Department of Orthopaedic Surgery, Koc University Hospital, Zeytinburnu/Istanbul, Turkey.
Wright-Patterson Medical Center, Wright-Patterson AFB, Ohio, U.S.A.
Arthroscopy. 2021 Jun;37(6):1920-1928. doi: 10.1016/j.arthro.2021.01.066. Epub 2021 Feb 10.
The purpose of this study was to quantitatively evaluate the radiographic outcomes of allograft dowels used in 2-stage revision anterior cruciate ligament reconstruction (ACLR) and to compare the incorporation rates of dowels placed in tibial and femoral tunnels.
Prospective review of patients who underwent 2-stage revision ACLR with allograft bone dowels. Inclusion criteria were tibial/femoral tunnel diameter of ≥14 mm on preoperative computed tomography (CT) or overlapping of prior tunnels with planned tunnels. Second-stage timing was determined based on qualitative dowel integration on CT obtained at ∼3 months after the first stage. Quantitative analysis of incorporation rates was performed with the union ratio (UR) and occupying ratio (OR) on postoperative CT scans.
Twenty-one patients, with a mean (SD) age of 32.1 (11.4; range, 18-50) years, were included. Second-stage procedures were performed at a mean (SD) of 6.5 (2.1; range, 2.4-11.5) months after first-stage revision. All dowels showed no signs of degradation at the host bone/graft junction at the second-stage procedure. The mean (SD) diameter of the dowels placed in tibial tunnels was greater than those placed in femoral tunnels (16.1 [2.3] mm vs 12.4 [1.6] mm; P < .05). CT was obtained at a mean (SD) of 121 (28; range, 59-192) days after the first-stage surgery. There was no difference between the OR of femoral and tibial tunnels (mean [SD], 87.6% [4.8%] vs 85.7% [10.1%]; P = .484), but the UR was significantly higher in femoral tunnels (mean [SD], 83% [6.2%] vs 74% [10.5%], P = .005). The intraclass correlation coefficients of OR and UR measurements indicated good reliability.
Allograft bone dowels are a viable graft choice to replenish bone stock in the setting of a staged revision ACL reconstruction. Allograft dowels placed in femoral tunnels had a higher healing union ratio than tibial tunnel allografts and no evidence of degradation at the bone/graft junction, with no difference seen in occupying ratio.
Level IV, case series.
本研究旨在定量评估同种异体骨栓在 2 期翻修前交叉韧带重建（ACLR）中的影像学结果，并比较放置在胫骨和股骨隧道中的栓的融合率。
对接受同种异体骨栓 2 期翻修 ACLR 的患者进行前瞻性回顾。纳入标准为术前 CT 显示胫骨/股骨隧道直径≥14mm，或计划隧道与既往隧道重叠。第二期手术时机根据第一期手术后约 3 个月 CT 上栓的定性融合来确定。术后 CT 扫描采用融合比（UR）和占据比（OR）进行定量分析。
21 例患者，平均（SD）年龄 32.1（11.4；范围，18-50）岁。第二期手术在第一期翻修后平均（SD）6.5（2.1；范围，2.4-11.5）个月进行。所有栓在第二期手术时在宿主骨/移植物交界处均未见降解迹象。胫骨隧道中放置的栓的平均（SD）直径大于股骨隧道中的栓（16.1[2.3]mm 比 12.4[1.6]mm；P<0.05）。CT 于第一期手术后平均（SD）121（28；范围，59-192）天获得。股骨和胫骨隧道的 OR 无差异（平均[SD]，87.6%[4.8%]比 85.7%[10.1%]；P=0.484），但股骨隧道的 UR 明显较高（平均[SD]，83%[6.2%]比 74%[10.5%]，P=0.005）。OR 和 UR 测量的组内相关系数表明具有良好的可靠性。
同种异体骨栓是分期翻修 ACLR 中补充骨量的可行移植物选择。与胫骨隧道同种异体骨相比，股骨隧道中的同种异体骨栓具有更高的愈合融合率，且在骨/移植物交界处未见降解迹象，而占据比无差异。
IV 级，病例系列。
