Patro Bishnu Prasad, Patra Saroj Kumar, Das Gurudip, Jeyaraman Naveen, Jeyaraman Madhan
Department of Orthopaedics, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India.
Department of Trauma and Emergency Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India.
J Orthop Case Rep. 2024 Jul;14(7):172-178. doi: 10.13107/jocr.2024.v14.i07.4618.
Anterior cruciate ligament (ACL) reconstruction is a common orthopedic procedure, employing various grafts such as the hamstring tendon, bone-patellar bone, and quadriceps tendon. Fixation methods include suspensory loop with button, interferential screw, and cortical fixation. The optimal screw diameter for tibial tunnel fixation remains undefined, with choices ranging from 1mm smaller to 1-2 mm larger than the tunnel diameter. Screw-related complications such as breakage and thread flattening are concerns. This study was to determine the ideal screw diameter for secure graft fixation in the tibial tunnel during ACL reconstruction.
A novel arthroscopic probe technique was utilized to assess tibial tunnel bone integrity. Bone quality was categorized into weak, strong, and very strong. Screw size selection, either equal to or 1-2 mm larger than the tunnel diameter, was based on bone quality. Screw lengths varied from 25 mm to 35 mm.
The novel technique significantly reduced screw-related complications, from 9.6% (24 out of 248 patients) to 0.5% (l out of 187 patients). The need for additional cortical stabilization decreased from 14.5% (36 out of248 patients) to 1.6% (3 out of 187 patients).
The low-cost, efficient 2-min probe test is a secure and effective method for selecting interferential screws in ACL reconstruction, minimizing complications, and additional stabilization needs.
前交叉韧带（ACL）重建是一种常见的骨科手术，采用多种移植物，如腘绳肌腱、髌腱骨和股四头肌肌腱。固定方法包括纽扣悬吊环、干涉螺钉和皮质固定。胫骨隧道固定的最佳螺钉直径仍未明确，选择范围从比隧道直径小1毫米到比隧道直径大1 - 2毫米。诸如螺钉断裂和螺纹变平之类的与螺钉相关的并发症令人担忧。本研究旨在确定ACL重建过程中在胫骨隧道内实现移植物牢固固定的理想螺钉直径。
采用一种新型关节镜探头技术评估胫骨隧道的骨完整性。骨质量分为弱、强和非常强三类。根据骨质量选择与隧道直径相等或比隧道直径大1 - 2毫米的螺钉尺寸。螺钉长度从25毫米到35毫米不等。
该新技术显著降低了与螺钉相关的并发症，从9.6%（248例患者中的24例）降至0.5%（187例患者中的1例）。额外进行皮质稳定的需求从14.5%（248例患者中的36例）降至1.6%（187例患者中的3例）。
这种成本低廉、高效的2分钟探头测试是ACL重建中选择干涉螺钉的一种安全有效的方法，可将并发症及额外稳定需求降至最低。
