Department of Orthopedic Surgery, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto, Nagano, 390-8621, Japan.
Department of Rehabilitation, Shinshu University Hospital, 3-1-1, Asahi, Matsumoto, Nagano, 390-8621, Japan.
Knee Surg Sports Traumatol Arthrosc. 2023 Jun;31(6):2394-2405. doi: 10.1007/s00167-022-07180-3. Epub 2022 Oct 1.
To investigate the effects of a new remnant-preserving double-bundle anterior cruciate ligament reconstruction (ACLR) technique, focused on avoiding remnant damage and preserving continuity of remnants, on graft maturity using magnetic resonance imaging (MRI).
A total of 169 patients were divided into three groups: 41 in the preservation group, 70 in the resection group, and 58 in the absent group. In the preservation group, rather than passing the graft through the remnant tissue, the graft was reconstructed such that the anteromedial and posterolateral bundles sandwiched the remnant to avoid damage to the remnant and maintain its continuity. Based on 1-year postoperative MRI, the grafts were divided into three regions: distal, middle, and proximal. The signal/noise quotient (SNQ) of each region of interest was calculated to evaluate the signal intensity of the graft and was compared among the three groups. Additionally, to identify factors influencing graft maturity, a multiple regression analysis was performed with SNQ as the dependent variable and patient demographics, bone morphology, and surgical factors as independent variables.
In a three-group comparison of mean SNQs, the distal region was 3.3 ± 3.4, 8.9 ± 8.3, and 9.0 ± 8.6 (p < 0.001), the middle region was 5.3 ± 3.7, 10.9 ± 11.1, and 11.3 ± 10.2 (p < 0.001), and the proximal region was 6.8 ± 4.5, 11.1 ± 8.8, and 11.7 ± 10.8 (p = 0.017), in order of the preservation, resection, and absent groups, respectively. That indicated that the remnant-preserving ACLR was more hypointense than ACLR with remnant resection or absent in all three regions. Multiple regression analysis showed that remnant preservation remained the relevant factor affecting SNQ of the graft at the distal and middle levels.
The new remnant-preserving anatomic double-bundle ACLR had significantly better graft maturity, measured by SNQ on MRI, than the remnant resection and absent groups. The remnant procedure was the relevant factor affecting graft maturity.
Level III.
通过磁共振成像（MRI）研究一种新的保留残端的双束前交叉韧带重建（ACLR）技术对移植物成熟度的影响，该技术侧重于避免残端损伤和保持残端的连续性。
将 169 例患者分为 3 组：保留组 41 例，切除组 70 例，无残端组 58 例。在保留组中，移植物的重建方式是使前内侧束和后外侧束夹在残端之间，而不是穿过残端组织，以避免残端损伤并保持其连续性。根据术后 1 年的 MRI，将移植物分为 3 个区域：远端、中间和近端。计算每个感兴趣区域的信噪比（SNQ），以评估移植物的信号强度，并比较 3 组之间的 SNQ。此外，为了确定影响移植物成熟度的因素，将 SNQ 作为因变量，患者的人口统计学、骨骼形态和手术因素作为自变量进行多元回归分析。
3 组间平均 SNQ 的比较结果为，远端区域分别为 3.3±3.4、8.9±8.3 和 9.0±8.6（p<0.001），中间区域分别为 5.3±3.7、10.9±11.1 和 11.3±10.2（p<0.001），近端区域分别为 6.8±4.5、11.1±8.8 和 11.7±10.8（p=0.017），即保留组、切除组和无残端组的顺序。这表明在所有 3 个区域，保留残端的 ACLR 比 ACLR 残端切除或无残端的信号强度更低。多元回归分析表明，在远端和中间水平，残端保留仍然是影响移植物 SNQ 的相关因素。
新的保留残端的解剖双束 ACLR 具有更好的移植物成熟度，通过 MRI 上的 SNQ 测量，与残端切除和无残端组相比有显著改善。残端处理是影响移植物成熟度的相关因素。
III 级。
