AIM To quantitatively assess rotatory and anterior-posterior instability in vivo after anterior cruciate ligament(ACL) reconstruction using bone-patellar tendon-bone(BTB) autografts, and to clarify the influence of tu...AIM To quantitatively assess rotatory and anterior-posterior instability in vivo after anterior cruciate ligament(ACL) reconstruction using bone-patellar tendon-bone(BTB) autografts, and to clarify the influence of tunnel positions on the knee stability.METHODS Single-bundle ACL reconstruction with BTB autograft was performed on 50 patients with a mean age of 28 years using the trans-tibial(TT)(n = 20) and trans-portal(TP)(n = 30) techniques. Femoral and tibial tunnel positions were identified from the high-resolution 3 D-CT bone models two weeks after surgery. Anterolateral rotatory translation was examined using a Slocum anterolateral rotatory instability test in open magnetic resonance imaging(MRI) 1.0-1.5 years after surgery, by measuring anterior tibial translation at the medial and lateral compartments on its sagittal images. Anterior-posterior stability was evaluated with a Kneelax3 arthrometer.RESULTS A total of 40 patients(80%) were finally followed up. Femoral tunnel positions were shallower(P < 0.01) and higher(P < 0.001), and tibial tunnel positions were more posterior(P < 0.05) in the TT group compared with the TP group. Anterolateral rotatory translations in reconstructed knees were significantly correlated with the shallow femoral tunnel positions(R = 0.42, P < 0.01), and the rotatory translations were greater in the TT group(3.2 ± 1.6 mm) than in the TP group(2.0 ± 1.8 mm)(P < 0.05). Side-to-side differences of Kneelax3 arthrometer were 1.5 ± 1.3 mm in the TT, and 1.7 ± 1.6 mm in the TP group(N.S.). Lysholm scores, KOOS subscales and reinjury rate showed no difference between the two groups.CONCLUSION Anterolateral rotatory instability significantly correlated shallow femoral tunnel positions after ACL reconstruction using BTB autografts. Clinical outcomes, rotatory and anterior-posterior stability were overall satisfactory in both techniques, but the TT technique located femoral tunnels in shallower and higher positions, and tibial tunnels in more posterior positions than the TP technique, thus increased the anterolateral rotation. Anatomic ACL reconstruction with BTB autografts may restore knee function and stability.展开更多
背景:同种异体移植物在膝关节前交叉韧带重建的相关基础及临床实践中有着积极的推动作用与重要地位。目的:归纳总结近年来同种异体移植物在膝关节前交叉韧带重建中的应用及研究进展。方法:以"allograft tends OR allografts、intra...背景:同种异体移植物在膝关节前交叉韧带重建的相关基础及临床实践中有着积极的推动作用与重要地位。目的:归纳总结近年来同种异体移植物在膝关节前交叉韧带重建中的应用及研究进展。方法:以"allograft tends OR allografts、intra-articular knee ligament OR anterior cruciate ligament OR ACL"为检索词,检索2012年1月至2018年2月PubMed、Embase等数据库中发表的相关文献,语言设定为英文。结果与结论:国内膝关节前交叉韧带重建使用同种异体肌腱的相关研究目前仍处在发展阶段。目前,对于前交叉韧带重建中使用同种异体移植物或自体移植物的优劣暂无定论。对于选择同种异体移植物的担忧主要来源于可能存在感染及愈合缓慢等问题。对于同种异体移植及自体移植术后效果比较,不同试验得出的结果差异较大。所反映出的结论大致为:2种移植物术后患者膝关节功能无差异,或自体移植后患者膝关节功能较好。有研究表明,同种异体移植物可能会增高二次手术的风险。因此,同种异体肌腱在膝关节前交叉韧带重建的临床应用中面临着诸多挑战。展开更多
基金Supported by JSPS Fellowships for Research Abroad,No.H27-787International Research Fund for Subsidy of Kyushu University School of Medicine Alumni
文摘AIM To quantitatively assess rotatory and anterior-posterior instability in vivo after anterior cruciate ligament(ACL) reconstruction using bone-patellar tendon-bone(BTB) autografts, and to clarify the influence of tunnel positions on the knee stability.METHODS Single-bundle ACL reconstruction with BTB autograft was performed on 50 patients with a mean age of 28 years using the trans-tibial(TT)(n = 20) and trans-portal(TP)(n = 30) techniques. Femoral and tibial tunnel positions were identified from the high-resolution 3 D-CT bone models two weeks after surgery. Anterolateral rotatory translation was examined using a Slocum anterolateral rotatory instability test in open magnetic resonance imaging(MRI) 1.0-1.5 years after surgery, by measuring anterior tibial translation at the medial and lateral compartments on its sagittal images. Anterior-posterior stability was evaluated with a Kneelax3 arthrometer.RESULTS A total of 40 patients(80%) were finally followed up. Femoral tunnel positions were shallower(P < 0.01) and higher(P < 0.001), and tibial tunnel positions were more posterior(P < 0.05) in the TT group compared with the TP group. Anterolateral rotatory translations in reconstructed knees were significantly correlated with the shallow femoral tunnel positions(R = 0.42, P < 0.01), and the rotatory translations were greater in the TT group(3.2 ± 1.6 mm) than in the TP group(2.0 ± 1.8 mm)(P < 0.05). Side-to-side differences of Kneelax3 arthrometer were 1.5 ± 1.3 mm in the TT, and 1.7 ± 1.6 mm in the TP group(N.S.). Lysholm scores, KOOS subscales and reinjury rate showed no difference between the two groups.CONCLUSION Anterolateral rotatory instability significantly correlated shallow femoral tunnel positions after ACL reconstruction using BTB autografts. Clinical outcomes, rotatory and anterior-posterior stability were overall satisfactory in both techniques, but the TT technique located femoral tunnels in shallower and higher positions, and tibial tunnels in more posterior positions than the TP technique, thus increased the anterolateral rotation. Anatomic ACL reconstruction with BTB autografts may restore knee function and stability.
文摘背景:同种异体移植物在膝关节前交叉韧带重建的相关基础及临床实践中有着积极的推动作用与重要地位。目的:归纳总结近年来同种异体移植物在膝关节前交叉韧带重建中的应用及研究进展。方法:以"allograft tends OR allografts、intra-articular knee ligament OR anterior cruciate ligament OR ACL"为检索词,检索2012年1月至2018年2月PubMed、Embase等数据库中发表的相关文献,语言设定为英文。结果与结论:国内膝关节前交叉韧带重建使用同种异体肌腱的相关研究目前仍处在发展阶段。目前,对于前交叉韧带重建中使用同种异体移植物或自体移植物的优劣暂无定论。对于选择同种异体移植物的担忧主要来源于可能存在感染及愈合缓慢等问题。对于同种异体移植及自体移植术后效果比较,不同试验得出的结果差异较大。所反映出的结论大致为:2种移植物术后患者膝关节功能无差异,或自体移植后患者膝关节功能较好。有研究表明,同种异体移植物可能会增高二次手术的风险。因此,同种异体肌腱在膝关节前交叉韧带重建的临床应用中面临着诸多挑战。
