在采用带悬吊式股骨固定的骨-髌腱-骨自体移植物进行前交叉韧带重建时，关节处骨栓深度增加会加大隧道扩大程度。
Increased Bone Plug Depth From the Joint Increases Tunnel Enlargement in Anterior Cruciate Ligament Reconstruction Using Bone-Patellar Tendon-Bone Autograft With Suspensory Femoral Fixation.
作者信息
Kurihara Shingo, Yanagisawa Shinya, Takahashi Tsuneari, Hagiwara Keiichi, Hatayama Kazuhisa, Takase Ryota, Kimura Masashi, Chikuda Hirotaka
机构信息
Department of Orthopaedic Surgery, Zenshukai Hospital Gunma Sports Medicine Research Center, Gunma, Japan.
Department of Orthopaedic Surgery, Ishibashi General Hospital, Shimokoyama, Japan.
出版信息
Arthrosc Sports Med Rehabil. 2023 Jul 22;5(4):100755. doi: 10.1016/j.asmr.2023.100755. eCollection 2023 Aug.
PURPOSE
To determine a safe bone plug depth fixation zone based on early tunnel enlargement rates in anterior cruciate ligament (ACL) reconstruction using bone-patellar tendon-bone (BPTB) autograft with suspensory femoral fixation.
METHODS
Patients who had undergone rectangular tunnel ACL reconstruction using BPTB autograft with suspensory femoral fixation were retrospectively identified. Femoral and tibial tunnel aperture areas were measured on computed tomography 2 weeks and 6 months after surgery to calculate rates of femoral and tibial tunnel enlargement (FTE and TTE), respectively. Femoral bone plug depth (FBPD) and tibial bone plug depth (TBPD) were defined as the distance of the tip of the plug from the respective joint lines. Optimal FBPD and TBPD cutoff values were calculated for the following rates of FTE and TTE, respectively: 0%, 15%, 30%, and 50%.
RESULTS
Sixty-four patients (19 females, 45 males; mean age, 29.5 ± 12.3 years) were included in the study. The femoral and tibial tunnel apertures significantly enlarged over time. FBPD ( < .001; = 0.607) and TBPD ( = .013; = 0.308) were positively correlated with FTE and TTE, respectively. The optimal FBPD cutoff value was 2.8 mm for FTE rates of 0% and 15%, 3.6 mm for 30%, and 6.0 mm for 50%. The optimal TBPD cutoff value was 1.48 mm for a 0% TTE rate and 5.1 mm for those higher. The cutoff value specificities were lower for the tibial tunnel than the femoral tunnel for each tunnel enlargement rate.
CONCLUSION
Early tunnel enlargement and bone plug depth were significantly correlated in bone the femoral and tibial tunnels. The degree of correlation was higher in the femoral tunnel. To minimize bone tunnel enlargement, the distal end of the femoral bone plug should be placed less than 2.8 mm from the tunnel aperture.
LEVEL OF EVIDENCE
Level IV, therapeutic case series.
目的
基于采用带悬吊股骨固定的自体骨-髌腱-骨（BPTB）进行前交叉韧带（ACL）重建时早期隧道扩大率，确定一个安全的骨栓深度固定区域。
方法
回顾性纳入接受采用带悬吊股骨固定的BPTB自体移植物进行矩形隧道ACL重建的患者。在术后2周和6个月时通过计算机断层扫描测量股骨和胫骨隧道孔径面积，分别计算股骨和胫骨隧道扩大率（FTE和TTE）。股骨骨栓深度（FBPD）和胫骨骨栓深度（TBPD）定义为骨栓尖端距各自关节线的距离。分别针对以下FTE和TTE率计算最佳FBPD和TBPD临界值：0%、15%、30%和50%。
结果
64例患者（19例女性，45例男性；平均年龄29.5±12.3岁）纳入研究。股骨和胫骨隧道孔径随时间显著扩大。FBPD（<.001；=0.607）和TBPD（=.013；=0.308）分别与FTE和TTE呈正相关。FTE率为0%和15%时，最佳FBPD临界值为2.8 mm；30%时为3.6 mm；50%时为6.0 mm。TTE率为0%时，最佳TBPD临界值为1.48 mm；更高TTE率时为5.1 mm。对于每个隧道扩大率，胫骨隧道的临界值特异性低于股骨隧道。
结论
股骨和胫骨隧道早期隧道扩大与骨栓深度显著相关。股骨隧道的相关程度更高。为使骨隧道扩大最小化，股骨骨栓远端应放置在距隧道孔径小于2.8 mm处。
证据水平
IV级，治疗性病例系列。
Zotero 插件