Götschi Tobias, Hodel Sandro, Kühne Nathalie, Bachmann Elias, Li Xiang, Zimmermann Stefan M, Snedeker Jess G, Fucentese Sandro F
Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
Institute for Biomechanics, ETH Zurich, Zurich, Switzerland.
Orthop J Sports Med. 2023 Jun 5;11(6):23259671231174478. doi: 10.1177/23259671231174478. eCollection 2023 Jun.
Bone tunnel enlargement after single-bundle anterior cruciate ligament reconstruction remains an unsolved problem that complicates revision surgery.
Positioning of an osteoconductive scaffold at the femoral tunnel aperture improves graft-to-bone incorporation and thereby decreases bone tunnel widening.
Randomized controlled trial; Level of evidence, 1.
In a 1:1 ratio, 56 patients undergoing primary anterior cruciate ligament reconstruction were randomized to receive femoral fixation with cortical suspension fixation and secondary press-fit fixation at the tunnel aperture of the tendon graft only (control) or with augmentation by an osteoconductive scaffold (intervention). Adverse events, patient-reported outcomes, and passive knee stability were recorded over 2 years after the index surgery. Three-dimensional bone tunnel widening was assessed using computed tomography at the time of surgery and 4.5 months and 1 year postoperatively.
The intervention group exhibited a similar number of adverse events as the control group (8 vs 10; = .775) including 2 partial reruptures in both groups. The approach was feasible, although 1 case was encountered where the osteoconductive scaffold was malpositioned without adversely affecting the patient's recovery. There was no difference between the intervention and control groups in femoral bone tunnel enlargement, as expressed by the relative change in tunnel volume from surgery to 4.5 months (mean ± SD, 36% ± 25% vs 40% ± 25%; = .644) and 1 year (19% ± 20% vs 17% ± 25%; =.698).
Press-fit graft fixation with an osteoconductive scaffold positioned at the femoral tunnel aperture is safe but does not decrease femoral bone tunnel enlargement at postoperative 1 year.
NCT03462823 (ClinicalTrials.gov identifier).
单束前交叉韧带重建术后骨隧道扩大仍是一个未解决的问题，这使翻修手术变得复杂。
在股骨隧道开口处放置骨传导支架可改善移植物与骨的融合，从而减少骨隧道增宽。
随机对照试验；证据等级，1级。
56例行初次前交叉韧带重建的患者按1:1比例随机分为两组，一组仅在肌腱移植物隧道开口处采用皮质悬吊固定和二次压配固定进行股骨固定（对照组），另一组采用骨传导支架增强固定（干预组）。在初次手术后2年内记录不良事件、患者报告的结局和被动膝关节稳定性。在手术时、术后4.5个月和1年使用计算机断层扫描评估三维骨隧道增宽情况。
干预组不良事件数量与对照组相似（8例对10例；P = 0.775），两组均有2例部分再断裂。该方法可行，尽管有1例骨传导支架位置不当，但未对患者恢复产生不利影响。干预组和对照组在股骨骨隧道扩大方面无差异，从手术到4.5个月时隧道体积的相对变化（均值±标准差，36%±25%对40%±25%；P = 0.644）以及到1年时（19%±20%对17%±25%；P = 0.698）均如此。
在股骨隧道开口处放置骨传导支架进行压配移植物固定是安全的，但在术后1年并不能减少股骨骨隧道扩大。
NCT03462823（ClinicalTrials.gov标识符）
