全软组织股四头肌肌腱自体移植和骨-髌腱-骨自体移植均未显示出明显的前交叉韧带隧道增宽：一项MRI比较。
All-soft tissue quadriceps tendon autograft and bone-patellar tendon-bone autograft demonstrate no significant ACL tunnel widening: An MRI comparison.
作者信息
Ashy Cody C, Lynch Mary-Katherine, Baird Henry B G, Xerogeanes John W, Pullen William, Slone Harris S
机构信息
Department of Orthopaedic Surgery and Physical Medicine, Medical University of South Carolina, Charleston, South Carolina, USA.
College of Medicine, Clinical Science Building, Medical University of South Carolina, Charleston, South Carolina, USA.
出版信息
Knee Surg Sports Traumatol Arthrosc. 2025 Jun;33(6):1959-1966. doi: 10.1002/ksa.12479. Epub 2024 Sep 20.
PURPOSE
This study sought to quantify the tunnel widening associated with quadriceps tendon (QT) autograft after anterior cruciate ligament reconstruction (ACLR) and compare it to bone-patellar tendon-bone (BTB) autografts.
METHODS
A retrospective review of each ACLR performed at a single academic institution from 2011 to 2021 were reviewed. Subjects with repeat ipsilateral knee magnetic resonance imaging (MRI) studies performed after ACLR were included. Two reviewers independently measured the maximum diameter of the femoral and tibial tunnels 1 cm from the aperture. Tunnel widening was calculated as the difference between the initial drilled diameter and the measured diameters.
RESULTS
Seventy-five patients (38 BTB and 37 QT autografts) were identified including 42 females and 33 males. With respect to graft type (QT vs. BTB), there was no statistically significant difference in median patient age (19.0 (16.0-31.5) years vs. 20.0 (16.8-30.0) years respectively; p = n.s.) or median time to MRI (12.0 [9.0-19.5] months vs. 13.0 [7.0-43.3] months respectively, p = n.s.). Mean tunnel diameter changes or widening was statistically significantly greater for QT autografts than BTB autografts at the tibial tunnel: (0.4 [±0.6] mm] vs. -0.4 [±1.1 mm; p < 0.001). Similarly, the mean tunnel diameter change was also significantly greater at the femoral tunnel for QT compared to BTB. (0.2 [±0.6] mm vs. -0.4 [±0.8] mm; p < 0.001) However, no patients with QT grafts demonstrated tibial or femoral tunnel diameters >12 mm.
CONCLUSION
Although QT autografts had a statistically significant greater amount of tunnel widening compared to BTB autografts; the mean tibial and femoral net widening of 0.4 mm and 0.2 mm, respectively, does not meet previously reported clinically significant values. Thus, the tunnel widening presented in this study is unlikely to affect clinical outcomes and should not preclude the use of either graft.
LEVEL OF EVIDENCE
Level III (Retrospective comparative study).
目的
本研究旨在量化前交叉韧带重建（ACLR）后与股四头肌肌腱（QT）自体移植相关的隧道扩大情况，并将其与髌腱-骨（BTB）自体移植进行比较。
方法
对2011年至2021年在单一学术机构进行的每例ACLR进行回顾性分析。纳入在ACLR后进行同侧膝关节磁共振成像（MRI）复查的受试者。两名阅片者独立测量距开口处1 cm的股骨和胫骨隧道的最大直径。隧道扩大计算为初始钻孔直径与测量直径之间的差值。
结果
共纳入75例患者（38例BTB和37例QT自体移植），其中女性42例，男性33例。关于移植物类型（QT与BTB），患者年龄中位数（分别为19.0 [16.0 - 31.5]岁和20.0 [16.8 - 30.0]岁；p = 无统计学意义）或MRI检查的中位时间（分别为12.0 [9.0 - 19.5]个月和13.0 [7.0 - 43.3]个月，p = 无统计学意义）无统计学显著差异。QT自体移植在胫骨隧道的平均隧道直径变化或扩大在统计学上显著大于BTB自体移植：（0.4 [±0.6] mm]对 -0.4 [±1.1 mm；p < 0.001）。同样，QT在股骨隧道的平均隧道直径变化也显著大于BTB。（0.2 [±0.6] mm对 -0.4 [±0.8] mm；p < 0.001）然而，没有QT移植物患者的胫骨或股骨隧道直径>12 mm。
结论
尽管QT自体移植与BTB自体移植相比，在统计学上有显著更大的隧道扩大量；但胫骨和股骨的平均净扩大量分别为0.4 mm和0.2 mm，未达到先前报道的临床显著值。因此，本研究中出现的隧道扩大不太可能影响临床结果，不应排除使用任何一种移植物。
证据水平
III级（回顾性比较研究）。
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