Laterally shifted tibial tunnel can be the risk of residual knee laxity for double-bundle anterior cruciate ligament reconstruction.
Laterally shifted tibial tunnel can be the risk of residual knee laxity for double-bundle anterior cruciate ligament reconstruction.
复制标题
横向移位的胫骨隧道可能是双束前交叉韧带重建时残余膝关节松弛的风险。
DOI：
10.1007/s00167-021-06546-3
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发表时间：
2021
期刊：
影响因子：
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通讯作者：
Daisuke Chiba
中科院分区：
文献类型：
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作者：
Okada Y;Yokota S;Fukushi I;木下まどか;Ryuki Hashida;布宮亜樹;布宮亜樹;木村 由佳;木村由佳;木村由佳;Ryotaro Kumahara;Daisuke Chiba
目的探讨双束ACL重建术中移植物隧道位置与膝关节松弛度的关系。在3D-CT上采用象限法评价股骨和胫骨隧道。作为胫骨的额外参考，评价内侧胫骨棘至隧道中心的距离（DMS）和Parsons结至隧道中心的距离（DPK）;计算%DMS/ML和%DPK/AP（ML和AP：胫骨平台的内外侧和前后宽度）。术前和术后（术后1年）的稳定性进行了评价Lachman和双移位程序。如果存在≥ 2 mm的侧侧差异，则将受试者定义为膝前松弛（AKL）;如果观察到IKDC ≥ 1级的平移现象，则为旋转性膝关节松弛（RKL）。多元Logistic回归分析进行了AKL或RKL的患病率为因变量和隧道的位置作为individuals.ResultsOverall，21例（15.9%）显示AKL，和15例（11.4%）显示RKL。术后松弛组的%DMS/ML和股骨位置均高于无松弛组。关于后外侧束，logistic回归模型估计%DMS/ML与AKL的患病率相关（B= 0.608;p< 0.001）和RKL（B= 0.789;p< 0.001）; %高-低股骨隧道位置（B= − 0.127; P= 0.023）与RKL相关。重建膝关节时，胫骨隧道移位更外侧或更高的股骨隧道创建后外侧束。证据等级III。
PurposeTo elucidate the relationship between graft tunnel position and knee laxity in the cases of double-bundle ACL reconstruction.MethodsTotal of 132 cases were included. Femoral and tibial tunnels were evaluated by quadrant method on 3D-CT. As additional reference of tibia, the distances from medial tibial spine to the tunnel center (DMS) and from Parsons’ knob to the tunnel center (DPK) were evaluated; %DMS/ML and %DPK/AP were calculated (ML and AP: mediolateral and anteroposterior width of tibial plateau). Preoperative and postoperative (1 year from surgery) stabilities were evaluated by Lachman and pivot-shift procedures. If there was ≥ 2 mm side-to-side difference, the subject was defined as having anterior knee laxity (AKL); if the pivot-shift phenomenon was observed with IKDC grade ≥ 1, there was rotatory knee laxity (RKL). Multiple logistic regression analysis was conducted with the prevalence of AKL or RKL as the dependent variable and with tunnel positions as the independent variables.ResultsOverall, 21 subjects (15.9%) showed AKL, and 15 subjects (11.4%) showed RKL. Those with postoperative laxity showed higher %DMS/ML and higher femoral position than those without laxity. Regarding posterolateral bundle, logistic regression model estimated that %DMS/ML was associated with the prevalence of AKL (B= 0.608;p< 0.001) and RKL (B= 0.789;p< 0.001); %high-low femoral tunnel position (B= − 0.127;p= 0.023) was associated with that of RKL.ConclusionThere was the risk of residual knee laxity in ACL-reconstructed knee when tibial tunnel shifted more laterally or higher femoral tunnel was created with regard to posterolateral bundle.Level of evidenceIII.