{"title":"前交叉韧带重建后隧道拓宽的预测因素","authors":"Romir Patel, Maher Ghandour, Fabio Sammartino, Julien Druel, Drew Slater, Wiemi Douoguih, Matthieu Ollivier","doi":"10.1177/03635465251382911","DOIUrl":null,"url":null,"abstract":"Background: Posterior tibial slope (PTS) has been implicated in tunnel widening after anterior cruciate ligament reconstruction (ACLR), yet its precise effect remains unclear. Additionally, the influence of lateral extra-articular tenodesis (LET) and meniscus root injuries on tunnel widening has not been well established. Purpose: To evaluate the effect of medial and lateral PTS, LET, and meniscus root injuries on tibial and femoral tunnel widening after ACL reconstruction using a hamstring tendon graft. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 307 patients who underwent primary ACLR with a hamstring tendon graft were included. Tibial and femoral tunnel diameters were measured immediately postoperatively and at 2-year follow-up. PTS was assessed by long lateral radiographs. Univariate and multivariate regression models were used to identify predictors of tunnel widening. Results: At 2 years, the mean ± Standard Deviation (SD) tibial tunnel diameter increased from 9.46 ± 1.00 mm postoperatively to 11.35 ± 1.55 mm ( <jats:italic>P</jats:italic> < .001), and the mean femoral tunnel diameter increased from 9.27 ± 0.83 mm to 11.52 ± 1.63 mm ( <jats:italic>P</jats:italic> < .001). Univariate analysis demonstrated that steeper medial and lateral PTS were significantly associated with tibial ( <jats:italic>P</jats:italic> < .0001) and femoral ( <jats:italic>P</jats:italic> < .0001) tunnel widening. Meniscus root injuries ( <jats:italic>P</jats:italic> = .0024) and higher body mass index ( <jats:italic>P</jats:italic> = .0127) were also associated with increased tunnel widening. In multivariate regression, medial PTS (β = −0.321; <jats:italic>P</jats:italic> < .0001), lateral PTS (β = −0.137; <jats:italic>P</jats:italic> = .0356), LET (β = 0.2207; <jats:italic>P</jats:italic> = .0257), and meniscus root injuries ( <jats:italic>P</jats:italic> = .0024) remained independent predictors of tunnel widening. Conclusion: Steeper medial and lateral PTSs, the addition of LET, and the presence of meniscus root injuries are significant independent predictors of tibial and femoral tunnel widening after ACLR with a hamstring graft. These findings highlight key anatomic and surgical factors influencing postoperative tunnel remodeling and emphasize the importance of considering these variables in ACLR planning.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"1 1","pages":"3635465251382911"},"PeriodicalIF":0.0000,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Predictors of Tunnel Widening After Anterior Cruciate Ligament Reconstruction\",\"authors\":\"Romir Patel, Maher Ghandour, Fabio Sammartino, Julien Druel, Drew Slater, Wiemi Douoguih, Matthieu Ollivier\",\"doi\":\"10.1177/03635465251382911\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Background: Posterior tibial slope (PTS) has been implicated in tunnel widening after anterior cruciate ligament reconstruction (ACLR), yet its precise effect remains unclear. Additionally, the influence of lateral extra-articular tenodesis (LET) and meniscus root injuries on tunnel widening has not been well established. Purpose: To evaluate the effect of medial and lateral PTS, LET, and meniscus root injuries on tibial and femoral tunnel widening after ACL reconstruction using a hamstring tendon graft. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 307 patients who underwent primary ACLR with a hamstring tendon graft were included. Tibial and femoral tunnel diameters were measured immediately postoperatively and at 2-year follow-up. PTS was assessed by long lateral radiographs. Univariate and multivariate regression models were used to identify predictors of tunnel widening. Results: At 2 years, the mean ± Standard Deviation (SD) tibial tunnel diameter increased from 9.46 ± 1.00 mm postoperatively to 11.35 ± 1.55 mm ( <jats:italic>P</jats:italic> < .001), and the mean femoral tunnel diameter increased from 9.27 ± 0.83 mm to 11.52 ± 1.63 mm ( <jats:italic>P</jats:italic> < .001). Univariate analysis demonstrated that steeper medial and lateral PTS were significantly associated with tibial ( <jats:italic>P</jats:italic> < .0001) and femoral ( <jats:italic>P</jats:italic> < .0001) tunnel widening. Meniscus root injuries ( <jats:italic>P</jats:italic> = .0024) and higher body mass index ( <jats:italic>P</jats:italic> = .0127) were also associated with increased tunnel widening. In multivariate regression, medial PTS (β = −0.321; <jats:italic>P</jats:italic> < .0001), lateral PTS (β = −0.137; <jats:italic>P</jats:italic> = .0356), LET (β = 0.2207; <jats:italic>P</jats:italic> = .0257), and meniscus root injuries ( <jats:italic>P</jats:italic> = .0024) remained independent predictors of tunnel widening. Conclusion: Steeper medial and lateral PTSs, the addition of LET, and the presence of meniscus root injuries are significant independent predictors of tibial and femoral tunnel widening after ACLR with a hamstring graft. These findings highlight key anatomic and surgical factors influencing postoperative tunnel remodeling and emphasize the importance of considering these variables in ACLR planning.\",\"PeriodicalId\":517411,\"journal\":{\"name\":\"The American Journal of Sports Medicine\",\"volume\":\"1 1\",\"pages\":\"3635465251382911\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2025-10-09\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"The American Journal of Sports Medicine\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1177/03635465251382911\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"The American Journal of Sports Medicine","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1177/03635465251382911","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
背景：胫骨后坡（PTS）与前交叉韧带重建（ACLR）后隧道拓宽有关，但其确切作用尚不清楚。此外，外侧关节外肌腱固定术（LET）和半月板根损伤对隧道拓宽的影响尚未得到很好的证实。目的：评价内侧和外侧PTS、LET和半月板根损伤对腘绳肌腱移植重建前交叉韧带后胫骨和股骨隧道拓宽的影响。研究设计：队列研究；证据水平，3。方法：共纳入307例行原发性ACLR合并腘绳肌腱移植的患者。术后立即测量胫骨和股骨隧道直径，随访2年。通过长侧位x线片评估PTS。采用单变量和多变量回归模型确定隧道扩宽的预测因子。结果：术后2年，胫骨隧道直径平均值±标准差（SD）由术后9.46±1.00 mm增加到11.35±1.55 mm (P < 0.001)，股骨隧道直径平均值由术后9.27±0.83 mm增加到11.52±1.63 mm （P < 0.001）。单因素分析表明，内侧和外侧更陡的PTS与胫骨（P < .0001）和股骨（P < .0001）隧道拓宽显著相关。半月板根损伤（P = 0.0024）和较高的身体质量指数（P = 0.0127）也与隧道拓宽增加有关。在多元回归中，内侧PTS （β = - 0.321; P < 0.0001）、外侧PTS （β = - 0.137; P = 0.056）、LET （β = 0.2207; P = 0.0257）和半月板根损伤（P = 0.0024）仍然是隧道拓宽的独立预测因素。结论：内侧和外侧PTSs更陡、LET的增加以及半月板根损伤的存在是ACLR合并腿筋移植后胫骨和股骨隧道拓宽的重要独立预测因素。这些发现强调了影响术后隧道重塑的关键解剖和手术因素，并强调了在ACLR计划中考虑这些变量的重要性。
Predictors of Tunnel Widening After Anterior Cruciate Ligament Reconstruction
Background: Posterior tibial slope (PTS) has been implicated in tunnel widening after anterior cruciate ligament reconstruction (ACLR), yet its precise effect remains unclear. Additionally, the influence of lateral extra-articular tenodesis (LET) and meniscus root injuries on tunnel widening has not been well established. Purpose: To evaluate the effect of medial and lateral PTS, LET, and meniscus root injuries on tibial and femoral tunnel widening after ACL reconstruction using a hamstring tendon graft. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 307 patients who underwent primary ACLR with a hamstring tendon graft were included. Tibial and femoral tunnel diameters were measured immediately postoperatively and at 2-year follow-up. PTS was assessed by long lateral radiographs. Univariate and multivariate regression models were used to identify predictors of tunnel widening. Results: At 2 years, the mean ± Standard Deviation (SD) tibial tunnel diameter increased from 9.46 ± 1.00 mm postoperatively to 11.35 ± 1.55 mm ( P < .001), and the mean femoral tunnel diameter increased from 9.27 ± 0.83 mm to 11.52 ± 1.63 mm ( P < .001). Univariate analysis demonstrated that steeper medial and lateral PTS were significantly associated with tibial ( P < .0001) and femoral ( P < .0001) tunnel widening. Meniscus root injuries ( P = .0024) and higher body mass index ( P = .0127) were also associated with increased tunnel widening. In multivariate regression, medial PTS (β = −0.321; P < .0001), lateral PTS (β = −0.137; P = .0356), LET (β = 0.2207; P = .0257), and meniscus root injuries ( P = .0024) remained independent predictors of tunnel widening. Conclusion: Steeper medial and lateral PTSs, the addition of LET, and the presence of meniscus root injuries are significant independent predictors of tibial and femoral tunnel widening after ACLR with a hamstring graft. These findings highlight key anatomic and surgical factors influencing postoperative tunnel remodeling and emphasize the importance of considering these variables in ACLR planning.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
