Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan.
Department of Rehabilitation Medicine, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan.
Knee Surg Sports Traumatol Arthrosc. 2022 Jan;30(1):319-327. doi: 10.1007/s00167-021-06546-3. Epub 2021 Apr 30.
To elucidate the relationship between graft tunnel position and knee laxity in the cases of double-bundle ACL reconstruction.
Total of 132 cases were included. Femoral and tibial tunnels were evaluated by quadrant method on 3D-CT. As additional reference of tibia, the distances from medial tibial spine to the tunnel center (D) and from Parsons' knob to the tunnel center (D) were evaluated; %D/ML and %D/AP were calculated (ML and AP: mediolateral and anteroposterior width of tibial plateau). Preoperative and postoperative (1 year from surgery) stabilities were evaluated by Lachman and pivot-shift procedures. If there was ≥ 2 mm side-to-side difference, the subject was defined as having anterior knee laxity (AKL); if the pivot-shift phenomenon was observed with IKDC grade ≥ 1, there was rotatory knee laxity (RKL). Multiple logistic regression analysis was conducted with the prevalence of AKL or RKL as the dependent variable and with tunnel positions as the independent variables.
Overall, 21 subjects (15.9%) showed AKL, and 15 subjects (11.4%) showed RKL. Those with postoperative laxity showed higher %D/ML and higher femoral position than those without laxity. Regarding posterolateral bundle, logistic regression model estimated that %D/ML was associated with the prevalence of AKL (B = 0.608; p < 0.001) and RKL (B = 0.789; p < 0.001); %high-low femoral tunnel position (B = - 0.127; p = 0.023) was associated with that of RKL.
There was the risk of residual knee laxity in ACL-reconstructed knee when tibial tunnel shifted more laterally or higher femoral tunnel was created with regard to posterolateral bundle.
III.
阐明双束 ACL 重建中移植物隧道位置与膝关节松弛之间的关系。
共纳入 132 例患者。通过三维 CT 对股骨和胫骨隧道进行象限法评估。作为胫骨的附加参考，评估胫骨内髁到隧道中心的距离（D）和 Parsons 结节到隧道中心的距离（D）；计算 %D/ML 和 %D/AP（ML 和 AP：胫骨平台的内外宽度）。通过 Lachman 和枢轴转移试验评估术前和术后（手术 1 年后）的稳定性。如果存在≥2mm 的侧-侧差异，则将患者定义为存在前膝松弛（AKL）；如果观察到枢轴转移现象且 IKDC 分级≥1，则存在旋转性膝松弛（RKL）。将 AKL 或 RKL 的发生率作为因变量，将隧道位置作为自变量进行多因素逻辑回归分析。
总体而言，21 例（15.9%）出现 AKL，15 例（11.4%）出现 RKL。术后出现松弛的患者 %D/ML 较高，股骨位置较高。对于后外侧束，逻辑回归模型估计 %D/ML 与 AKL 的发生率（B=0.608；p<0.001）和 RKL（B=0.789；p<0.001）相关；%高位-低位股骨隧道位置（B=-0.127；p=0.023）与 RKL 的发生率相关。
后外侧束的胫骨隧道向外侧移位或股骨隧道位置较高时，ACL 重建膝关节存在残留膝关节松弛的风险。
III 级。
