L'Insalata J C, Klatt B, Fu F H, Harner C D
The University of Pittsburgh Medical Center, Pennsylvania, USA.
Knee Surg Sports Traumatol Arthrosc. 1997;5(4):234-8. doi: 10.1007/s001670050056.
Thirty patients having had anterior cruciate ligament (ACL) reconstruction with bone-patellar tendon-bone (BPTB) autograft and thirty patients having had ACL reconstruction with hamstring (HS) autograft were enrolled. All procedures were performed using an endoscopic technique with identical postoperative rehabilitation, such that the only variable was the type of graft and its fixation. Lateral and 45 degrees posteroanterior (PA) weightbearing radiographs were performed in each patient at 6-12 (mean 9) months postoperatively in the HS group and 9-22 (mean 13) months postoperatively in the PT group. The sclerotic margins of the tunnel were measured at the widest dimension of the tunnel by a single observer and were compared with the initially drilled tunnel size after correction for radiographic magnification. For the BPTB group, all bone plugs appeared to be incorporated radiographically. On the femoral side, the bone plug was incorporated at the roof of the intercondylar notch, such that no tunnel measurement could be made. Well-defined sclerotic margins were always present at the tibial and femoral tunnels for the HS group and at the tibial tunnel for the BPTB group. The mean percentage increase in tunnel size in the PA view was 9.7%+/-14.7% for the BPTB tibial tunnel, 20.9%+/-13.4% for the HS tibial tunnel, and 30.2%+/-17.2% for the HS femoral tunnel. The mean percentage increase in tunnel size in the lateral view was 14.4%+/-16.1% for the BPTB tibial tunnel, 25.5%+/-16.7% for the HS tibial tunnel, and 28.1%+/-14.7% for the HS femoral tunnel. The difference in HS and BPTB tibial tunnel expansion on both the PA and lateral views was statistically significant (P = 0.003 and P = 0.01, respectively). Inter-observer variability was excellent with an intra-class correlation coefficient of 0.92. Tunnel expansion was significantly greater following ACL reconstruction using HS autografts than in those using BPTB autografts. The points of fixation for the HS grafts are at a greater distance from the normal insertion site and biomechanical point of action of the ACL than the points of fixation for BPTB grafts. We believe that this greater distance creates a potentially larger force moment during graft cycling which may lead to greater expansion of bone tunnels.
招募了30例行自体骨-髌腱-骨（BPTB）移植重建前交叉韧带（ACL）的患者和30例行自体腘绳肌（HS）移植重建ACL的患者。所有手术均采用关节镜技术进行，术后康复方案相同，因此唯一的变量是移植物的类型及其固定方式。HS组在术后6 - 12个月（平均9个月）、PT组在术后9 - 22个月（平均13个月）对每位患者进行了负重位的外侧和45度后前位（PA）X线片检查。由一名观察者在隧道最宽处测量隧道的硬化边缘，并在校正X线放大率后与最初钻孔的隧道尺寸进行比较。对于BPTB组，所有骨栓在X线片上似乎均已融合。在股骨侧，骨栓融合于髁间切迹顶部，因此无法进行隧道测量。HS组的胫骨和股骨隧道以及BPTB组的胫骨隧道始终存在清晰的硬化边缘。在PA位上，BPTB组胫骨隧道尺寸的平均增加百分比为9.7%±14.7%，HS组胫骨隧道为20.9%±13.4%，HS组股骨隧道为30.2%±17.2%。在侧位上，BPTB组胫骨隧道尺寸的平均增加百分比为14.4%±16.1%，HS组胫骨隧道为25.5%±16.7%，HS组股骨隧道为28.1%±14.7%。HS组和BPTB组胫骨隧道在PA位和侧位上的扩张差异均具有统计学意义（分别为P = 0.003和P = 0.01）。观察者间的变异性极佳，组内相关系数为0.92。与使用BPTB自体移植物相比，使用HS自体移植物重建ACL后隧道扩张明显更大。HS移植物的固定点与正常ACL插入部位和生物力学作用点的距离比BPTB移植物的固定点更远。我们认为，这种更大的距离在移植物循环过程中会产生潜在更大的力矩，这可能导致骨隧道更大程度的扩张。
