{"title":"解剖矩形隧道ACL重建中骨栓位置与隧道孔径形态变化的关系。","authors":"Ryohei Uchida, Yoshiki Shiozaki, Yoshinari Tanaka, Keisuke Kita, Hiroshi Amano, Takashi Kanamoto, Tatsuo Mae, Yuta Tachibana, Rikio Takao, Shuji Horibe","doi":"10.1007/s00167-018-5224-8","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>In 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.</p><p><strong>Methods: </strong>Subjects were 30 consecutive patients (six females and 24 males; mean age, 20.4 ± 5.4 years) who underwent primary ACL-R using BTB. The distance from the tunnel aperture to the tendon-bone junction (TBJ) at 2 weeks postoperatively, and tunnel aperture enlargement and tunnel wall migration from 2 weeks to 6 months postoperatively, were evaluated.</p><p><strong>Results: </strong>The distance from the femoral tunnel aperture to the TBJ in most cases was less than 2 mm, whereas the TBJ was located within the tibial tunnel. Femoral tunnel aperture was significantly enlarged (17.0 ± 11.7%) 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).</p><p><strong>Conclusion: </strong>Both 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.</p><p><strong>Level of evidence: </strong>4 (case series).</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":"2417-2425"},"PeriodicalIF":0.0000,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00167-018-5224-8","citationCount":"11","resultStr":"{\"title\":\"Relationship between bone plug position and morphological changes of tunnel aperture in anatomic rectangular tunnel ACL reconstruction.\",\"authors\":\"Ryohei Uchida, Yoshiki Shiozaki, Yoshinari Tanaka, Keisuke Kita, Hiroshi Amano, Takashi Kanamoto, Tatsuo Mae, Yuta Tachibana, Rikio Takao, Shuji Horibe\",\"doi\":\"10.1007/s00167-018-5224-8\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>In 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.</p><p><strong>Methods: </strong>Subjects were 30 consecutive patients (six females and 24 males; mean age, 20.4 ± 5.4 years) who underwent primary ACL-R using BTB. The distance from the tunnel aperture to the tendon-bone junction (TBJ) at 2 weeks postoperatively, and tunnel aperture enlargement and tunnel wall migration from 2 weeks to 6 months postoperatively, were evaluated.</p><p><strong>Results: </strong>The distance from the femoral tunnel aperture to the TBJ in most cases was less than 2 mm, whereas the TBJ was located within the tibial tunnel. Femoral tunnel aperture was significantly enlarged (17.0 ± 11.7%) 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).</p><p><strong>Conclusion: </strong>Both 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.</p><p><strong>Level of evidence: </strong>4 (case series).</p>\",\"PeriodicalId\":520702,\"journal\":{\"name\":\"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA\",\"volume\":\" \",\"pages\":\"2417-2425\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2019-08-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://sci-hub-pdf.com/10.1007/s00167-018-5224-8\",\"citationCount\":\"11\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s00167-018-5224-8\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2018/11/21 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00167-018-5224-8","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2018/11/21 0:00:00","PubModel":"Epub","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 11
摘要
目的:在使用骨-髌腱-骨(BTB)重建前交叉韧带(ACL- r)后的动物研究中，发现骨塞与隧道壁的关系决定了移植愈合模式。这种移植物愈合方式的差异会影响术后隧道的形态变化。然而，尚未有研究评估骨栓位置与隧道形态变化的关系。因此，本研究的主要目的是利用计算机断层扫描研究ACL-R中股骨或胫骨隧道内骨塞位置与各隧道孔径形态变化的关系。方法:研究对象为30例连续患者(女性6例，男性24例;平均年龄(20.4±5.4岁)。观察术后2周隧道开口至肌腱-骨交界处(TBJ)的距离，以及术后2周至6个月隧道开口扩大和隧道壁移动情况。结果:股骨隧道开口至TBJ的距离多数小于2mm，而TBJ位于胫骨隧道内。股骨隧道远端开孔显著增大(17.0±11.7%)，胫骨隧道后外侧开孔显著增大(19.6±12.5%)。只有股骨远端骨塞位置与股骨隧道孔径扩大相关(r = 0.454, p = 0.0015)。结论:术后6个月，股骨、胫骨隧道孔远端和后外侧均明显扩大。仅发现股骨远端骨塞位置与股骨隧道扩大之间存在相关性，提示股骨隧道中较深的骨塞位置是股骨隧道扩大的危险因素，突出了将TBJ准确定位在股骨隧道开口处的重要性。另一种选择是偏离髌腱的收获位置，以匹配TBJ和隧道孔径的形状。证据等级:4(案例系列)。
Relationship between bone plug position and morphological changes of tunnel aperture in anatomic rectangular tunnel ACL reconstruction.
Purpose: In 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.
Methods: Subjects were 30 consecutive patients (six females and 24 males; mean age, 20.4 ± 5.4 years) who underwent primary ACL-R using BTB. The distance from the tunnel aperture to the tendon-bone junction (TBJ) at 2 weeks postoperatively, and tunnel aperture enlargement and tunnel wall migration from 2 weeks to 6 months postoperatively, were evaluated.
Results: The distance from the femoral tunnel aperture to the TBJ in most cases was less than 2 mm, whereas the TBJ was located within the tibial tunnel. Femoral tunnel aperture was significantly enlarged (17.0 ± 11.7%) 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).
Conclusion: Both 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.
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