{"title":"自体腘绳肌腱重建双束前交叉韧带时纤维蛋白凝块植入缩小骨隧道扩大的效果。","authors":"Nobuyoshi Suzuki, Shintaro Onishi, Ryo Kanto, Hiroshi Nakayama, Shinichi Yoshiya, Toshiya Tachibana, Tomoya Iseki","doi":"10.1177/23259671251349750","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Although previous reports have stated that the addition of a fibrin clot to an allograft can effectively inhibit femoral bone tunnel enlargement (BTE) after anterior cruciate ligament reconstruction (ACLR), no relevant study has quantitatively evaluated the chronological changes in the cross-sectional area (CSA) of the bone tunnel on 3-dimensional computed tomography (3D-CT) images in double-bundle ACLR (DB-ACLR) with hamstring tendon autografts.</p><p><strong>Purpose: </strong>To evaluate whether adding a fibrin clot to a hamstring autograft would reduce postoperative femoral BTE by means of 3D-CT image analysis.</p><p><strong>Study design: </strong>Cohort study; Level of evidence, 3.</p><p><strong>Method: </strong>A total of 21 patients with fibrin clot who underwent anatomic DB-ACLR using hamstring tendon autografts and 24 control patients without fibrin clot were included in the study. In preparing the graft, a fibrin clot was placed between the 2 strands of the graft end to be inserted into the femoral bone tunnel. The CSAs of the anteromedial (AM) and posterolateral (PL) femoral bone tunnels at the intra-articular aperture, 5 mm and 10 mm from the tunnel aperture, were measured on 3D-CT images at 1 week and 1 year postoperatively, and the difference between the 2 time points was defined as the BTE.</p><p><strong>Results: </strong>In the autograft group with fibrin clot, a significantly smaller BTE ratio was observed in the AM tunnel 5 mm (<i>P</i> = .003; with fibrin clot: 29.3% ± 58.1%; autograft alone: 58.8% ± 57.8%) and 10 mm (<i>P</i> < .001; with fibrin clot: -8.0% ± 43.7%; autograft alone: 42.3% ± 39.7%) from the intra-articular tunnel aperture and in the PL tunnel at all levels (<i>P</i> = .048, <i>P</i> < .001, and <i>P</i> < .001; with fibrin clot: 49.1% ± 89.3%, 7.9% ± 28.4%, and -5.1% ± 25.6%; autograft alone: 89.8% ± 57.0%, 28.9% ± 26.8%, and 51.4% ± 38.6%, respectively) compared with controls who received only autograft.</p><p><strong>Conclusion: </strong>Adding a fibrin clot to the autograft of an anatomic DB-ACLR was associated with a decreased BTE at 1 year. This effect was more evident in the PL tunnel and the midportion of the AM tunnel.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"13 7","pages":"23259671251349750"},"PeriodicalIF":2.5000,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12267899/pdf/","citationCount":"0","resultStr":"{\"title\":\"Efficacy of Fibrin Clot Implantation for Reduction of Bone Tunnel Enlargement in Double-Bundle ACL Reconstruction Using Autogenous Hamstring Graft.\",\"authors\":\"Nobuyoshi Suzuki, Shintaro Onishi, Ryo Kanto, Hiroshi Nakayama, Shinichi Yoshiya, Toshiya Tachibana, Tomoya Iseki\",\"doi\":\"10.1177/23259671251349750\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Although previous reports have stated that the addition of a fibrin clot to an allograft can effectively inhibit femoral bone tunnel enlargement (BTE) after anterior cruciate ligament reconstruction (ACLR), no relevant study has quantitatively evaluated the chronological changes in the cross-sectional area (CSA) of the bone tunnel on 3-dimensional computed tomography (3D-CT) images in double-bundle ACLR (DB-ACLR) with hamstring tendon autografts.</p><p><strong>Purpose: </strong>To evaluate whether adding a fibrin clot to a hamstring autograft would reduce postoperative femoral BTE by means of 3D-CT image analysis.</p><p><strong>Study design: </strong>Cohort study; Level of evidence, 3.</p><p><strong>Method: </strong>A total of 21 patients with fibrin clot who underwent anatomic DB-ACLR using hamstring tendon autografts and 24 control patients without fibrin clot were included in the study. In preparing the graft, a fibrin clot was placed between the 2 strands of the graft end to be inserted into the femoral bone tunnel. The CSAs of the anteromedial (AM) and posterolateral (PL) femoral bone tunnels at the intra-articular aperture, 5 mm and 10 mm from the tunnel aperture, were measured on 3D-CT images at 1 week and 1 year postoperatively, and the difference between the 2 time points was defined as the BTE.</p><p><strong>Results: </strong>In the autograft group with fibrin clot, a significantly smaller BTE ratio was observed in the AM tunnel 5 mm (<i>P</i> = .003; with fibrin clot: 29.3% ± 58.1%; autograft alone: 58.8% ± 57.8%) and 10 mm (<i>P</i> < .001; with fibrin clot: -8.0% ± 43.7%; autograft alone: 42.3% ± 39.7%) from the intra-articular tunnel aperture and in the PL tunnel at all levels (<i>P</i> = .048, <i>P</i> < .001, and <i>P</i> < .001; with fibrin clot: 49.1% ± 89.3%, 7.9% ± 28.4%, and -5.1% ± 25.6%; autograft alone: 89.8% ± 57.0%, 28.9% ± 26.8%, and 51.4% ± 38.6%, respectively) compared with controls who received only autograft.</p><p><strong>Conclusion: </strong>Adding a fibrin clot to the autograft of an anatomic DB-ACLR was associated with a decreased BTE at 1 year. This effect was more evident in the PL tunnel and the midportion of the AM tunnel.</p>\",\"PeriodicalId\":19646,\"journal\":{\"name\":\"Orthopaedic Journal of Sports Medicine\",\"volume\":\"13 7\",\"pages\":\"23259671251349750\"},\"PeriodicalIF\":2.5000,\"publicationDate\":\"2025-07-16\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12267899/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Orthopaedic Journal of Sports Medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1177/23259671251349750\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/7/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q2\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Orthopaedic Journal of Sports Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1177/23259671251349750","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/7/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
引用次数: 0
摘要
背景:虽然之前的报道指出,在同种异体移植中添加纤维蛋白凝块可以有效地抑制前交叉韧带重建(ACLR)后股骨骨隧道扩大(BTE),但没有相关研究定量评估双束ACLR (DB-ACLR)与腘绳肌腱自体移植的骨隧道三维计算机断层扫描(3D-CT)图像上骨隧道横截面积(CSA)的时间变化。目的:通过3D-CT图像分析,评价自体腘绳肌移植后添加纤维蛋白凝块是否能降低术后股骨BTE。研究设计:队列研究;证据水平,3。方法:选取21例自体腘绳肌腱移植行解剖性DB-ACLR的纤维蛋白凝块患者和24例无纤维蛋白凝块的对照患者作为研究对象。在准备移植物时,将纤维蛋白凝块置于移植物末端的两股之间,将其插入股骨隧道。分别于术后1周和1年在3D-CT图像上测量股骨隧道前内侧(AM)和后外侧(PL)在距隧道开口5 mm和10 mm处的csa,并将两个时间点的差异定义为BTE。结果:有纤维蛋白凝块的自体移植物组,AM隧道5 mm处BTE比值明显减小(P = 0.003;伴纤维蛋白凝块:29.3%±58.1%;单独自体移植物:58.8%±57.8%)和10 mm (P < 0.001;伴纤维蛋白凝块:-8.0%±43.7%;在关节内隧道孔和各节段PL隧道内单独植骨:42.3%±39.7% (P = 0.048, P < 0.001, P < 0.001);与纤维蛋白凝块:49.1%±89.3%,7.9%±28.4%和-5.1%±25.6%;单独自体移植物:分别为89.8%±57.0%、28.9%±26.8%和51.4%±38.6%)。结论:在解剖性DB-ACLR自体移植物中添加纤维蛋白凝块与1年BTE降低相关。这一效应在前路隧道和中路隧道中更为明显。
Efficacy of Fibrin Clot Implantation for Reduction of Bone Tunnel Enlargement in Double-Bundle ACL Reconstruction Using Autogenous Hamstring Graft.
Background: Although previous reports have stated that the addition of a fibrin clot to an allograft can effectively inhibit femoral bone tunnel enlargement (BTE) after anterior cruciate ligament reconstruction (ACLR), no relevant study has quantitatively evaluated the chronological changes in the cross-sectional area (CSA) of the bone tunnel on 3-dimensional computed tomography (3D-CT) images in double-bundle ACLR (DB-ACLR) with hamstring tendon autografts.
Purpose: To evaluate whether adding a fibrin clot to a hamstring autograft would reduce postoperative femoral BTE by means of 3D-CT image analysis.
Study design: Cohort study; Level of evidence, 3.
Method: A total of 21 patients with fibrin clot who underwent anatomic DB-ACLR using hamstring tendon autografts and 24 control patients without fibrin clot were included in the study. In preparing the graft, a fibrin clot was placed between the 2 strands of the graft end to be inserted into the femoral bone tunnel. The CSAs of the anteromedial (AM) and posterolateral (PL) femoral bone tunnels at the intra-articular aperture, 5 mm and 10 mm from the tunnel aperture, were measured on 3D-CT images at 1 week and 1 year postoperatively, and the difference between the 2 time points was defined as the BTE.
Results: In the autograft group with fibrin clot, a significantly smaller BTE ratio was observed in the AM tunnel 5 mm (P = .003; with fibrin clot: 29.3% ± 58.1%; autograft alone: 58.8% ± 57.8%) and 10 mm (P < .001; with fibrin clot: -8.0% ± 43.7%; autograft alone: 42.3% ± 39.7%) from the intra-articular tunnel aperture and in the PL tunnel at all levels (P = .048, P < .001, and P < .001; with fibrin clot: 49.1% ± 89.3%, 7.9% ± 28.4%, and -5.1% ± 25.6%; autograft alone: 89.8% ± 57.0%, 28.9% ± 26.8%, and 51.4% ± 38.6%, respectively) compared with controls who received only autograft.
Conclusion: Adding a fibrin clot to the autograft of an anatomic DB-ACLR was associated with a decreased BTE at 1 year. This effect was more evident in the PL tunnel and the midportion of the AM tunnel.
期刊介绍:
The Orthopaedic Journal of Sports Medicine (OJSM), developed by the American Orthopaedic Society for Sports Medicine (AOSSM), is a global, peer-reviewed, open access journal that combines the interests of researchers and clinical practitioners across orthopaedic sports medicine, arthroscopy, and knee arthroplasty.
Topics include original research in the areas of:
-Orthopaedic Sports Medicine, including surgical and nonsurgical treatment of orthopaedic sports injuries
-Arthroscopic Surgery (Shoulder/Elbow/Wrist/Hip/Knee/Ankle/Foot)
-Relevant translational research
-Sports traumatology/epidemiology
-Knee and shoulder arthroplasty
The OJSM also publishes relevant systematic reviews and meta-analyses.
This journal is a member of the Committee on Publication Ethics (COPE).