Short and proximalized interference screw fixation leads to tibial tunnel bone re-growth and better hamstring graft integration in ACL reconstruction.

IF 3.3 2区医学 Q1 ORTHOPEDICS

Knee Surgery, Sports Traumatology, Arthroscopy Pub Date : 2024-12-12 DOI:10.1002/ksa.12551

Francisco J Simon-Sanchez, Simone Perelli, Nicola Pizza, Michelangelo Delmedico, Rodolfo Morales-Avalos, Raúl Torres Claramunt, Joan C Monllau

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引用次数: 0

Abstract

Purpose: The stability of the graft in the bony tunnels is of utmost importance in the anterior cruciate ligament reconstruction (ACLR) since it ensures safe healing at the tendon-bone interface. The hypothesis was that when a double tibial fixation was used in ACLR with a short graft of autologous hamstrings, tibial tunnel bone re-growth and better graft integration would be observed at short-term follow-up.

Methods: The analysis included a cohort of 112 patients after a primary ACLR with hamstring tendons who underwent postoperative magnetic resonance imaging (MRI) 3.0-Tesla (3.0-T) 6 months after the surgery. The patients were divided into three groups based on the tibial fixation technique: 40 had a screw (group S), 35 had a screw and cortical button (group S + B) and 37 had a screw and anchor (group S + A). Two orthopaedic specialists independently evaluated the images, who measured the screw-free tunnel space, and assessed the presence of bone filling in the free tunnel. Furthermore, Ge's protocol was used to determine the graft healing in the tunnel.

Results: In 94 patients a screw-free tunnel space was detected, and a filling of the tunnel was reported in 80.85% of the cases (76 patients), being partial in 15.79% (12 patients) and complete in 84.21% (64 patients). Patients who presented better graft integration (Ge1) had significantly higher values of screw-free tunnel length compared to the other ones who had lower graft integration (Ge3)(p < 0.05).

Conclusions: At 6 months postoperative MRI, tibial tunnel bone re-growth and graft-tunnel tibial integration after hamstring ACLR is significantly associated with the presence of free space between the anterior tibial cortex and the most distal portion of the interference screw, hence the use of a short and proximalized interference screw is suggested to restore bone stock after hamstring ACLR.

Level of evidence: Level IV retrospective comparative cohort study.

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在前交叉韧带重建术中，短而近端化的干扰螺钉固定可使胫骨隧道骨重新生长，并更好地整合腘绳肌移植。

目的：骨隧道内移植物的稳定性在前交叉韧带重建（ACLR）中至关重要，因为它保证了肌腱-骨界面的安全愈合。假设在ACLR中采用双胫骨固定并短段自体腘绳肌移植物时，在短期随访中可以观察到胫骨隧道骨再生和更好的移植物融合。方法：分析纳入112例腘绳肌腱原发ACLR术后6个月行MRI 3.0-Tesla （3.0-T）检查的患者。根据胫骨固定技术将患者分为3组：40例采用螺钉（S组），35例采用螺钉+皮质扣（S + B组），37例采用螺钉+锚钉（S + a组）。两位骨科专家独立评估了这些图像，他们测量了无螺钉的隧道空间，并评估了自由隧道中骨填充物的存在。此外，Ge的方案被用于确定隧道中的移植物愈合。结果：94例患者发现无螺钉隧道间隙，76例（80.85%）的患者报告隧道填充，12例（15.79%）的患者报告隧道部分填充，64例（84.21%）的患者报告隧道完全填充。移植物整合度（Ge1）较好的患者无螺钉隧道长度值明显高于移植物整合度（Ge3）较低的患者(p)。术后6个月MRI显示，腘绳肌ACLR术后胫骨隧道骨再生和移植物-胫骨隧道融合与胫骨前皮质与干涉螺钉最远端部分之间存在自由空间显著相关，因此建议使用短的近端干涉螺钉来修复腘绳肌ACLR后的骨源。证据等级：四级回顾性比较队列研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Knee Surgery, Sports Traumatology, Arthroscopy 医学-外科

CiteScore

8.10

自引率

18.40%

发文量

418

审稿时长

2 months

期刊介绍： Few other areas of orthopedic surgery and traumatology have undergone such a dramatic evolution in the last 10 years as knee surgery, arthroscopy and sports traumatology. Ranked among the top 33% of journals in both Orthopedics and Sports Sciences, the goal of this European journal is to publish papers about innovative knee surgery, sports trauma surgery and arthroscopy. Each issue features a series of peer-reviewed articles that deal with diagnosis and management and with basic research. Each issue also contains at least one review article about an important clinical problem. Case presentations or short notes about technical innovations are also accepted for publication. The articles cover all aspects of knee surgery and all types of sports trauma; in addition, epidemiology, diagnosis, treatment and prevention, and all types of arthroscopy (not only the knee but also the shoulder, elbow, wrist, hip, ankle, etc.) are addressed. Articles on new diagnostic techniques such as MRI and ultrasound and high-quality articles about the biomechanics of joints, muscles and tendons are included. Although this is largely a clinical journal, it is also open to basic research with clinical relevance. Because the journal is supported by a distinguished European Editorial Board, assisted by an international Advisory Board, you can be assured that the journal maintains the highest standards. Official Clinical Journal of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA).