Perry Allison K, Dandu Navya, Knapik Derrick M, Inoue Nozomu, Gursoy Safa, Bush-Joseph Charles A, Yanke Adam B, Chahla Jorge
Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA.
Orthop J Sports Med. 2022 May 6;10(5):23259671221093685. doi: 10.1177/23259671221093685. eCollection 2022 May.
Patellar fracture after quadriceps tendon (QT) autograft harvest for anterior cruciate ligament reconstruction (ACLR) has been reported in up to 8.8% of patients.
To determine the thickness of the remaining patellar bone across the QT graft harvest location while providing clinical guidance for safely harvesting a patellar bone block when using a QT graft in ACLR.
Descriptive laboratory study.
Medial and lateral QT graft boundaries were marked using a bone saw on 13 cadaveric patellae, and 3-dimensional computed tomography models were created. After the harvest of a virtual bone block with a maximum depth of 10 mm, the thickness of the remaining bone was measured across the graft harvest location in 9 zones. The thickness of the remaining bone was analyzed according to zone, graft harvest location, and patellar facet length. Risk zones were defined as <50% total patellar depth remaining.
We observed substantial variability in QT bone block harvest location, in which the distance between the lateral boundary of the harvest location and the lateral patellar cortex was from 21.2% to 49.2% of the axial patellar width. There was significantly less bone remaining in the lateral columns (mean ± SD, 7.56 ± 2.19 mm) compared with the medial columns (9.83 ± 2.10 mm) of the graft harvest location ( = .028). The number of risk zones was significantly associated with distance to the lateral cortical edge, with an increase in 0.59 zones with every 1-mm decrease in distance to the lateral cortex edge ( = -0.585; = 0.620; = .001). With every 1-mm increase in the distance of the lateral cortex to the lateral graft boundary, the thickness of bone remaining in the lateral column increased by 0.412 mm ( < .001). No risk zones were encountered when the lateral boundary of the harvest location was created 18.9 mm from the lateral edge of the patella or 43% of the total patellar width from the lateral edge.
Harvest of a more laterally based QT autograft bone block resulted in thinner remaining patellar thickness, increasing the potential of encountering a risk zone for fracture.
Care should be taken to avoid harvesting the patellar bone block too laterally during ACLR.
据报道，在进行前交叉韧带重建（ACLR）采用股四头肌肌腱（QT）自体移植时，髌骨骨折发生率高达8.8%。
确定在QT移植物取材部位剩余髌骨骨的厚度，同时为在ACLR中使用QT移植物安全获取髌骨骨块提供临床指导。
描述性实验室研究。
使用骨锯在13具尸体髌骨上标记QT移植物的内侧和外侧边界，并创建三维计算机断层扫描模型。在获取一个最大深度为10mm的虚拟骨块后，在9个区域测量移植物取材部位剩余骨的厚度。根据区域、移植物取材部位和髌骨关节面长度分析剩余骨的厚度。风险区域定义为剩余髌骨总深度小于50%。
我们观察到QT骨块取材部位存在很大差异，取材部位外侧边界与髌骨外侧皮质之间的距离为髌骨轴向宽度的21.2%至49.2%。与移植物取材部位的内侧柱（9.83±2.10mm）相比，外侧柱剩余骨明显更少（平均±标准差，7.56±2.19mm）（P = 0.028）。风险区域的数量与到外侧皮质边缘的距离显著相关，到外侧皮质边缘的距离每减少1mm，风险区域数量增加0.59个（r = -0.585；P = 0.620；P = 0.001）。随着外侧皮质到外侧移植物边界的距离每增加1mm，外侧柱剩余骨的厚度增加0.412mm（P < 0.001）。当取材部位的外侧边界距离髌骨外侧边缘18.9mm或距离髌骨外侧边缘为髌骨总宽度的43%时，未遇到风险区域。
获取更偏外侧的QT自体移植骨块会导致剩余髌骨厚度变薄，增加发生骨折风险区域的可能性。
在ACLR期间应注意避免过于偏外侧获取髌骨骨块。
