Relationship between bone plug position and morphological changes of tunnel aperture in anatomic rectangular tunnel ACL reconstruction
Relationship between bone plug position and morphological changes of tunnel aperture in anatomic rectangular tunnel ACL reconstruction
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DOI：
10.1007/s00167-018-5224-8
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发表时间：
2019-08-01
影响因子：
3.8
通讯作者：
Horibe, Shuji
中科院分区：
文献类型：
--
作者：
Uchida, Ryohei;Shiozaki, Yoshiki;Horibe, Shuji
目的在动物实验中，骨-髌腱-骨（BTB）重建ACL（ACL-R）后，移植物的愈合模式取决于骨栓与隧道壁的关系。移植物愈合方式的差异可能影响术后隧道的形态学变化。然而，没有研究评估骨栓位置和隧道形态变化之间的关系。因此，本研究的主要目的是探讨股骨或胫骨隧道内的骨栓位置和ACL-R中每个隧道孔的形态变化之间的关系using computed tomography.MethodsSubjects是30个连续的患者（6名女性和24名男性;平均年龄，20.45.4years）谁接受了初级ACL-R使用BTB。术后2周观察股骨隧道口至肌腱-骨交界处（TBJ）的距离，术后2周至6个月观察股骨隧道口扩大情况及隧道壁移位情况。股骨隧道开口远端显著扩大（17.0 ± 11.7%），胫骨隧道开口后外侧显著扩大（19.6 ± 12.5%）。结论术后6个月，股骨和胫骨隧道口均明显扩大（P <0.01），但骨栓远端位置与隧道口扩大相关（r=0.454，p=0.0015）。仅发现股骨骨栓远端位置与股骨隧道扩大之间存在相关性，表明骨栓在隧道中的深位置是股骨隧道扩大的风险因素，强调了准确定位股骨隧道开口处的TBJ的重要性。另一种选择是在髌腱中偏离采集部位，以匹配TBJ和隧道开口的形状。证据等级id= Par 5 4（病例系列）。
PurposeIn animal studies after ACL reconstruction (ACL-R) using the bone-patellar tendon-bone (BTB), the graft-healing pattern was found to depend on the relationship between bone plug and the tunnel wall. This difference of graft-healing pattern could influence the postoperative morphological changes of the tunnel. However, no study has assessed the relationship between bone plug position and the change of tunnel morphology. Therefore, the main purpose of this study was to investigate the relationship between the bone plug position within femoral or tibial tunnel and morphological changes of each tunnel aperture in ACL-R using computed tomography.MethodsSubjects were 30 consecutive patients (six females and 24 males; mean age, 20.45.4years) who underwent primary ACL-R using BTB. The distance from the tunnel aperture to the tendon-bone junction (TBJ) at 2weeks postoperatively, and tunnel aperture enlargement and tunnel wall migration from 2weeks to 6months postoperatively, were evaluated.ResultsThe distance from the femoral tunnel aperture to the TBJ in most cases was less than 2mm, whereas the TBJ was located within the tibial tunnel. Femoral tunnel aperture was significantly enlarged (17.011.7%) distally, and the tibial tunnel aperture was significantly enlarged (19.6 +/- 12.5%) posterolaterally. Only the position at distal portion of femoral bone plug was correlated with femoral tunnel aperture enlargement (r=0.454, p=0.0015).Conclusionp id=Par4Both femoral and tibial tunnel aperture were significantly enlarged distally and posterolaterally 6 months postoperatively. Only correlation between the position at distal portion of femoral bone plug and femoral tunnel enlargement were found, suggesting the deep plug position in the tunnel is a risk factor for femoral tunnel enlargement, highlighting the importance of accurately locating the TBJ just at the femoral tunnel aperture. Another option is to deviate the harvest site in the patellar tendon to match the shape of the TBJ and the tunnel aperture.Level of evidencep id=Par5 4 (case series).