Tátrai Miklós, Halasi Tamás, Tállay András, Tátrai Annamária, Pavlik Attila
Department of Orthopedic Surgery, Kastélypark Clinic, Hajdú Street 15., Tata, 2890 Hungary.
Budapest, Hungary.
Indian J Orthop. 2023 Feb 24;57(4):596-602. doi: 10.1007/s43465-023-00836-3. eCollection 2023 Apr.
Femoral tunnel widening after ACL reconstruction is a common phenomenon. We hypothesized that using a patellar tendon graft with a press-fit fixation technique without any fixation device reduces the incidence of femoral tunnel widening.
This study was conducted on 467 patients with ACL surgery between 2003 and 2015. Two hundred and nineteen of them had an ACL surgery with patellar tendon (PT) graft, and two hundred and forty-eight of them with hamstring tendon (HS). Exclusion criteria were history of previous ACL reconstruction of either knee, multiple ligament injury, or evidence of osteoarthritis on radiographs. The femoral tunnels were measured on the anteroposterior (ap) and lateral radiographs 6 months after the operation. Two independent orthopedic surgeons measured all radiographs twice and recorded the tunnel widenings. We hypothesized that using an implant-free press-fit technique with PT graft can reduce the femoral tunnel widening incidence rate.
The mean incidence rate of the tunnel widening in the HS group was, on the AP and the lateral femoral views, 88% ( = 217) and 83% ( = 205), while in the PT group, 17% ( = 37) and 2% ( = 4), respectively. There was a significant difference both on AP and lateral radiographs (HS vs. PT: fem. AP: 89% vs. 17% < 0.001; HS vs. PT: fem. lat: 84% vs. 2% < 0.001).
The femoral tunnel widening incidence rate during an ACL reconstruction is significantly less when using PT tendon with femoral press-fit fixation than when using HT tendon with suspensory fixation method.
前交叉韧带（ACL）重建术后股骨隧道增宽是一种常见现象。我们假设使用髌腱移植物并采用压配固定技术且不使用任何固定装置可降低股骨隧道增宽的发生率。
本研究对2003年至2015年间接受ACL手术的467例患者进行。其中219例采用髌腱（PT）移植物进行ACL手术，248例采用腘绳肌腱（HS）。排除标准为既往有任何一侧膝关节ACL重建史、多发韧带损伤或X线片显示骨关节炎的证据。术后6个月在前后位（ap）和侧位X线片上测量股骨隧道。两名独立的骨科医生对所有X线片测量两次并记录隧道增宽情况。我们假设采用无植入物的PT移植物压配技术可降低股骨隧道增宽的发生率。
HS组在股骨前后位和侧位视图上隧道增宽的平均发生率分别为88%（n = 217）和83%（n = 205），而PT组分别为17%（n = 37）和2%（n = 4）。前后位和侧位X线片均有显著差异（HS组与PT组：股骨前后位：89%对17%，P < 0.001；HS组与PT组：股骨侧位：84%对2%，P < 0.001）。
与采用悬吊固定法使用腘绳肌腱相比，ACL重建术中采用股骨压配固定的PT肌腱时，股骨隧道增宽的发生率显著降低。
