Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
Knee Surg Sports Traumatol Arthrosc. 2021 Nov;29(11):3818-3824. doi: 10.1007/s00167-020-06419-1. Epub 2021 Jan 18.
This study aimed to conduct a multivariate analysis to identify independent factors that predict tibial tunnel widening (TW) after anatomical anterior cruciate ligament (ACL) reconstruction using bone-patellar tendon-bone (BPTB) grafts.
In total, 103 patients who underwent ACL reconstructions using BPTB grafts were included. Tunnel aperture area was measured using three-dimensional computed tomography 1 week and 1 year postoperatively, and the tibial TW was calculated. The patients were divided into group S comprising 58 patients who had tibial TW < 30% and group L comprising 45 patients who had tibial TW > 30%, retrospectively. Using univariate analyses, age, gender, body mass index, Tegner activity scale, the time between injury and surgery, tibial tunnel location, tibial tunnel angle, medial posterior tibial slope, lateral posterior tibial slope, and length of the tendon in the tibial tunnel were compared between two groups. Multivariate regression analysis was conducted to reveal the independent risk factors for the tibial TW among preoperative demographic factors and radiographic parameters that correlated with the tibial TW in the univariate analyses.
Compared with those at 1 week postoperatively, mean tibial tunnel aperture areas were increased by 30.3% ± 26.8% when measured at 1 year postoperatively. The lateral posterior tibial slope was significantly larger (p < 0.001), and the length of the tendon within the tibial tunnel was significantly longer in group L than that in group S (p = 0.03) in the univariate analyses. Multivariate regression analysis showed that the increase in lateral posterior tibial slope (p = 0.001) and the length of the tendon within the tibial tunnel (p = 0.03) were predictors of the tibial TW.
This study showed that increased lateral posterior tibial slope and a longer tendinous portion within the tibial tunnel were independent factors that predicted the tibial TW following anatomical ACL reconstruction with a BPTB graft.
III.
本研究旨在进行多变量分析，以确定使用骨-髌腱-骨（BPTB）移植物进行解剖前交叉韧带（ACL）重建后预测胫骨隧道增宽（TW）的独立因素。
共纳入 103 例使用 BPTB 移植物行 ACL 重建的患者。术后 1 周和 1 年使用三维 CT 测量隧道孔径面积，并计算胫骨 TW。患者被分为 S 组（58 例，胫骨 TW < 30%）和 L 组（45 例，胫骨 TW > 30%）。采用单因素分析比较两组患者的年龄、性别、体重指数、Tegner 活动量表、受伤至手术时间、胫骨隧道位置、胫骨隧道角度、胫骨后内侧倾斜角、胫骨后外侧倾斜角和胫骨隧道内肌腱长度。对术前人口统计学因素和与胫骨 TW 相关的影像学参数进行多变量回归分析，以揭示胫骨 TW 的独立危险因素。
与术后 1 周相比，术后 1 年时胫骨隧道孔径面积平均增加 30.3%±26.8%。L 组的胫骨后外侧倾斜角显著较大（p < 0.001），胫骨隧道内肌腱长度显著较长（p=0.03）。单因素分析显示，胫骨后外侧倾斜角增加（p=0.001）和胫骨隧道内肌腱长度增加（p=0.03）是预测胫骨 TW 的独立因素。
本研究表明，胫骨后外侧倾斜角增加和胫骨隧道内肌腱长度增加是使用 BPTB 移植物进行解剖 ACL 重建后预测胫骨 TW 的独立因素。
III 级。
