Bone-Patellar Tendon-Bone Autograft versus Hamstring Tendon Autograft for Anatomical Anterior Cruciate Ligament Reconstruction with Three-Dimensional Validation of Femoral and Tibial Tunnel Positions
Bone-Patellar Tendon-Bone Autograft versus Hamstring Tendon Autograft for Anatomical Anterior Cruciate Ligament Reconstruction with Three-Dimensional Validation of Femoral and Tibial Tunnel Positions
复制标题
DOI：
10.1055/s-0037-1615813
复制
发表时间：
2018-10-01
影响因子：
1.7
通讯作者：
Tanaka, Sakae
中科院分区：
文献类型：
--
作者：
Taketomi, Shuji;Inui, Hiroshi;Tanaka, Sakae
本研究的目的是首先比较解剖双束(DB)前交叉韧带重建(ACLR)与解剖矩形隧道ACLR加自体骨-髌腱-骨(BPTB)重建前交叉韧带的临床效果。其次，我们的目标是利用术后三维计算机断层扫描(3D CT)显示股骨和胫骨隧道的定量位置。25例采用BPTB移植物行解剖矩形隧道人工晶状体植入术(B组)，23例采用解剖DB型人工晶状体植入术(H组)。所有患者术后均接受Lysholm评分、膝关节损伤评分和骨关节炎预后评分。患者还接受了国际膝关节文件委员会评分、Lachman测试、轴移测试和活动范围的客观评估。此外，我们使用KneLax3关节测量仪和大腿力量定量评估了膝关节前的稳定性。除大腿力量外的所有评估都在至少两年的随访期内进行。所有患者术后均使用三维CT图像对股骨和胫骨隧道孔位置进行定量评估。BPTB移植物的膝关节前稳定性明显好于HT移植物(0.1 mm对1.1 mm，p=0.01)，尽管两种移植物在其他客观和所有主观评价上没有显著差异。对股骨和胫骨隧道位置的形态计量分析表明，这两种手术基于相同的解剖学概念。总之，BPTB移植物的膝关节前稳定性明显好于HT移植物，尽管在解剖学ACLR中，两种移植物类型之间的其他客观评价和所有主观评价均无显著差异。更多的3D CT数据证实了这两种手术的解剖学概念。
The purpose of this retrospective study was to first compare the clinical outcome of anatomical double-bundle (DB) anterior cruciate ligament reconstruction (ACLR) with hamstring tendon (HT) autografts and anatomical rectangular tunnel ACLR with bone-patellar tendon-bone (BPTB) autografts. Secondly, we aimed to demonstrate the quantitative locations of the femoral and tibial tunnel apertures using postoperative three-dimensional computed tomography (3D CT). Twenty-five patients underwent anatomical rectangular tunnel ACLR using BPTB grafts (Group B) and 23 patients underwent anatomical DB ACLR using HT grafts (Group H). All patients underwent subjective postoperative evaluations using the Lysholm score and Knee Injury and Osteoarthritis Outcome Score. Patients also underwent objective evaluations by the International Knee Documentation Committee score, the Lachman test, the pivot-shift test, and range of motion. In addition, we quantitatively assessed anterior knee stability using a KneeLax3 arthrometer and thigh strength. All evaluations except for thigh strength were assessed for a minimum 2 years of follow-up period. Femoral and tibial tunnel aperture locations were quantitatively evaluated postoperatively using 3D CT images in all patients. BPTB grafts showed significantly better anterior knee stability than HT grafts (0.1 mm versus 1.1 mm, p = 0.01), although there were no significant differences in other objective and all subjective evaluations between the two graft types. Morphometric analysis of femoral and tibial tunnel locations revealed that the two procedures were based on the same anatomical concept. In conclusion, BPTB grafts showed significantly better anterior knee stability than HT grafts, although no significant differences in other objective evaluations and all subjective evaluations were detected between the two graft types in anatomical ACLR. Additional 3D CT data validated the anatomical concepts of these two procedures.