可调式皮质骨悬吊固定重建 ACL 后胫骨隧道扩大与四股移植物成熟无相关性。
Tibial tunnel expansion does not correlate with four-strand graft maturation after ACL reconstruction using adjustable cortical suspensory fixation.
机构信息
MD, Sports Clinic of Bordeaux-Merignac, Merignac, France.
MB BS FRCS (Tr and Orth) MS, Knee Specialists, Bristol, UK.
出版信息
Knee Surg Sports Traumatol Arthrosc. 2023 May;31(5):1761-1770. doi: 10.1007/s00167-022-07051-x. Epub 2022 Jul 25.
PURPOSE
Anterior cruciate ligament reconstruction (ACLR) using a short, quadrupled semitendinosus (ST-4) autograft, fixed with an adjustable suspensory fixation (ASF), has several potential advantages. However, the construct is suspected to generate micromotion, tunnel widening and poor graft maturation. The aim of this study was to evaluate post-operative tibial tunnel expansion, graft maturation and clinical outcomes for this type of ACLR.
METHODS
One-hundred and forty-nine patients were reviewed at a minimum of 2 years following 4-ST ACLR, mean 25.6 ± 3.5 months [24-55], with clinical follow-up and MRI scans. Graft maturity of the intra-articular part of the graft and the tibial tunnel portion was assessed using Signal-to-Noise Quotient (SNQ) and Howell score. Tibial tunnel expansion, bone-graft contact and graft volume in the tibial tunnel were calculated from the MRI scans.
RESULTS
Mean tibial tunnel expansion was 13 ± 16.5% [12-122]. Mean SNQ for graft within the tibial tunnel was 3.8 ± 7.1 [ - 7.7 to 39] and 2.0 ± 3.5 [ - 14 to 17] for the intra-articular portion of the graft. The Howell score for graft within the tibial tunnel was 41% Grade I, 37% Grade 2, 20% Grade 3, 2% grade 4, and for the intra-articular part 61% Grade 1, 26% Grade 2, 13% Grade 3 and 1% Grade 4. The mean tibial tunnel bone-graft contact was 81 ± 23% [0-100] and mean graft volume was 80 ± 22% [0-100]. No correlation was found between tibial tunnel expansion and graft maturity assessed at both locations. Graft maturity was correlated with higher graft-bone contact and graft volume in the tibial tunnel (p < 0.05).
CONCLUSIONS
ST-4 ACLR with ASF had low levels of tunnel enlargement at 2 years. No correlation was found between graft maturation and tibial tunnel expansion. Graft maturity was correlated with graft-bone contact and graft volume in the tibial tunnel.
LEVEL OF EVIDENCE
Level III.
目的
使用短的、四倍化的半腱肌（ST-4）自体移植物进行前交叉韧带重建（ACLR），采用可调节悬吊固定（ASF）固定，具有几个潜在的优势。然而，这种结构被怀疑会产生微动、隧道增宽和移植物成熟不良。本研究旨在评估这种 ACLR 术后胫骨隧道扩张、移植物成熟和临床结果。
方法
149 例患者在 4-ST ACLR 后至少 2 年进行了回顾性分析，平均 25.6 ± 3.5 个月[24-55]，进行了临床随访和 MRI 扫描。使用信噪比（SNQ）和豪威尔评分评估移植物关节内部分和胫骨隧道部分的成熟度。从 MRI 扫描中计算胫骨隧道扩张、骨-移植物接触和胫骨隧道内移植物体积。
结果
平均胫骨隧道扩张率为 13 ± 16.5%[12-122]。SNQ 平均值为 3.8 ± 7.1[−7.7 至 39]，关节内部分的 SNQ 平均值为 2.0 ± 3.5[−14 至 17]。胫骨隧道内移植物的豪威尔评分 41%为 1 级，37%为 2 级，20%为 3 级，2%为 4 级，关节内部分 61%为 1 级，26%为 2 级，13%为 3 级，1%为 4 级。胫骨隧道内骨-移植物的平均接触率为 81 ± 23%[0-100]，移植物体积平均为 80 ± 22%[0-100]。胫骨隧道扩张与两个部位的移植物成熟度之间无相关性。移植物成熟度与胫骨隧道内较高的移植物-骨接触率和移植物体积呈正相关（p<0.05）。
结论
ST-4 ACLR 采用 ASF 术后 2 年隧道扩大程度较低。移植物成熟度与胫骨隧道扩张无相关性。移植物成熟度与胫骨隧道内的移植物-骨接触率和移植物体积呈正相关。
证据水平
III 级。
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