Simon-Sanchez Francisco J, Perelli Simone, Pizza Nicola, Delmedico Michelangelo, Morales-Avalos Rodolfo, Torres Claramunt Raúl, Monllau Joan C
Knee and Arthroscopy Unit, Institut Català de Traumatologia i Medicina del'Esport (ICATME)-Hospital Universitari Dexeus, Universitat Autònoma de Barcelona, Barcelona, Spain.
Department of Surgery and Morphologic Science, Orthopaedic Surgery Service, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain.
Knee Surg Sports Traumatol Arthrosc. 2025 Sep;33(9):3080-3087. doi: 10.1002/ksa.12551. Epub 2024 Dec 12.
The stability of the graft in the bony tunnels is of utmost importance in the anterior cruciate ligament reconstruction (ACLR) since it ensures safe healing at the tendon-bone interface. The hypothesis was that when a double tibial fixation was used in ACLR with a short graft of autologous hamstrings, tibial tunnel bone re-growth and better graft integration would be observed at short-term follow-up.
The analysis included a cohort of 112 patients after a primary ACLR with hamstring tendons who underwent postoperative magnetic resonance imaging (MRI) 3.0-Tesla (3.0-T) 6 months after the surgery. The patients were divided into three groups based on the tibial fixation technique: 40 had a screw (group S), 35 had a screw and cortical button (group S + B) and 37 had a screw and anchor (group S + A). Two orthopaedic specialists independently evaluated the images, who measured the screw-free tunnel space, and assessed the presence of bone filling in the free tunnel. Furthermore, Ge's protocol was used to determine the graft healing in the tunnel.
In 94 patients a screw-free tunnel space was detected, and a filling of the tunnel was reported in 80.85% of the cases (76 patients), being partial in 15.79% (12 patients) and complete in 84.21% (64 patients). Patients who presented better graft integration (Ge1) had significantly higher values of screw-free tunnel length compared to the other ones who had lower graft integration (Ge3)(p < 0.05).
At 6 months postoperative MRI, tibial tunnel bone re-growth and graft-tunnel tibial integration after hamstring ACLR is significantly associated with the presence of free space between the anterior tibial cortex and the most distal portion of the interference screw, hence the use of a short and proximalized interference screw is suggested to restore bone stock after hamstring ACLR.
Level IV retrospective comparative cohort study.
在膝关节前交叉韧带重建术（ACLR）中，移植物在骨隧道中的稳定性至关重要，因为它能确保肌腱-骨界面的安全愈合。研究假设为，在采用自体腘绳肌短移植物进行ACLR并使用双胫骨固定时，在短期随访中会观察到胫骨隧道骨再生以及更好的移植物整合情况。
该分析纳入了112例初次行腘绳肌腱ACLR术后6个月接受3.0特斯拉（3.0-T）术后磁共振成像（MRI）检查的患者队列。根据胫骨固定技术将患者分为三组：40例采用螺钉固定（S组），35例采用螺钉和皮质纽扣固定（S + B组），37例采用螺钉和锚钉固定（S + A组）。两名骨科专家独立评估图像，测量无螺钉隧道空间，并评估游离隧道内骨填充情况。此外，使用Ge氏方案确定隧道内移植物的愈合情况。
在94例患者中检测到无螺钉隧道空间，80.85%的病例（76例患者）报告隧道有填充，其中部分填充占15.79%（12例患者），完全填充占84.21%（64例患者）。与移植物整合较差（Ge3）的患者相比，移植物整合较好（Ge1）的患者无螺钉隧道长度值显著更高（p < 0.05）。
术后6个月MRI显示，腘绳肌ACLR术后胫骨隧道骨再生及移植物与胫骨隧道的整合与胫骨前皮质和干涉螺钉最远端之间的游离空间显著相关，因此建议在腘绳肌ACLR术后使用短的、近端放置的干涉螺钉以恢复骨量。
IV级回顾性比较队列研究。
