Sakamoto Takuya, Horii Manato, Watanabe Shotaro, Ito Ryu, Akagi Ryuichiro, Hosokawa Hiroaki, Kimura Seiji, Yamaguchi Satoshi, Ohtori Seiji, Sasho Takahisa
Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, JPN.
Center for Preventive Medical Sciences, Chiba University, Chiba, JPN.
Cureus. 2024 Jul 11;16(7):e64357. doi: 10.7759/cureus.64357. eCollection 2024 Jul.
Introduction Restoring knee joint stability and resuming sports activities are important objectives of anterior cruciate ligament (ACL) reconstruction. The maintenance of anterior knee stability after ACL reconstruction is contingent on graft tension. Various devices and techniques have been used to achieve robust tibial graft tendon fixation, and their advantages and disadvantages are established. However, a gold standard has not been established. Therefore, we aimed to determine whether anterior knee joint stability and clinical outcomes of graft tendon fixation could be improved using a recently modified suture button (MSB) compared with using an adjustable suspensory fixator (ASF) at 1 year after double-bundle ACL reconstruction. Methods This study retrospectively analyzed postoperative data derived from 79 patients at a single center between January 2016 and December 2021. The patients were assigned to groups that underwent double-bundle ACL reconstruction with tibial fixation using an MSB (n = 30) that maintains tension while tying sutures, or an ASF (n = 49). We then compared complications, clinical outcomes and knee joint stability at 1 year postoperatively. Rates of postoperative infection, graft rupture, implant removal and residual anterior knee laxity (AKL) were compared between the groups using chi-square tests. Patient-reported outcome measures (PROM) based on Forgot Joint Score-12, Knee Injury and Osteoarthritis Outcome, and Lysholm Knee scores were compared using Mann-Whitney U tests. Results One patient in the MSB group developed postoperative infection. Rates of graft rupture and implant removal in the MSB and ASF groups were 3.3% and 4.1%, and 3.6% and 10.2%, respectively. None of the PROMs differed between the groups. The proportions of postoperative AKL were 3.6% and 14.9% in the MSB and ASF groups, respectively. A trend towards lower postoperative AKL in the MSB group did not reach statistical significance (p = 0.25). Conclusions The incidence of AKL at a year after ACL reconstruction using the MSB was 3%. Postoperative AKL and clinical outcomes were comparable between the MSB and ASF groups. A low AKL rate and positive postoperative outcomes indicated that MSB could be an option for tibial-side fixation in ACL reconstruction.
引言 恢复膝关节稳定性和恢复体育活动是前交叉韧带（ACL）重建的重要目标。ACL重建后膝关节前侧稳定性的维持取决于移植物张力。已使用各种装置和技术来实现强大的胫骨移植物肌腱固定，其优缺点已明确。然而，尚未确立金标准。因此，我们旨在确定与双束ACL重建术后1年使用可调式悬吊固定器（ASF）相比，使用最近改良的缝线纽扣（MSB）是否能改善膝关节前侧稳定性和移植物肌腱固定的临床结果。
方法 本研究回顾性分析了2016年1月至2021年12月期间单个中心79例患者的术后数据。患者被分为两组，一组接受使用在打结缝线时能维持张力的MSB进行胫骨固定的双束ACL重建（n = 30），另一组接受ASF进行胫骨固定的双束ACL重建（n = 49）。然后我们比较了术后1年时的并发症、临床结果和膝关节稳定性。使用卡方检验比较两组之间的术后感染率、移植物破裂率、植入物取出率和残余膝关节前侧松弛度（AKL）。使用曼-惠特尼U检验比较基于遗忘关节评分-12、膝关节损伤和骨关节炎结果以及Lysholm膝关节评分的患者报告结局指标（PROM）参数。
结果 MSB组有1例患者发生术后感染。MSB组和ASF组的移植物破裂率和植入物取出率分别为3.3%和4.1%，以及3.6%和10.2%。两组之间的任何PROM参数均无差异。MSB组和ASF组术后AKL的比例分别为3.6%和14.9%。MSB组术后AKL较低的趋势未达到统计学意义（p = 0.25）。
结论 使用MSB进行ACL重建术后1年时AKL的发生率为3%。MSB组和ASF组术后AKL和临床结果具有可比性。低AKL率和良好的术后结果表明，MSB可作为ACL重建中胫骨侧固定的一种选择。
