Tachibana Yuta, Tanaka Yoshinari, Kinugasa Kazutaka, Mae Tatsuo, Horibe Shuji
Department of Sports Orthopaedics, Osaka Rosai Hospital, Sakai, Japan.
Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Japan.
Orthop J Sports Med. 2021 Jan 29;9(1):2325967120977834. doi: 10.1177/2325967120977834. eCollection 2021 Jan.
There exists little information in the relevant literature regarding tunnel enlargement after posterior cruciate ligament (PCL) reconstruction (PCLR).
To sequentially evaluate tunnel enlargement and radiographic posterior laxity through double-bundle PCLR using autologous hamstring tendon grafts.
Case series; Level of evidence, 4.
We prospectively analyzed 13 patients who underwent double-bundle PCLR for an isolated PCL injury. Three-dimensional computed tomography images were obtained at 3 weeks, 6 months, and 1 year postoperatively, and the tunnel enlargement was calculated by sequentially comparing the cross-sectional areas of the bone tunnels. We also sequentially measured radiographic posterior laxity. The correlation between the tunnel enlargement ratio and the postoperative increase in posterior laxity was evaluated.
The cross-sectional area at the aperture in each tunnel significantly increased from 3 weeks to 6 months ( < .003), but it did not continue doing so thereafter. The 6-month tunnel enlargement ratios of the femoral anterolateral tunnel, the femoral posteromedial tunnel, the tibial anterolateral tunnel, and the tibial posteromedial tunnel were 31.6% ± 23.5%, 90.3% ± 54.7%, 30.5% ± 26.8%, and 49.6% ± 37.0%, respectively, while the corresponding ratios at 1 year were 28.1% ± 19.8%, 83.1% ± 56.9%, 26.8% ± 32.8%, and 47.6% ± 39.0%, respectively. The posterior laxity was 9.0 ± 4.0 mm, -1.5 ± 2.3 mm, 3.4 ± 2.0 mm, and 3.9 ± 1.9 mm, preoperatively, immediately after surgery, 6 months and 1 year postoperatively, respectively. From the immediate postoperative period, the posterior laxity significantly increased at 6 months postoperatively ( < .001), but it did not thereafter. The postoperative increase in posterior laxity had a significant positive correlation with the anterolateral tunnel enlargement ratio in both femoral and tibial tunnels at 6 months (ρ = 0.571-0.699; = .011-.041) and 1 year (ρ = 0.582-0.615; = .033-.037).
Tunnel enlargement after PCLR mainly occurred within 6 months, with no progression thereafter. The anterolateral tunnel enlargement positively correlated with postoperative increase in posterior laxity.
相关文献中关于后交叉韧带（PCL）重建（PCLR）后隧道扩大的信息很少。
通过使用自体腘绳肌腱移植物的双束PCLR，序贯评估隧道扩大情况和影像学后向松弛度。
病例系列；证据等级，4级。
我们前瞻性分析了13例因孤立性PCL损伤接受双束PCLR的患者。在术后3周、6个月和1年获取三维计算机断层扫描图像，并通过序贯比较骨隧道的横截面积来计算隧道扩大情况。我们还序贯测量影像学后向松弛度。评估隧道扩大率与术后后向松弛度增加之间的相关性。
每个隧道开口处的横截面积从3周时到6个月时均显著增加（P <.003），但此后未继续增加。股骨前外侧隧道、股骨后内侧隧道、胫骨前外侧隧道和胫骨后内侧隧道在6个月时的隧道扩大率分别为31.6%±23.5%、90.3%±54.7%、30.5%±26.8%和49.6%±37.0%，而在1年时相应的比率分别为28.1%±19.8%、83.1%±56.9%、26.8%±32.8%和47.6%±39.0%。术前、术后即刻、术后6个月和1年时的后向松弛度分别为9.0±4.0mm、-1.5±2.3mm、3.4±2.0mm和3.9±1.9mm。从术后即刻开始，后向松弛度在术后6个月时显著增加（P <.001），但此后未再增加。术后后向松弛度的增加与股骨和胫骨隧道在6个月时（ρ = 0.571 - 0.699；P =.011 -.041）和1年时（ρ = 0.582 - 0.615；P =.033 -.037）的前外侧隧道扩大率均呈显著正相关。
PCLR后隧道扩大主要发生在6个月内，此后无进展。前外侧隧道扩大与术后后向松弛度增加呈正相关。
