Daniel Sam James, Timothy Jozy, Kandagaddala Madhavi, Reka K, Poonnoose Pradeep Mathew, Oommen Anil Thomas
Department of Orthopaedics, Unit 2, Christian Medical College, Vellore, Tamil Nadu, 632004, India.
Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, 632004, India.
J Clin Orthop Trauma. 2023 Dec 30;48:102331. doi: 10.1016/j.jcot.2023.102331. eCollection 2024 Jan.
Tunnel widening after Anterior cruciate ligament (ACL) reconstruction using a hamstring graft is known to occur at follow-up. Our study aimed to investigate the effect of suspensory fixation augmentation using an interference screw on tunnel widening in single-bundle hamstring ACL reconstruction.
48 patients who had single bundle ACL reconstruction with femoral fixed loop fixation technique in 15 knees, and, fixed loop with augmented aperture (bio screw) fixation in 33 knees were analyzed. The width of the tunnel was measured using radiographs immediate post-op and at follow-up within 1 year. Computerized Tomogram (CT) measurements of the tunnels and functional scores were also done with overall follow-up for the fixed loop group being 21.33 months (Standard Deviation (SD)11.14) and the Augmentation group 9.12 months (SD 3.83).
Midpoint femur tunnel widening was reduced in the augmentation group, with measurements of 0.74 (SD 1.05) mm Antero Posterior (AP) and 1.01 (SD 1.04) mm in the Lateral view, compared to 1.54 (SD 1.48) mm AP and 1.79 (SD1.47 mm) in the Lateral for the fixed button group. The radiological widening was considerably less in the augmentation group with a p-value of 0.07. AP aperture widening in the augmentation group was 1.25(SD 1.10 mm), and 1.09(SD0.98) mm in the lateral view. The fixed button-only group measured 1.53 (SD1.30) mm in the AP, and 1.65 (SD 1.29) mm in the lateral view, both of which were not statistically significant. The follow-up Lysholm and International Knee Documentation Committee (IKDC) scores were similar for the 2 groups.
Femoral tunnel midpoint and aperture widening were reduced with the fixed loop with aperture (bio screw) augmentation technique for hamstring grafts in single bundle ACL fixation within 1 year with comparable functional scores.
使用腘绳肌移植物进行前交叉韧带（ACL）重建后，随访时已知会出现隧道增宽。我们的研究旨在探讨使用干涉螺钉进行悬吊固定增强对单束腘绳肌ACL重建中隧道增宽的影响。
分析48例患者，其中15例膝关节采用股骨固定环固定技术进行单束ACL重建，33例膝关节采用带扩大孔径（生物螺钉）固定的固定环进行重建。术后即刻及1年内随访时，使用X线片测量隧道宽度。还对隧道进行了计算机断层扫描（CT）测量并评估功能评分，固定环组的总体随访时间为21.33个月（标准差（SD）11.14），增强组为9.12个月（SD 3.83）。
增强组股骨隧道中点增宽减少，前后位（AP）测量为0.74（SD 1.05）mm，侧位为1.01（SD 1.04）mm，而固定纽扣组AP为1.54（SD 1.48）mm，侧位为1.79（SD 1.47）mm。增强组的放射学增宽明显较小，p值为0.07。增强组AP孔径增宽为1.25（SD 1.10）mm，侧位为1.09（SD 0.98）mm。仅固定纽扣组AP为1.53（SD 1.30）mm，侧位为1.65（SD 1.29）mm，两者均无统计学意义。两组的随访Lysholm和国际膝关节文献委员会（IKDC）评分相似。
采用带孔径（生物螺钉）增强技术的固定环进行单束ACL固定腘绳肌移植物时，1年内股骨隧道中点和孔径增宽减少，功能评分相当。
4级。
