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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >ACL Reconstruction: Is There A Difference In Graft Motion For Bone-patellar Tendon-bone Vs Hamstring Autograft At 6 Weeks Post-operatively?
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ACL Reconstruction: Is There A Difference In Graft Motion For Bone-patellar Tendon-bone Vs Hamstring Autograft At 6 Weeks Post-operatively?

机译：ACL重建：术后6周，-骨肌腱腱与自体Ham绳肌的植骨运动有区别吗？

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Objectives: Graft-tunnel healing following ACL reconstruction (ACLR) is a complex process influenced by multiple surgical variables, one of which is graft type. Clinical outcomes of bone-patellar tendon-bone (BTB) and hamstring (HS) autografts are similar, yet animal studies suggest that the healing processes may differ between the two autografts. Moreover, little is known about the relationship between graft-tunnel motion and the healing process in vivo in humans. This study was designed to compare BTB and HS graft motion within the femoral and tibial tunnels and the intra-articular graft post-operatively. We hypothesized that tunnel motion and mid-substance stretch would be greater for HS than BTB at 6 weeks following surgery. Methods: After IRB approval, 16 subjects (8 BTB, 8 HS) with an average age of 20 (range 16 to 37) underwent anatomic single-bundle ACLR by the same surgeon. Tunnel location, drilling and fixation were identical for all patients. Six 0.8 mm tantalum beads were embedded into ACL grafts prior to implantation using a custom injector. Pairs of beads were located within each bone tunnel and in the graft mid-substance (See image of graft constructs). Six weeks after surgery, CT scans were obtained and used to create 3D femur and tibia bone models. Cylindrical coordinate systems were fit to the bone tunnels to assess motion along tunnel axes. Dynamic stereo x-ray (DSX) images were collected at 100 frames/s while subjects performed treadmill walking and stair descent. Tibiofemoral kinematics were analyzed by combining the 3D models with DSX data. Graft-tunnel motion was defined as the maximum displacement of the implanted beads along the direction of the bone tunnel axis following footstrike. BTB and HS graft tunnel motions were compared using t-tests, with a significance level of p < 0.05. Results: Data are currently available for 6 BTB and 6 HS patients (N=12). Graft motion was seen in both groups within the femoral and tibial tunnels (range: 0.39 - 3.97 mm). Contrary to our hypothesis there was a trend towards greater femoral tunnel graft motion in the BTB relative to HS grafts during walking and stair descent (P=0.14 and 0.12, Table 1A-1B). There was more BTB graft motion in the femoral tunnel than in the tibial tunnel (significantly different for gait), and conversely more HS graft motion in the tibial tunnel than in the femoral tunnel (significantly different for stair descent). There was no detectable mid-substance stretch across all subjects. Conclusion: Six weeks following ACLR, less tunnel motion was expected for the BTB group compared to HS, due to the perceived advantages of bone-on-bone healing. However, more motion was observed for the BTB group within the femoral tunnel compared to HS, challenging the assumption that at 6 weeks after surgery there is greater graft-tunnel healing with BTB grafts. Based on previous studies, the native ACL elongates around 1-4% (0.3-1.2 mm) during loaded knee extension. At 6 weeks post surgery, it appears that the ACL grafts are moving in the tunnels rather than stretching in the mid-substance portion. This pattern may reverse over time, as graft-tunnel healing progresses (1-year followup testing is planned). Additionally, graft type appeared to affect the relative amount of motion between the tibial and femoral tunnels, though the cause and clinical significance of this finding is unclear. Results of this study could have important implications for graft selection, rehabilitation progression and return to sports.
机译：目的：ACL重建（ACLR）后的移植物隧道愈合是一个受多种外科手术变量影响的复杂过程，其中之一是移植物类型。 TB骨肌腱（BTB）和绳肌（HS）自体移植的临床结果相似，但是动物研究表明，两种自体移植的愈合过程可能有所不同。此外，对于人体中的移植物隧道运动与体内愈合过程之间的关系知之甚少。这项研究旨在比较术后BTB和HS移植物在股，胫骨隧道内以及关节内移植物的运动。我们假设，术后6周，HS的隧道运动和中段舒展将大于BTB。方法：IRB批准后，由同一位外科医生对平均年龄为20岁（16至37岁）的16位受试者（8 BTB，8 HS）进行了解剖性单束ACLR。所有患者的隧道位置，钻孔和固定均相同。在使用定制注射器植入之前，将六个0.8 mm钽珠嵌入ACL移植物中。成对的珠子位于每个骨通道内和移植物的中间物质中（参见移植物结构的图像）。手术六周后，获得了CT扫描，并用于创建3D股骨和胫骨模型。圆柱坐标系适合骨骼隧道，以评估沿隧道轴的运动。动态立体X射线（DSX）图像以100帧/秒的速度收集，而受试者则在跑步机上行走和下楼梯。通过将3D模型与DSX数据相结合来分析胫股运动学。移植隧道运动定义为在脚部敲打后植入的小珠沿着骨隧道轴方向的最大位移。使用t检验比较BTB和HS移植隧道的运动，显着性水平p <0.05。结果：目前有6名BTB和6名HS患者的数据（N = 12）。两组均在股骨和胫骨隧道内观察到了移植物运动（范围：0.39-3.97 mm）。与我们的假设相反，在步行和楼梯下降期间，相对于HS移植物，BTB的股骨隧道移植物运动趋于增加（P = 0.14和0.12，表1A-1B）。股骨隧道中的BTB移植物运动比胫骨隧道中的更多（步态显着不同），而胫骨隧道中的HS移植物运动比股骨隧道中的更多（对于台阶下降显着不同）。在所有受试者中均未检测到中间物质伸展。结论：ACLR六周后，由于骨对骨愈合的优势，预计BTB组的隧道运动将少于HS。但是，与HS相比，在股骨隧道内观察到BTB组的运动更多，这挑战了以下假设：手术后6周，BTB移植物的移植隧道愈合更大。根据以前的研究，在负载的膝盖伸展过程中，原始ACL会延长大约1-4％（0.3-1.2毫米）。术后6周，ACL移植物似乎在隧道中移动，而不是在中间物质部分拉伸。随着移植隧道愈合的进展，这种模式可能会随着时间而逆转（计划进行1年的随访测试）。此外，尽管这一发现的原因和临床意义尚不清楚，但移植物类型似乎会影响胫骨和股骨隧道之间的相对运动量。这项研究的结果可能对移植物的选择，康复进程和恢复运动有重要意义。

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