髌腱重建后至少5年的三维磁共振成像显示大腿肌肉体积仍然减少，而不是同种异体前交叉韧带重建

Q3 Medicine

Arthroscopy Sports Medicine and Rehabilitation Pub Date : 2025-08-01 DOI:10.1016/j.asmr.2025.101191

Collin D.R. Hunter B.S., Natalya McNamara M.D., Reece M. Rosenthal, Joseph Featherall M.D., Patrick Greis M.D., Travis G. Maak M.D., Stephen K. Aoki M.D., Justin J. Ernat M.D.

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引用次数: 0

摘要

目的利用三维磁共振成像（MRI）模型，评价同种异体组织或自体骨-髌腱-骨（BPTB）移植行前交叉韧带重建（ACLR）患者大腿肌肉体积的差异。方法：这是一项回顾性的单中心研究，研究对象是接受原发性ACLR的同侧BPTB自体移植或同种异体移植组织患者。纳入标准为年龄18-45岁，随访5 - 8年，体重指数30。如果患者有膝关节多韧带损伤，手术治疗半月板撕裂（修复或重建），以及指数ACLR后的任何后续膝关节手术，则排除患者。对双侧大腿进行三维MRI扫描，用三维建模软件绘制图像，分别对大腿、大腿前侧、后侧和大腿内侧隔室肌肉组织进行分割并计算体积。使用t检验对数据进行评估，并将肌肉体积标准化为相应非手术肢体的百分比，然后与替代移植物类型进行比较。结果10例BPTB患者均接受同种异体移植。同种异体移植患者在手术时年龄较大(平均年龄34.6岁比23.4岁（P < 0.001），在研究MRI时年龄较大（平均年龄40.9岁比29.7岁；P < 0.001）。同种异体移植物在手术和非手术肢体之间的总大腿或室间肌体积没有差异。BPTB患者手术侧大腿总容积减少（103 cm3, 97.0%, P = 0.013），而四肢间室容积保持相似。不同移植物类型组间对侧大腿体积百分率变化无显著性差异。结论同种异体ACLR移植后各股间室及总容积均无显著差异。BPTB ACLR对长期总大腿肌肉容量有适度的影响（约3%）。证据水平：III级，回顾性队列研究。

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Thigh Muscle Volume Remains Decreased on 3-Dimensional Magnetic Resonance Imaging at Minimum of 5 Years After Patellar Tendon but not Allograft Anterior Cruciate Ligament Reconstruction

Purpose

To evaluate thigh muscle volume differences in patients undergoing anterior cruciate ligament reconstruction (ACLR) with either allograft tissue or bone−patellar tendon−bone (BPTB) autografts, using 3-dimensional magnetic resonance imaging (MRI) modeling.

Methods

This is a retrospective, single-center study of patients undergoing primary ACLR with either ipsilateral BPTB autograft or allograft tissue. Inclusion criteria were age 18-45 years, 5 to 8 years of follow-up, and body mass index <30. Patients were excluded if they had multiligamentous knee injuries, surgical treatment of meniscus tears (repair or reconstruction), and any subsequent knee procedures after the index ACLR. 3D MRI of the bilateral thighs was performed and images were rendered with 3D modeling software and the total thigh, anterior-, posterior-, and medial-thigh compartment musculature were individually segmented and the volumes were calculated. Data were evaluated using a t test, and muscle volumes were standardized as a percentage of the corresponding nonoperative extremity and then tested in comparison with the alternative graft type.

Results

Ten allograft and 10 patients with BPTB were included. Patients with allograft were older at surgery (mean age 34.6 vs 23.4 years (P < .001) and at study MRI (mean age 40.9 vs 29.7 years; P < .001). Allografts showed no differences in total thigh or compartmental muscle volumes between the operative and nonoperative limbs. BPTB showed a statistically significant reduction in total thigh volume on the operative side (103 cm³, 97.0%, P = .013), whereas compartment volumes remained similar between limbs. Percentage changes in volume comparing injured with contralateral thigh volume was not significantly different between graft type groups.

Conclusions

No significant side-to-side differences were found in individual thigh compartments or total volume after allograft ACLR. BPTB ACLR has a modest effect (∼3%) on long-term total thigh muscle volume.