Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, PA, USA.
Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.
Knee Surg Sports Traumatol Arthrosc. 2022 Jan;30(1):61-70. doi: 10.1007/s00167-021-06480-4. Epub 2021 Feb 12.
Lateral extra-articular tenodesis (LET) may confer improved rotational stability after anterior cruciate ligament reconstruction (ACLR). Little is known about how LET affects in vivo cartilage contact after ACLR. The aim of this study was to investigate the effect of LET in combination with ACLR (ACLR + LET) on in vivo cartilage contact kinematics compared to isolated ACLR (ACLR) during downhill running. It was hypothesised that cartilage contact area in the lateral compartment would be larger in ACLR + LET compared with ACLR, and that the anterior-posterior (A-P) position of the contact center on the lateral tibia would be more anterior after ACLR + LET than after ACLR.
Twenty patients were randomly assigned into ACLR + LET or ACLR during surgery (ClinicalTrials.gov:NCT02913404). At 6 months and 12 months after surgery, participants were imaged during downhill running using biplane radiography. Tibiofemoral motion was tracked using a validated registration process. Patient-specific cartilage models, obtained from 3 T MRI, were registered to track bone models and used to calculate the dynamic cartilage contact area and center of cartilage contact in both the medial and lateral tibiofemoral compartments, respectively. The side-to-side differences (SSD) were compared between groups using a Mann-Whitney U test.
At 6 months after surgery, the SSD in A-P cartilage contact center in ACLR + LET (3.9 ± 2.6 mm, 4.4 ± 3.1 mm) was larger than in ACLR (1.2 ± 1.6 mm, 1.5 ± 2.0 mm) at 10% and 20% of the gait cycle, respectively (p < 0.01, p < 0.05). There was no difference in the SSD in cartilage contact center at 12 months after surgery. There was no difference in SSD of cartilage contact area in the medial and lateral compartments at both 6 and 12 months after surgery. There were no adverse events during the trial.
LET in combination with ACLR may affect the cartilage contact center during downhill running in the early post-operation phase, but this effect is lost in the longer term. This suggests that healing and neuromuscular adaptation occur over time and may also indicate a dampening of the effect of LET over time. (337 /350 words) LEVEL OF EVIDENCE: Level II.
外侧骺外腱固定术（LET）可在前交叉韧带重建（ACLR）后提供更好的旋转稳定性。关于 LET 如何影响 ACLR 后关节内软骨接触知之甚少。本研究旨在探讨 LET 联合 ACLR（ACLR+LET）与单独 ACLR（ACLR）相比，在下山跑步时对关节内软骨接触运动学的影响。假设与 ACLR 相比，LET 联合 ACLR（ACLR+LET）后外侧间室的软骨接触面积会更大，并且 LET 联合 ACLR（ACLR+LET）后胫骨外侧的接触中心点的前后（A-P）位置会比 ACLR 更靠前。
20 名患者在手术中被随机分配到 ACLR+LET 或 ACLR（ClinicalTrials.gov：NCT02913404）。术后 6 个月和 12 个月，参与者在下山跑步时使用双平面射线照相进行成像。使用经过验证的配准过程跟踪胫股运动。从 3T MRI 获得的患者特定软骨模型被注册以跟踪骨骼模型，并用于计算内侧和外侧胫股间室的动态软骨接触面积和软骨接触中心点。使用 Mann-Whitney U 检验比较组间的侧间差异（SSD）。
术后 6 个月，ACL+LET 组（10%和 20%步态周期时分别为 3.9±2.6mm 和 4.4±3.1mm）的 ACL+LET（10%和 20%步态周期时分别为 3.9±2.6mm 和 4.4±3.1mm）的 A-P 软骨接触中心点 SSD 大于 ACLR 组（1.2±1.6mm 和 1.5±2.0mm）（p<0.01，p<0.05）。术后 12 个月，软骨接触中心点 SSD 无差异。术后 6 个月和 12 个月，内侧和外侧间室软骨接触面积 SSD 无差异。试验期间无不良事件发生。
LET 联合 ACLR 可能会影响术后早期下坡跑步时的软骨接触中心点，但这种影响在长期内会消失。这表明愈合和神经肌肉适应是随着时间的推移发生的，也可能表明 LET 的影响随着时间的推移而减弱。（337/350 字）证据水平：2 级。
