Tunnel widening in single- versus double-bundle anterior cruciate ligament reconstructed knees.
Tunnel widening in single- versus double-bundle anterior cruciate ligament reconstructed knees.
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DOI：
10.1007/s00167-016-4204-0
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发表时间：
2017-04
期刊：
影响因子：
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通讯作者：
Engebretsen L
中科院分区：
文献类型：
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作者：
Aga C;Wilson KJ;Johansen S;Dornan G;La Prade RF;Engebretsen L
对于翻修手术来说，前交叉韧带重建后隧道加宽的后果是最重要的。隧道扩张会导致关节附近的骨丢失，在翻修手术之前可能需要进行额外的植骨手术。该研究的目的是测量单束(SB)和双束(DB)前交叉韧带重建膝关节在术后第一年的隧道增宽，通过一种新型的半自动三维CT成像设备进行检测。我们的假设是，由于隧道加宽过程，初始隧道大小与术后一年测量的大小会有差异。此外，目的是评估两种手术技术在隧道加宽程度上是否有任何差异。20例接受DB前交叉韧带重建的患者和22例接受SB前交叉韧带重建的患者在术后第一天和术后一年进行了骨隧道的CT扫描。将CT图像转换为三维CT重建图像，采用“最佳拟合圆柱法”对隧道进行测量，测量平面为隧道口径水平，距关节线10.0 mm。在手术后的第一年，DB和SB前交叉韧带重建膝关节的所有隧道都出现了增宽(P<；0.001)。与DB股AM隧道相比，SB股骨隧道有更多的增宽(1.40±0.9vs.0.5±0.6 mm)(P<0.001)；与DB胫骨PL隧道相比，SB胫骨隧道有更多的增宽(1.0±10.0 vs.0.5±0.6 mm)(P<0.043)。在前交叉韧带重建后的第一年，所有隧道都变宽了，其中SB隧道比DB股骨AM隧道和DB胫骨PL隧道的增宽幅度更大。这是第一项通过半自动三维CT成像设备检测DB重建膝关节隧道增宽的研究。前瞻性队列研究，III级。
The consequence of tunnel widening after ACL reconstructions is foremost of importance in case of revision surgery. Tunnel expansion leads to bone loss close to the joint, and additional surgery with bone grafting prior to revision surgery might be necessary. The purpose of the study was to measure widening of the tunnels in single-bundle (SB) and double-bundle (DB) ACL reconstructed knees during the first year after surgery, detected by a novel, semi-automated 3D CT imaging modality. Our hypothesis was that there would be a difference between the initial tunnel size and the size measured one year post-operatively due to the tunnel widening process. Further, the purpose was to evaluate whether there were any differences in the amount of tunnel widening between the two surgical techniques. Twenty patients who underwent DB ACL reconstruction, and 22 patients who underwent SB ACL reconstruction, performed a CT scan of the bony tunnels, during their first days after surgery and one year post-operatively. The CT scans were transformed into 3D CT reconstructions, and the tunnels were measured with the “best-fit cylinder” method, measurements at the level of tunnel aperture and 10.0 mm from the joint line. All tunnels in the DB and SB ACL reconstructed knees exhibited widening during the first year after the operation (p < 0.001). The SB femoral tunnels showed more widening compared to the DB femoral AM tunnels (1.4 ± 0.9 vs. 0.5 ± 0.6 mm) (p < 0.001), and the SB tibial tunnels widened more compared to the DB tibial PL tunnels (1.0 ± 1.0 vs. 0.5 ± 0.6) (p < 0.043). All tunnels widened during the first year after the ACL reconstruction with a larger amount of widening in the SB tunnels compared to the DB femoral AM tunnels and the DB tibial PL tunnels. This is the first study to detect tunnel widening in DB reconstructed knees through a semi-automated 3D CT imaging modality. Prospective cohort study, Level III.