospectively: 31 received an ST4 graft, and 31 received an ST4 graft plus LET. Graft incorporation was evaluated with MRI at the 1-year follow-up visit. The following parameters were evaluated: signal-to-noise quotient (SNQ), tibial tunnel widening, graft healing, and graft maturity according to the Howell scale. The primary endpoint was the SNQ of the ST4 graft at 1 year postoperatively; this parameter was adjusted because of unequal baseline characteristics between groups. Clinical and functional outcomes as well as incorporation of the graft were analyzed as secondary endpoints.
RESULTS
The mean adjusted SNQ was 0.5 ± 2.1 (95% CI, 0.4-4.6) in the ST4 + LET group and 5.9 ± 3.7 (95% CI, 4.7-7.0) in the ST4 group ( = .0297). The mean tibial tunnel widening was 73.7% ± 42.2% in the ST4 + LET group versus 77.5% ± 46.7% in the ST4 group ( = .5685). Howell grade I, indicative of better graft maturity, was statistically more frequent in the ST4 + LET group ( = .0379). No statistically significant difference was seen between groups in terms of graft healing ( = .1663). The Lysholm score was statistically higher in the ST4 + LET group ( = .0058). No significant differences were found between groups in terms of the International Knee Documentation Committee subjective score ( = .2683) or Tegner score ( = .7428). The mean SNQ of the LET graft at the 1-year follow-up visit was 2.6 ± 4.9.
CONCLUSION
At 1 year postoperatively, the MRI appearance of ACL grafts showed generally better incorporation and maturation when combined with LET.
背景
研究表明，在标准前交叉韧带（ACL）重建术中增加外侧关节外肌腱固定术（LET）可显著降低ACL复合移植物上的负荷。迄今为止，LET对ACL移植物整合的可能影响尚不清楚。
目的
使用磁共振成像（MRI）比较术后1年时标准四股半腱肌（ST4）移植物与ST4移植物加LET在胫骨骨隧道中的整合情况。
研究设计
队列研究；证据等级，3级。
方法
前瞻性纳入62例行ACL重建的患者：31例接受ST4移植物，31例接受ST4移植物加LET。在1年随访时通过MRI评估移植物整合情况。评估以下参数：信噪比（SNQ）、胫骨隧道增宽、移植物愈合情况以及根据豪厄尔量表评估的移植物成熟度。主要终点是术后1年时ST4移植物的SNQ；由于组间基线特征不相等，对该参数进行了调整。临床和功能结果以及移植物整合情况作为次要终点进行分析。
结果
ST4 + LET组的平均调整后SNQ为0.5±2.1（95%CI，0.4 - 4.6），ST4组为5.9±3.7（95%CI，4.7 - 7.0）（P = 0.0297）。ST4 + LET组胫骨隧道平均增宽为73.7%±42.2%，ST4组为77.5%±46.7%（P = 0.5685）。ST4 + LET组中提示移植物成熟度更好的豪厄尔I级在统计学上更常见（P = 0.0379）。两组间在移植物愈合方面未见统计学显著差异（P = 0.1663）。ST4 + LET组的Lysholm评分在统计学上更高（P = 0.0058）。两组间在国际膝关节文献委员会主观评分（P = 0.2683）或特格纳评分（P = 0.7428）方面未发现显著差异。LET移植物在1年随访时的平均SNQ为2.6±4.9。
结论
术后1年时，ACL移植物与LET联合使用时，MRI表现显示出总体上更好的整合和成熟度。
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