Orthopaedic Department, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
Arch Orthop Trauma Surg. 2023 Apr;143(4):1923-1930. doi: 10.1007/s00402-022-04408-2. Epub 2022 Mar 14.
There is no evidence on screw diameter with regards to tunnel size in anterior cruciate ligament reconstruction (ACLR) using hybrid fixation devices. The hypothesis was that an undersized tunnel coverage by the tibial screw leads to subsequent tunnel enlargement in ACLR in hybrid fixation technique.
In a retrospective case series, radiographs and clinical scores of 103 patients who underwent primary hamstring tendon ACLR with a hybrid fixation technique at the tibial site (interference screw and suspensory fixation) were obtained. Tunnel diameters in the frontal and sagittal planes were measured on radiographs 6 weeks and 12 months postoperatively. Tunnel enlargement of more than 10% between the two periods was defined as tunnel widening. Tunnel coverage ratio was calculated as the tunnel diameter covered by the screw in percentage.
Overall, tunnel widening 12 months postoperatively was 23.1 ± 17.1% and 24.2 ± 18.2% in the frontal and sagittal plane, respectively. Linear regression analysis revealed the tunnel coverage ratio to be a negative predicting risk factor for tunnel widening (p = 0.001). The ROC curve analysis provided an ideal cut-off for tunnel enlargement of > 10% at a tunnel coverage ratio of 70% (sensitivity 60%, specificity 81%, AUC 75%, p < 0.001). Patients (n = 53/103) with a tunnel coverage ratio of < 70% showed significantly higher tibial tunnel enlargement of 15% in the frontal and sagittal planes. The binary logistic regression showed a significant OR of 6.9 (p = 0.02) for tunnel widening > 10% in the frontal plane if the tunnel coverage ratio was < 70% (sagittal plane: OR 14.7, p = 0.001). Clinical scores did not correlate to tunnel widening.
Tibial tunnel widening was affected by the tunnel diameter coverage ratio. To minimize the likelihood of disadvantageous tunnel expansion-which is of importance in case of revision surgery-an interference screw should not undercut the tunnel diameter by more than 1 mm.
在使用混合固定装置进行前交叉韧带重建（ACL）时，没有关于螺钉直径与隧道大小的证据。假设胫骨螺钉覆盖的隧道尺寸较小会导致混合固定技术中 ACLR 后续隧道扩大。
在一项回顾性病例系列研究中，我们获得了 103 例采用混合固定技术（干扰螺钉和悬吊固定）进行初次腘绳肌腱 ACLR 的患者的影像学和临床评分。术后 6 周和 12 个月时，在 X 线片上测量了额状面和矢状面的隧道直径。如果两个时间段之间的隧道扩大超过 10%，则定义为隧道增宽。计算螺钉覆盖的隧道百分比作为隧道覆盖率。
总体而言，术后 12 个月时，额状面和矢状面的隧道增宽分别为 23.1±17.1%和 24.2±18.2%。线性回归分析显示，隧道覆盖率是隧道增宽的负预测风险因素（p=0.001）。ROC 曲线分析提供了一个理想的隧道扩大>10%的截断值，即隧道覆盖率为 70%（敏感性 60%，特异性 81%，AUC 75%，p<0.001）。隧道覆盖率<70%的患者（n=53/103）的胫骨隧道增宽明显更高，分别为额状面和矢状面 15%。二元逻辑回归显示，如果隧道覆盖率<70%，则隧道覆盖率与额状面隧道增宽>10%显著相关（OR 6.9，p=0.02）（矢状面：OR 14.7，p=0.001）。临床评分与隧道增宽无关。
胫骨隧道增宽受隧道直径覆盖率的影响。为了最大限度地减少不利隧道扩张的可能性-这在翻修手术中很重要-干扰螺钉不应切入隧道直径超过 1 毫米。
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