Watanabe B M, Howell S M
University of Texas Medical Branch, Division of Orthopedic Surgery, Galveston, USA.
Am J Sports Med. 1995 Sep-Oct;23(5):616-25. doi: 10.1177/036354659502300517.
Nineteen patients with roof impingement of an anterior cruciate ligament graft had their grafts inspected during second-look arthroscopy. The diagnosis of roof impingement was suspected from the clinical findings of an effusion, extension deficit, recurrent instability, or anterior knee pain. The diagnosis was confirmed when a portion of the tibial tunnel was anterior to the tibial intersection of the slope of the intercondylar roof on a lateral roentgenogram of the fully extended knee. During second-look arthroscopy the impinged anterior cruciate ligament graft had one or more of the following features: fractured bundles, guillotined remnants at the tibial insertion, parallel fragmentation of an uninterrupted graft, fibrous nodule, or an extrusion of graft material at the outlet of the notch. We hypothesize that these changes in the integrity of the anterior cruciate ligament graft are caused by mechanical injury from roof impingement. CLINICAL RELEVANCE. One should suspect that a patient with an effusion, extension deficit, recurrent instability, or anterior knee pain after an anterior cruciate ligament reconstruction may have roof impingement. A lateral roentgenogram in full extension is diagnostic if the tibial tunnel is anterior to the intercondylar roof. The surgeon should be aware that impinged grafts can have a variety of arthroscopic appearances in addition to the previously reported fibrous nodule or Cyclops lesion.
19例前交叉韧带移植物发生髁间窝顶撞击的患者在二次关节镜检查时对其移植物进行了检查。根据积液、伸直受限、反复不稳定或膝关节前部疼痛等临床表现怀疑存在髁间窝顶撞击。当在膝关节完全伸直的侧位X线片上，胫骨隧道的一部分位于髁间窝顶斜坡与胫骨交点的前方时，即可确诊。在二次关节镜检查时，受撞击的前交叉韧带移植物具有以下一种或多种特征：束状断裂、胫骨附着处的断头状残端、连续移植物的平行断裂、纤维结节或在髁间切迹出口处的移植物材料挤出。我们推测前交叉韧带移植物完整性的这些改变是由髁间窝顶撞击导致的机械损伤引起的。临床意义。对于前交叉韧带重建术后出现积液、伸直受限、反复不稳定或膝关节前部疼痛的患者，应怀疑可能存在髁间窝顶撞击。如果胫骨隧道位于髁间窝顶的前方，则膝关节完全伸直位的侧位X线片具有诊断价值。外科医生应意识到，除了先前报道的纤维结节或独眼巨人病变外，受撞击的移植物还可能有多种关节镜表现。
