Gong Jue, Wei Zhiheng, Jia Mengyang, Wang Weiming, Xiang Xianxiang
Department of Sports Medicine, Xinhua Hospital Affiliated to Dalian University, Institute of Sports Medicine, Dalian University, Dalian Liaoning, 116021, P. R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2025 Mar 15;39(3):307-313. doi: 10.7507/1002-1892.202412009.
To compare early graft healing between over-the-top (OTT) and anatomic single-bundle (SB) anterior cruciate ligament (ACL) reconstruction.
A clinical data of 40 patients underwent ACL reconstruction, who admitted between June 2021 and October 2022 and met the selective criteria, was retrospectively analyzed. Among them, 20 patients were treated with OTT reconstruction (OTT group) and 20 with SB reconstruction (SB group). There was no significant difference between groups ( >0.05) in the gender, age, affected side, disease duration, degree of meniscus injury, body mass index, and preoperative International Knee Documentation Committee (IKDC) score, Lysholm score, pain visual analogue scale (VAS) score, and KT-2000 measurement. At 3, 6, and 12 months, MRI was performed to measure the signal noise quotient (SNQ) of the proximal end, middle, and distal end of the graft in the two groups, as well as at the corner of the graft with lateral femoral condyle and 1 cm around the femoral fixation point in the OTT group, to observe the degree of graft healing. Before operation and at 3, 6, and 12 months, the knee function and pain were evaluated by IKDC score, Lysholm score, and VAS score. Before operation and at 12 months after operation, the KT-2000 measurement was taken to evaluation the knee joint stability.
All operations were successfully completed in both groups and the incisions healed by first intention. All patients were followed up 12-15 months (mean, 12.9 months), with no significant difference in the follow-up time between groups ( >0.05). After operation, the IKDC score, VAS score, and Lysholm score improved gradually over time in both groups, with significant differences between different time points ( <0.05). The differences between groups at 3, 6, and 12 months after operation were not significant ( >0.05). The anterior and posterior stability of the knee joint improved significantly in both groups at 12 months after operation, and the difference in KT-2000 measurements was significant when compared with the preoperative value ( <0.05), but the difference of pre- and post-operation between groups was not significant ( >0.05). At 3, 6, and 12 months after operation, MRI showed that the differences in the SNQ of the proximal end and middle of the grafts between the two groups were not significant ( >0.05), and the SNQ of distal end was significantly higher in the SB group than in the OTT group ( <0.05). At each time point, grafts in the OTT group had the highest SNQ at the corner and the lowest at the fixation point, and the differences were significant compared to the other sites ( <0.05). In the two groups, except for the fixation point, the SNQ of the remaining sites were highest at 6 months and lowest at 12 months ( <0.05). In addition, there were significant differences in SNQ between the different sites of grafts ( <0.05), and the SNQ was lowest at proximal end and highest at distal end. At last follow-up, the knee grafts in both groups were in good shape and no graft necrosis or loosening of the internal fixation was observed.
The knee joint function and graft healing after OTT reconstruction of ACL are similar to those of SB reconstruction, but it should be noted that the healing at the corner of the graft is slower.
比较过顶（OTT）与解剖单束（SB）前交叉韧带（ACL）重建术后早期移植物愈合情况。
回顾性分析2021年6月至2022年10月收治的40例行ACL重建且符合入选标准患者的临床资料。其中，20例患者接受OTT重建（OTT组），20例接受SB重建（SB组）。两组在性别、年龄、患侧、病程、半月板损伤程度、体重指数以及术前国际膝关节文献委员会（IKDC）评分、Lysholm评分、疼痛视觉模拟量表（VAS）评分和KT-2000测量结果方面差异均无统计学意义（>0.05）。在术后3、6和12个月，行MRI检查测量两组移植物近端、中端和远端的信号噪声比（SNQ），以及OTT组移植物与股骨外侧髁拐角处和股骨固定点周围1 cm处的SNQ，以观察移植物愈合程度。术前及术后3、6和12个月，采用IKDC评分、Lysholm评分和VAS评分评估膝关节功能和疼痛情况。术前及术后12个月，行KT-2000测量以评估膝关节稳定性。
两组手术均顺利完成，切口均一期愈合。所有患者均获随访12 - 15个月（平均12.9个月），两组随访时间差异无统计学意义（>0.05）。术后两组IKDC评分、VAS评分和Lysholm评分均随时间逐渐改善，不同时间点差异有统计学意义（<0.05）。术后3、6和12个月两组间差异无统计学意义（>0.05）。两组术后12个月膝关节前后稳定性均显著改善，KT-2000测量值与术前相比差异有统计学意义（<0.05），但两组术前及术后差异无统计学意义（>0.05）。术后3、6和12个月，MRI显示两组移植物近端和中端的SNQ差异无统计学意义（>0.05），SB组远端SNQ显著高于OTT组（<0.05）。在每个时间点，OTT组移植物在拐角处SNQ最高，在固定点处最低，与其他部位相比差异有统计学意义（<0.05）。两组中，除固定点外，其余部位SNQ在6个月时最高，12个月时最低（<0.05）。此外，移植物不同部位的SNQ差异有统计学意义（<0.05），近端SNQ最低，远端最高。末次随访时，两组膝关节移植物形态良好，未观察到移植物坏死或内固定松动。
ACL的OTT重建术后膝关节功能和移植物愈合情况与SB重建相似，但需注意移植物拐角处愈合较慢。
