不同固定方式及移植物对膝ACL重建术后骨道扩大的相关研究
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摘要
目的：探讨自体胭绳肌腱重建膝ACL,移植物不同固定方式对术后股骨隧道的影响、与临床疗效关系。
方法：88例ACL损伤病例行关节镜下自体半腱肌、股薄肌腱重建ACL,根据移植物股骨侧固定方式不同,分为三组。A组26例,采用Endobutton固定；B组22例,采用可吸收挤压螺钉固定；C组40例,采用Rigidfix固定。术后平均随访16.5个月,进行MRI检查,测量矢状位骨道开口、开口1 cm、骨道最宽处三点骨道直径,以术后1周对应部位骨道直径为衡量标准,对其差值进行统计学分析。采用Lysholm评分评估各组临床疗效。结果：三组病例ACL术后骨道直径均有不同程度增宽。在股骨侧骨道最宽处、开口1 cm处,三组测量结果两两对比有统计学差异(P<0.05),B组增宽明显,c组骨道增宽最小；在股骨骨道开口处,C组骨道增宽程度最小(P<0.05),A组和B组无对比差异(P>0.05)。A组、C组股骨骨道形态呈线形；B组股骨骨道形态呈锥形。所有病例关节稳定性良好,无一例出现不稳。术后Lysholm评分,A组94.4±2.9,B组93.4±3.6,C组96.3±2.7,三组间比较无显著差异(P>0.05)。
结论：移植物固定方式影响ACL术后骨道扩大,是骨道扩大发生的重要因素；固定方式、骨道扩大程度与术后临床疗效无相关。
目的：探讨自体胭绳肌腱、同种异体肌腱对膝ACL重建术后骨隧道的影响、临床疗效差异。
方法：自2007年6月至2008年11月,61例ACL损伤病例行关节镜下ACL重建。根据采用移植物不同,分为二组,A组27例,采用同种异体肌腱；B组34例,采用自体胭绳肌腱。术后平均随访A组8.4月,B组8.5月。术后1周、6月-12月进行MRI检查,测量矢状位骨道开口、开口1cm、骨道最宽处三点骨道直径,以术后1周对应部位骨道直径为衡量标准,对其差值进行统计学分析。采用Lysholm评分评估各组临床疗效。结果：二组病例资料术前对比无差异。术后MRI随访发现股骨侧、胫骨侧骨道直径均有不同程度的增宽,其中胫骨侧较股骨侧增宽较重,两组资料在股骨、胫骨三个不同测量部位骨道增宽无对比差异。所有病例关节稳定性良好,无一例出现不稳。移植物呈连续性信号,未见明显骨髓水肿。术后Lysholm评分,A组90.1±4.2分,B组92.4±3.2分,比较无显著差异(p>0.05)。
结论：不同的移植物影响ACL术后骨道扩大,是骨道扩大发生的因素之一；自体肌腱、同种异体肌腱对ACL术后骨道扩大无对比差异,与术后临床疗效无相关。
目的：探讨保留或非保留ACL残迹对ACL术后胫骨骨道影响,与临床疗效的关系。方法：65例ACL损伤病例行关节镜下自体半腱肌、股薄肌腱重建ACL,其中A组27例,采用保留ACL残迹进行重建：B组38例,采用非保留残迹的ACL重建。术后随访进行MRI检查,测量胫骨矢状位骨道最宽处直径,以术后1周对应部位骨道直径为衡量标准,对骨道扩大率进行统计学分析。采用Lysholm评分评估各组临床疗效。结果：A组25例、B组35例得以随访,其中A组平均随访12.4月,B组平均随访12.1月。二组病例术后胫骨道直径均有不同程度的增宽,以B组骨道扩大程度相对较高。结果表明胫骨骨隧道扩大程度以术后6周最为显著,术后3个月骨隧道变化相对较小,术后6个月以后骨隧道扩大百分比略呈下降趋势；术后在各个时间段上两组资料胫骨骨隧道扩大程度均无统计学意义(P>0.05)。所有病例关节稳定性良好,术后Lysholm评分在随访过程中逐步提高,两组病例在各个时间段的Lysholm评分对比无统计学意义(P>0.05)。结论：保留ACL残迹韧带重建在预防术后骨道扩大没有明显优势。是否保留ACL残迹对骨道扩大、术后疗效无相关性,但保留ACL残迹可以促进腱-骨愈合,降低骨道扩大发生程度。
Objective To compare the changes in femoral bone tunnel after arthroscopically assisted hamstring ACL reconstruction with different graft fixation and investigate the relation with clinical effect.
Methods Eighty-eight cases in three groups were included and underwent hamstring ACL reconstruction with different femoral graft fixation for average 16.5-month follow-up evaluation. Twenty-six cases in group A received Endobutton fixation, twenty-two cases (group B) interference screw, and forty cases (group C) Rigidfix system. Femoral bone tunnel diameters at the articular line level, the widest point,1 cm away from tunnel aperture on sagittal MRI were compared at one week postoperatively. Lysholm score was used to evaluate the clinical effect.
Results Tunnel enlargement after ACL surgery was noted in the three groups. At the femoral widest point and 1 cm away from tunnel aperture, the tunnel enlargement was larger in group B and smaller in group C. At the femoral articular line level, the bone tunnel enlargement in group C was smallest. There was no difference between groups A and B. The shape of femoral tunnel was lineal in groups A and C, and conical in group B. No significant difference was found by Lysholm score.
Conclusions The type of graft fixation is a major factor in the development of tunnel enlargement after ACL surgery. No correlation between graft fixation, bone tunnel enlargement and clinical effect, was found.
Objective To compare the changes in bone tunnel after arthroscopic assisted ACL reconstruction with autograft and allograft and investigate the relation with clinical effect.
Methods From Jun,2007 to Dec,2008,61 cases were undergone ACL reconstruction.According to ACL graft, two groups were included.27cases in group A were performed with allograft for average 8.4 months follow-up evaluation.34 cases in group B with autograft. Bone tunnel diameter in 6-12months at the articular line level, the widest point,1 cm away from tunnel aperture in saggital and coronal MRI was compared with the results from 1 week postoperatively. Lysholm score was used to evaluate the clinical effect in groups.
Results Tunnel enlargement after ACL surgery in both groups was noted. The extent of bone tunnel was larger in tibia than in femur.At the femoral and tibial widest point,1 cm away from tunnel aperture and the articular line level, there was no difference in group A and B for bone tunnel enlargement. No significant difference was found with respect to Lysholm score.
Conclusions The type of ACL graft is a factor in the development of tunnel enlargement after ACL surgery. No evidence is proved correlation in ACL graft, bone tunnel enlargement and clinical effect.
Objective To compare the changes and the outcome of the tibial bone tunnel after arthroscopically assisted hamstring ACL reconstruction by preservation of the remnents of ACL or not and evaluate the relation with clinical effect.
Methods Sixty-five cases in two groups were included and underwent hamstring ACL reconstruction with Rigidfix and Intrafix fixation system by preservation of the remnents of ACL or not for MRI evaluation. Twenty-seven cases in group A received ACL reconstruction by preservation of the remnents of ACL, thirty-eight cases (group B) by non-preservative remnents. Tibial bone tunnel diameters at the widest point on sagittal MRI were compared at one week postoperatively. Lysholm score was used to evaluate the clinical effect.
Results Twenty-five cases in group A and thirty-five cases in group B were followed-up for average 12.4 and 12.1 months respectively.Tunnel enlargement after ACL surgery was noted in the two groups,the extent of enlargement of ACL tunnel was larger in group B comparatively. The changes of tibial tunnel enalargement was distinct in six weeks postoperatively and stable in three months postoperatively.The percentage of ACL tunnel enlargement decreased in the six and subsequent months There was no difference between groups A and B by the extent of tibial tunnel enlargement(p>0.05). All the cases in the two groups had stable knee function.No significant difference was found by Lysholm score in follow-up time.
Conclusions The preservation of the remnents of ACL had no evident advantages in the decreasement of ACL tunnel enlargement. No correlation of bone tunnel enlargement and clinical effect was found between the preservative and non-preservative ACL remnents.
方法：88例ACL损伤病例行关节镜下自体半腱肌、股薄肌腱重建ACL,根据移植物股骨侧固定方式不同,分为三组。A组26例,采用Endobutton固定；B组22例,采用可吸收挤压螺钉固定；C组40例,采用Rigidfix固定。术后平均随访16.5个月,进行MRI检查,测量矢状位骨道开口、开口1 cm、骨道最宽处三点骨道直径,以术后1周对应部位骨道直径为衡量标准,对其差值进行统计学分析。采用Lysholm评分评估各组临床疗效。结果：三组病例ACL术后骨道直径均有不同程度增宽。在股骨侧骨道最宽处、开口1 cm处,三组测量结果两两对比有统计学差异(P<0.05),B组增宽明显,c组骨道增宽最小；在股骨骨道开口处,C组骨道增宽程度最小(P<0.05),A组和B组无对比差异(P>0.05)。A组、C组股骨骨道形态呈线形；B组股骨骨道形态呈锥形。所有病例关节稳定性良好,无一例出现不稳。术后Lysholm评分,A组94.4±2.9,B组93.4±3.6,C组96.3±2.7,三组间比较无显著差异(P>0.05)。
结论：移植物固定方式影响ACL术后骨道扩大,是骨道扩大发生的重要因素；固定方式、骨道扩大程度与术后临床疗效无相关。
目的：探讨自体胭绳肌腱、同种异体肌腱对膝ACL重建术后骨隧道的影响、临床疗效差异。
方法：自2007年6月至2008年11月,61例ACL损伤病例行关节镜下ACL重建。根据采用移植物不同,分为二组,A组27例,采用同种异体肌腱；B组34例,采用自体胭绳肌腱。术后平均随访A组8.4月,B组8.5月。术后1周、6月-12月进行MRI检查,测量矢状位骨道开口、开口1cm、骨道最宽处三点骨道直径,以术后1周对应部位骨道直径为衡量标准,对其差值进行统计学分析。采用Lysholm评分评估各组临床疗效。结果：二组病例资料术前对比无差异。术后MRI随访发现股骨侧、胫骨侧骨道直径均有不同程度的增宽,其中胫骨侧较股骨侧增宽较重,两组资料在股骨、胫骨三个不同测量部位骨道增宽无对比差异。所有病例关节稳定性良好,无一例出现不稳。移植物呈连续性信号,未见明显骨髓水肿。术后Lysholm评分,A组90.1±4.2分,B组92.4±3.2分,比较无显著差异(p>0.05)。
结论：不同的移植物影响ACL术后骨道扩大,是骨道扩大发生的因素之一；自体肌腱、同种异体肌腱对ACL术后骨道扩大无对比差异,与术后临床疗效无相关。
目的：探讨保留或非保留ACL残迹对ACL术后胫骨骨道影响,与临床疗效的关系。方法：65例ACL损伤病例行关节镜下自体半腱肌、股薄肌腱重建ACL,其中A组27例,采用保留ACL残迹进行重建：B组38例,采用非保留残迹的ACL重建。术后随访进行MRI检查,测量胫骨矢状位骨道最宽处直径,以术后1周对应部位骨道直径为衡量标准,对骨道扩大率进行统计学分析。采用Lysholm评分评估各组临床疗效。结果：A组25例、B组35例得以随访,其中A组平均随访12.4月,B组平均随访12.1月。二组病例术后胫骨道直径均有不同程度的增宽,以B组骨道扩大程度相对较高。结果表明胫骨骨隧道扩大程度以术后6周最为显著,术后3个月骨隧道变化相对较小,术后6个月以后骨隧道扩大百分比略呈下降趋势；术后在各个时间段上两组资料胫骨骨隧道扩大程度均无统计学意义(P>0.05)。所有病例关节稳定性良好,术后Lysholm评分在随访过程中逐步提高,两组病例在各个时间段的Lysholm评分对比无统计学意义(P>0.05)。结论：保留ACL残迹韧带重建在预防术后骨道扩大没有明显优势。是否保留ACL残迹对骨道扩大、术后疗效无相关性,但保留ACL残迹可以促进腱-骨愈合,降低骨道扩大发生程度。
Objective To compare the changes in femoral bone tunnel after arthroscopically assisted hamstring ACL reconstruction with different graft fixation and investigate the relation with clinical effect.
Methods Eighty-eight cases in three groups were included and underwent hamstring ACL reconstruction with different femoral graft fixation for average 16.5-month follow-up evaluation. Twenty-six cases in group A received Endobutton fixation, twenty-two cases (group B) interference screw, and forty cases (group C) Rigidfix system. Femoral bone tunnel diameters at the articular line level, the widest point,1 cm away from tunnel aperture on sagittal MRI were compared at one week postoperatively. Lysholm score was used to evaluate the clinical effect.
Results Tunnel enlargement after ACL surgery was noted in the three groups. At the femoral widest point and 1 cm away from tunnel aperture, the tunnel enlargement was larger in group B and smaller in group C. At the femoral articular line level, the bone tunnel enlargement in group C was smallest. There was no difference between groups A and B. The shape of femoral tunnel was lineal in groups A and C, and conical in group B. No significant difference was found by Lysholm score.
Conclusions The type of graft fixation is a major factor in the development of tunnel enlargement after ACL surgery. No correlation between graft fixation, bone tunnel enlargement and clinical effect, was found.
Objective To compare the changes in bone tunnel after arthroscopic assisted ACL reconstruction with autograft and allograft and investigate the relation with clinical effect.
Methods From Jun,2007 to Dec,2008,61 cases were undergone ACL reconstruction.According to ACL graft, two groups were included.27cases in group A were performed with allograft for average 8.4 months follow-up evaluation.34 cases in group B with autograft. Bone tunnel diameter in 6-12months at the articular line level, the widest point,1 cm away from tunnel aperture in saggital and coronal MRI was compared with the results from 1 week postoperatively. Lysholm score was used to evaluate the clinical effect in groups.
Results Tunnel enlargement after ACL surgery in both groups was noted. The extent of bone tunnel was larger in tibia than in femur.At the femoral and tibial widest point,1 cm away from tunnel aperture and the articular line level, there was no difference in group A and B for bone tunnel enlargement. No significant difference was found with respect to Lysholm score.
Conclusions The type of ACL graft is a factor in the development of tunnel enlargement after ACL surgery. No evidence is proved correlation in ACL graft, bone tunnel enlargement and clinical effect.
Objective To compare the changes and the outcome of the tibial bone tunnel after arthroscopically assisted hamstring ACL reconstruction by preservation of the remnents of ACL or not and evaluate the relation with clinical effect.
Methods Sixty-five cases in two groups were included and underwent hamstring ACL reconstruction with Rigidfix and Intrafix fixation system by preservation of the remnents of ACL or not for MRI evaluation. Twenty-seven cases in group A received ACL reconstruction by preservation of the remnents of ACL, thirty-eight cases (group B) by non-preservative remnents. Tibial bone tunnel diameters at the widest point on sagittal MRI were compared at one week postoperatively. Lysholm score was used to evaluate the clinical effect.
Results Twenty-five cases in group A and thirty-five cases in group B were followed-up for average 12.4 and 12.1 months respectively.Tunnel enlargement after ACL surgery was noted in the two groups,the extent of enlargement of ACL tunnel was larger in group B comparatively. The changes of tibial tunnel enalargement was distinct in six weeks postoperatively and stable in three months postoperatively.The percentage of ACL tunnel enlargement decreased in the six and subsequent months There was no difference between groups A and B by the extent of tibial tunnel enlargement(p>0.05). All the cases in the two groups had stable knee function.No significant difference was found by Lysholm score in follow-up time.
Conclusions The preservation of the remnents of ACL had no evident advantages in the decreasement of ACL tunnel enlargement. No correlation of bone tunnel enlargement and clinical effect was found between the preservative and non-preservative ACL remnents.
引文
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4.Berg EE,Pollard ME,Kang Q.Interarticular bone tunnel healing. Arthroscopy, 2001,17:189-195.
5. Fink C, Zapp M, Benedetto KP, et al. Tibial tunnel enlargement following anterior cruciate ligament reconstruction with patellar tendon autograft. Arthroscopy, 2001,17(2):138-143.
6. Peyrache MD, Dijan P, Christel P, Witvoet J.Tibial tunnel enlargement after anterior cruciate ligament reconstruction by autogenous bone-patellar-tendon bone graft. Knee Surg Sports Traumatol Arthrosc.1996,4(1):2-8.
7. Pinczewski LA, Stange R, Russell VJ, et al. Tibial tunnel widening after ACL reconstruction:A 2 and 5 year comparison of patellar tendon autograft and 4-strand ham-string tendon autograft. Arthroscopy,2001,17:S2 (abstr 55).
8. Webster KE, Feller JA, Hameister KA.Bone tunnel enlargement following anterior cruciate ligament reconstruction:a randomised comparison of hamstring and patellar tendon grafts with 2-year follow-up. Knee Surg Sports Traumatol Arthrosc,2001, 9(2):86-91.
9. L'Insalata JC, Klatt B, Fu FH, Harner CD.Tunnel expansion following anterior cruciate ligament reconstruction:a comparison of hamstring and patellar tendon autografts. Knee Surg Sports Traumatol Arthrosc 1997,5(4):234-238.
10. Jansson KA, Harilainen A, Sandelin J et al.Bone tunnel enlargement after anterior cruciate ligament reconstruction with the hamstring autograft and endobutton fixation technique:a clinical, radiographic and magnetic resonance imaging study with 2 years follow-up. Knee Surg Sports Traumatol Arthrosc 1999,7(5):290-295.
11. Fules PJ, Madhav RT, Goddard RK et al.Evaluation of tibial bone tunnel enlargement using MRI scan cross-sectional area measurement after autologous hamstring tendon ACL. Knee 2003,10(1):87-91.
12. Nebelung W, Becker R, Merkel M et al Bone tunnel enlargement after anterior cruciate ligament reconstruction with semitendinous tendon using Endobutton fixation on the femoral side. Arthroscopy,1998,14(8):810-815.
1.Hoher J, Moller HD, Fu FH. Bone tunnel enlargement after anterior cruciate ligament reconstruction:fact or fiction? Knee Surg Sports Traumatol Arthrosc,1998,6(4):231-240.
2.Zysk SP, Fraunberger P, Veihelmann A. Tunnel enlargement and changes in synovial fluid cytokine profile following anterior cruciate ligament reconstruction with patellar tendon and hamstring tendon autografts. Knee Surg Sports Traumatol Arthrosc,2004,12(2):98-103.
3.Strobel MJ.Manual of Arthroscopic Surgery. Berlin-Heidelberg New York:Springer-Verlag,1998:409-412.
4.Fahey M, Indelicato PA. Bone tunnel enlargement after anterior cruciate ligament replacement.Am J Sports Med,1994,22(3):410-414.
5.Jackson DW, Windler GE, Simon TM. Intra-articular reaction associated with the use of freeze-dried, ethylene oxide-sterilized bone-patella tendon-bone allografts in the reconstruction of the anterior cruciate ligament. Am J Sports Med,1990,18(1):1-11.
6.Clatworthy MG, Annear P, Bulow JU, et al. Tunnel widening in anterior cruciate ligament reconstruction:a prospective evaluation of hamstring and patella tendon grafts. Knee Surg Sports Traumatol Arthrosc,1999,7:138-145.
7.L' Insalata JC, Klatt B, Fu FH, et al. Tunnel expansion following anterior cruciate ligament reconstruction:a comparison of hamstring and patellar tendon autografts.Knee Surg Sports Traumatol Arthrosc,1997,5:234-238.
8.Aglietti P, Giron F, Buzzi R, et al. Anterior cruciate ligament reconstruction:bone-patellar tendon-bone compared with double semitendinosus and gracilis tendon grafts:A prospective, randomized clinical trial. J Bone Joint Surg Am,2004,86-A:2143-2155.
9.Webster KE, Feller JA, Hameister KA. Bone tunnel enlargement following anterior cruciate ligament reconstruction:a randomized comparison of hamstring and patellar tendon grafts with 2-year follow-up. Knee Surg Sports Traumatol Arthrosc,2001,9(2):86-91.
10.Siebold R. Observations on bone tunnel enlargement after double-bundle anterior cruciate ligament reconstruction. Arthroscopy,2007,23(3):291-298.
11.Peter Fauno, S(?)ren Kaalund. Tunnel widening after hamstring anterior cruciate ligament reconstruction is influenced by the type of graft fixation used:a prospective randomized study. Arthroscopy,2005,21(11):1337-1341.
12.Joshua A, Baumfeld, David R, et al. Tunnel widening following anterior cruciate ligament reconstruction using hamstring autograft:a comparison between double cross-pin and suspensory graft fixation. Knee Surg Sports Traumatol Arthrosc,2008,16:1108-1113.
13.Kuskucu SM. Comparison of short-term results of bone tunnel enlargement between EndoButton CL and cross-pin fixation systems after chronic anterior cruciate ligament reconstruction with autologous quadrupled hamstring tendons.The Journal of International Medical Research,2008,36:23-30.
14.Hoher J, Scheffler SU, Withrow JD, et al. Mechanical behavior of two hamstring graft constructs for reconstruction of the anterior cruciate ligament. J Orthop Res,2000,18(3):456-461.
15.Wojcicki P, Kaczmarczyk J, Balcerkiewicz K. Anterior crucial ligament reconstruction with semitendineous tendons of Rigidfix and Intrafix anchorage. Chir Narzadow Ruchu Ortop Pol,2005,70(1):9-12.
16.Kousa P, Jarvinen TL, Vihavainen M, et al.The fixation strength of six harmstring tendon graft fixation devices in anterior cruciate ligament reconstruction. Part 1:femoral site.J Sports Med (Am),2003,31:174-181.
17.Buelow JU, Siebold R, Ellermann A.A prospective evaluation of tunnel enlargement in anterior cruciate ligament reconstruction with hamstrings: extra cortical versus anatomical fixation.Knee Surg Sports Traumatol Arthrosc, 2002,10:80-85.
18.Simonian PT, Erickson MS, Larson RV, et al.Tunnel expansion after hamstring anterior cruciate ligament reconstruction with 1-incision EndoButton femoral fixation.Arthroscopy 2000,16(7):707-714.
19.Jansson KA, Harilainen A, Sandelin J, et al. Bone tunnel enlargement after anterior cruciate ligament reconstruction with the hamstring autograft and endobutton fixation technique. A clinical, radiographic and magnetic resonance imaging study with 2 year s follow-up.Knee Surg Sports Traumatol Arthrosc,1999,7(5):290-295.
20.Wilson TC, Kantaras A, Atay A,et al. Tunnel enlargement after anterior ligament surgery. Am J Sports Med,2004,32(2):543-549.
21.Ma CB, Francis K, Towers J, et al. Hamstring anterior cruciate ligament recons ruction:a comparison of bioabsorbable interference screw and endobutton post fixation.Arthroscopy,2004; 20(2):122-128.
22.Fauno P, Kaalund S. Tunnel widening after hamstring anterior cruciate ligament reconstruction is influenced by the type of graft fixation used:a prospective randomized study. Arthroscopy,2005,21(11):1337-1341.
23. Hanters ME, Mastrokalos DS, Yu J, et al. The effect of early motion on tibial tunnel widening after anterior cruciate ligament replacement using hamstring tendon grafts.Arthroscopy,2004,20(6):572-580.
24.余家阔,Traumatol, Paessler HH.四股胭绳肌腱重建膝前交叉韧带后骨隧道增宽与术后康复程序的关系.中华外科杂志,2004,42(16)：984-988.
25.Vadala A, Iorio R, De Carli A, et al. The effect of accelerated, brace free, rehabilitation on bone tunnel enlargement after ACL reconstruction using hamstring tendons:a CT study. Knee Surg Sports Traumatol Arthrosc 2007,15(4):365-371.
26.Paessler HH, Mastrokalos DS. Anterior cruciate ligament reconstruction using semitendinosus and gracilis tendons,bone patellar tendon, or quadriceps tendon graft with press fit fixation without hardware. A new and innovative procedure. Orthop Clin North Am,2003,34(1):49-64.
27.Murty AN, el Zebdeh MY, Ireland J.Tibial tunnel enlargement following anterior cruciate reconstruction:does post-operative immobilisation make a difference? K nee,2001,8(1):39-43.
28.Weiler A, Hoffmann RF, Bail HJ, et al. Tendon healing in a bone tunnel. Part Ⅱ:Histologic analysis after biodegradable interference fit fixation in a model of anterior cruciate ligament reconstruction in sheep. Arthroscopy,2002,18(2):124-135.
29.Milano G, Mulas PD, Ziranu F, et al. Comparison between different femoral fixation devices for ACL reconstruction with doubled hamstring tendon graft:a biomechanical analysis. Arthroscopy,2006,22(6):660-668.
3O.Tetsumura S, Fujita A, Nakajima M, et al. Biomechanical comparison of different fixation methods on the tibial side in anterior cruciate ligament reconstruction:a biomechanical study in porcine tibial bone. J Orthop Sci,2006,11(3):278-282.
31.Nebelung W, Becker R, Merkel M, et al. Bone tunnel enlargement after anterior cruciate ligament reconstruction with semitendinous tendon using Endobutton fixation on the femoral side. Arthroscopy,1998,14:810-815.
32.Robert H, Es-Sayeh J, Heymann D, et al. Hamstring insertion site healing after anterior cruciate ligament reconstructionin patients with symptomatic hardware or repeat rupture:a histologic study in 12 patients. Arthroscopy, 2003,19(9):948-954.
33.Nebelung W, Becker R, Urbach D, et al. Histological findings of tendon-bone healing following anterior cruciate ligament reconstruction with hamstring grafts. Arch Orthop Trauma Surg,2003,123 (4):158-163.
34.Logan M, Williams A, Myers P. Is bone tunnel osseointegration in hamstring tendon autograft anterior cruciate ligament reconstruction important? Arthroscopy,2003,19(8):E1-E3.
35.Arnoczky SP, Tarvin, Marshall JL, et al. Anterior cruciate ligament replacement using patellar tendon.An evaluation of graft revascularization in the dog. J Bone Joint Surg Am,1982,64:217-224.
36.Weiler A, Peters G, Maurer J, et al. Biomechanical properties and vascularity of an anterior cruiciate ligament graft can be predicted by contrast-enhanced magnetic resonance imaging:a two-year study in sheep. Am J Sports Med,2001,29:75-761.
37.Peyrache MD, Djian P, Christel P, et al. Tibial tunnel enlargement after anterior cruciate ligament reconstruction by autogenous bone-patellar tendon-bone graft. Knee Surg Sports Traumatol Arthrosc,1996,4:2-8.
38.Klein JP, Lintner DM, Downs D, et al. The incidence and significance of femoral tunnel widening after quadrupled hamstring ACL reconstruction using femoral cross-pin fixation. Arthroscopy,2003,19:470-476.
39.Zijl JA, Kleipool AE, Willems WJ. Comparison of tibial tunnel enlargement after anterior cruciate ligament reconstruction using patellar tendon autograft or allograft. Am J Sports Med,2000,28(4):547-551.
40.Hogervorst T, van der Hart CP, Pels Rijcken TH, et al. Abnormal bone scans of the tibial tunnel 2 years after patella ligament anterior cruciate ligament reconstruction:correlation with tunnel enlargement and tibial graft length. Knee Surg Sports Traumatol Arthrosc,2000,8(6):322-328.
41.Jorgensen U, Thomsen HS. Behavior of the graft within the bone tunnels following anterior cruciate ligament reconstruction, studied by cinematic magnetic resonance imaging. Knee Surg Sports Traumatol Arthrosc, 2000,8:32-35.
42.Jansson KA, Harilainen A, Sandelin J, et al. Bone tunnel enlargement after anterior cruciate ligament reconstruction with the hamstring autograft and endobutton fixation technique. A clinical, radiographic and magnetic resonance imaging study with 2 years follow-up. Knee Surg Sports Traumatol Arthrosc,1999,7:290-295.
43.Fules PJ, Madhav RT, Goddard RK, et al. Evaluation of tibial bone tunnel enlargement using MRI scan cross-sectional area measurement after autologous hamstring tendon ACL replacement. Knee,2003,10:87-91.
44.Masahiko Kobayashi, Yasuaki Nakagawa, Takashi Suzuki, et al. A Retrospective Review of Bone Tunnel Enlargement After Anterior Cruciate Ligament Reconstruction With Hamstring Tendons Fixed With a Metal Round Cannulated Interference Screw in the Femur. Arthroscopy,2006,22 (10):1093-1099.
45.Raffaele Iorio, Antonio Vadala, Giuseppe Argento, et al. Bone tunnel enlargement after ACL reconstruction using autologous hamstring tendons:a CT study.Int Orthop,2007,31(1):49-55.
46.Antonio Vadala, Raffaele Iorio, Angelo De Carli, et al. The effect of accelerated, brace free, rehabilitation on bone tunnel enlargement after ACL reconstruction using hamstring tendons:a CT study. Knee Surg Sports Traumatol Arthrosc,2007,15:365-371.
47.Fink C, Zapp M, Benedetto KP, et al. Tibial tunnel enlargement following anterior cruciate ligament reconstruction with patellar tendon autograft. Arthroscopy,2001,17(2):138-143.
48.Fules PJ,Madhav RT, Goddard RK, et al. Evaluation of tibial bone tunnel enlargement using MRI scan cross sectional area measurement after autologous hamstring tendon ACL replacement. Knee,2003,10 (1):87-91.
49.Peyrache MD, Djian P, Christel P, et al. Tibial tunnel enlargement after anterior crueiate ligament reconstruction by autogenous bone patellar tendon-bone graft. Knee Surg Sports Traumatol Arthrosc,1996,4(1):2-8.
5O.Pinczewski LA, Stange R, Russell VJ, et al. Tibial tunnel widening after ACL reconstruction:A 2 and 5 year comparison of patellar tendon autograft and 4-strand ham-string tendon autograft. Arthroscopy,2001,17:S2 (abstr 55).
2.To JT, Howell SM, Hull ML. Contributions of femoral fixation methods to the stiffness of anterior cruciate ligament replacements at implantation. Arthroscopy 1999,15:379-387.
3. Fauno P, Kaalund S. Tunnel widening after hamstring anterior cruciate ligament reconstruction is influenced by the type of graft fixation used:a prospective randomized study. Arthroscopy,2005,21:1337-1341.
4.Buelow JU, Siebold R, Ellermann A.A prospective evaluation of tunnel enlargement in anterior cruciate ligament reconstruction with hamstrings: extra cortical versus anatomical fixation.Knee Surg Sports Traumatol Arthrosc, 2002,10:80-85.
5.Ma CB, Francis K, Towers J, et al. Hamstring anterior cruciate ligament recons ruction:a comparison of bioabsorbable interference screw and endobutton post fixation.Arthroscopy,2004; 20:122-128.
6.Joshua A, Baumfeld, David R, et al. Tunnel widening following anterior cruciate ligament reconstruction using hamstring autograft:a comparison between double cross-pin and suspensory graft fixation. Knee Surg Sports Traumatol Arthrosc,2008,16:1108-1113.
7.Kousa P, Jarvinen TL, Vihavainen M, et al.The fixation strength of six harmstring tendon graft fixation devices in anterior cruciate ligament reconstruction. Part 1:femoral site.J Sports Med (Am),2003,31:174-181.
8.Klein JP, Lintner DM, Downs D, et al.The incidence and significance of femoral tunnel widening after quadrupled hamstring ACL reconstruction using femoral cross-pin fixation. Arthroscopy,2003,19:470-476.
9.Zijl JA, Kleipool AE, Willems WJ.Comparison of tibial tunnel enlargement after anterior cruciate ligament reconstruction using patellar tendon autograft or allograft. Am J Sports Med,2000,28(4):547-551.
10.Fules PJ, Madhav RT, Goddard RK, et al. Evaluation of tibial bone tunnel enlargement using MRI scan cross-sectional area measurement after autologous hamstring tendon ACL replacement. Knee,2003,10:87-91.
11.L' Insalata JC, Klatt B, Fu FH, et al. Tunnel expansion following anterior cruciate ligament reconstruction:a comparison of hamstring and patellar tendon autografts.Knee Surg Sports Traumatol Arthrosc,1997,5:234-238.
12.Fink C, Zapp M, Benedetto KP, et al. Tibial tunnel enlargement following anterior cruciate ligament reconstruction with patellar tendon autograft. Arthroscopy,2001,17:138-143.
13.Peyrache MD, Djian P, Christel P, et al. Tibial tunnel enlargement after anterior cruciate ligament reconstruction by autogenous bone-patellar tendon-bone graft. Knee Surg Sports Traumatol Arthrosc,1996,4:2-8.
14.Pinczewski LA, Stange R, Russell VJ, et al. Tibial tunnel widening after ACL reconstruction:A 2 and 5 year comparison of patellar tendon autograft and 4-strand ham-string tendon autograft. Arthroscopy,2001,17:S2 (abstr55).
1. Jackson DW, Windler GE, Simon TM. Intraarticular reaction associated with the use of freeze-dried, ethylene oxide-sterilized bone-patella tendon-bone allografts in the reconstruction of the anterior cruciate ligament. Am J Sports Med,1990,18:1-11.
2. Hoher J, Moller HD, Fu FH. Bone tunnel enlargement after anterior cruciate ligament reconstruction:fact or fiction? Knee Surg Sports Traumatol Arthrosc,1998,6(4):231-240.
3. Zysk SP, Fraunberger P, Veihelmann A. Tunnel enlargement and changes in synovial fluid cytokine profile following anterior cruciate ligament reconstruction with patellar tendon and hamstring tendon autografts. Knee Surg Sports Traumatol Arthrosc,2004,12(2):98-103.
4. Fahey M, Indelicato PA. Bone tunnel enlargement after anterior cruciate ligament replacement.Am J Sports Med,1994,22(3):410-414.
5. Zijl JA, Kleipool AE, Willems WJ.Comparison of tibial tunnel enlargement after anterior cruciate ligament reconstruction using patellar tendon autograft or allograft. Am J Sports Med,2000,28(4):547-551.
6. Nyland J,Caborn DN, Rothbauer J, et al. Two-year outcomes following ACL reconstruction with allograft tibial anterior tendons:a retrospective study.Knee Surg Sports Traumatol Arthrosc,2003,11:212-218.
7.Chang SK, Egami DK, Shaieb MD,et al.Anterior cruciate ligament reconstruction:allograft versus autograft-Arthroscopy,2003,19:453-62.
8.Lawhorn KW, Howell SM·Scientific justification and technique foranterior cruciate ligament reconstruction using autogenous andallogeneic soft-tissue grafts.Orthop Clin North Am,2003,34:19-30.
9.Webster KE, Feller JA, Hameister KA. Bone tunnel enlargement following anterior cruciate ligament reconstruction:a randomized comparison of hamstring and patellar tendon grafts with 2-year follow-up. Knee Surg Sports Traumatol Arthrosc,2001,9(2):86-91.
11.Peyrache MD, Djian P, Christel P, et al. Tibial tunnel enlargement after anterior cruciate ligament reconstruction by autogenous bone-patellar tendon-bone graft. Knee Surg Sports Traumatol Arthrosc,1996,4:2-8.
12.Jansson KA, Harilainen A, Sandelin J, et al. Bone tunnel enlargement after anterior cruciate ligament reconstruction with the hamstring autograft and endobutton fixation technique. A clinical, radiographic and magnetic resonance imaging study with 2 year s follow-up.Knee Surg Sports Traumatol Arthrosc,1999,7(5):290-295.
13.Fules PJ,Madhav RT, Goddard RK, et al. Evaluation of tibial bone tunnel enlargement using MRI scan cross sectional area measurement after autologous hamstring tendon ACL replacement. Knee,2003,10 (1):87-91.
14. L' Insalata JC, Klatt B, Fu FH, et al. Tunnel expansion following anterior cruciate ligament reconstruction:a comparison of hamstring and patellar tendon autografts.Knee Surg Sports Traumatol Arthrosc,1997,5:234-238.
15.向芳友,杨柳,郭林,等.自体与同种异体骨-髌腱-骨重建前交叉韧带术后胫骨骨隧道演变过程的MRI对比研究. 第三军医大学学报,2005,27(8)：782-785.
16.Fink C, Zapp M, Benedetto KP, et al. Tibial tunnel enlargement following anterior cruciate ligament reconstruction with patellar tendon autograft. Arthroscopy,2001,17(2):138-143.
17.Fanelli GC, Giannotti BF, Edson CJ. Arthroscopically assisted combined posterior cruciate ligament /posterior lateral complex reconstruction. Arthroscopy,1996; 12 (5):521-530.
18.Mariani PP, Santoriello P,Iannone S, et al. Comparison of surgical treatments for knee dislocation. Am J Knee Surg,1999,12:214-221.
19. Gorschewsky O, Browa A, Vogel U, et al·Clinico-histologic comparison of allogenic and autologous bone-tendon-bone using one-third of the patellar tendon in reconstruction of the anterior cruciate ligament·Unfallchirurg,2002, 105:703-714.
20.孙康,王立德,张羽飞,等.前交叉韧带损伤的手术选择与疗效分析.中华创伤杂志,2001,17：320.
1.陈百成,栾广,张展翅,等.骨膜包裹自体胭绳肌腱重建前交叉韧带.中华骨科杂志,2006,26(2)：118-122.
2.孙磊,田敏,宁廷民,等.关节镜下保留残迹的前交叉韧带重建.中国矫形外科杂志,2007,15(22)：1691-1694.
3. Cameron M, Buchgraber A, Passler H,et al.The natural history of the anterior cruciate ligament-deficient knee.Changes in synovial fluid cytokine and keratan sulfate concentrations. Am J Sports Med 1997,25:751-754.
4.Berg EE,Pollard ME,Kang Q.Interarticular bone tunnel healing. Arthroscopy, 2001,17:189-195.
5. Fink C, Zapp M, Benedetto KP, et al. Tibial tunnel enlargement following anterior cruciate ligament reconstruction with patellar tendon autograft. Arthroscopy, 2001,17(2):138-143.
6. Peyrache MD, Dijan P, Christel P, Witvoet J.Tibial tunnel enlargement after anterior cruciate ligament reconstruction by autogenous bone-patellar-tendon bone graft. Knee Surg Sports Traumatol Arthrosc.1996,4(1):2-8.
7. Pinczewski LA, Stange R, Russell VJ, et al. Tibial tunnel widening after ACL reconstruction:A 2 and 5 year comparison of patellar tendon autograft and 4-strand ham-string tendon autograft. Arthroscopy,2001,17:S2 (abstr 55).
8. Webster KE, Feller JA, Hameister KA.Bone tunnel enlargement following anterior cruciate ligament reconstruction:a randomised comparison of hamstring and patellar tendon grafts with 2-year follow-up. Knee Surg Sports Traumatol Arthrosc,2001, 9(2):86-91.
9. L'Insalata JC, Klatt B, Fu FH, Harner CD.Tunnel expansion following anterior cruciate ligament reconstruction:a comparison of hamstring and patellar tendon autografts. Knee Surg Sports Traumatol Arthrosc 1997,5(4):234-238.
10. Jansson KA, Harilainen A, Sandelin J et al.Bone tunnel enlargement after anterior cruciate ligament reconstruction with the hamstring autograft and endobutton fixation technique:a clinical, radiographic and magnetic resonance imaging study with 2 years follow-up. Knee Surg Sports Traumatol Arthrosc 1999,7(5):290-295.
11. Fules PJ, Madhav RT, Goddard RK et al.Evaluation of tibial bone tunnel enlargement using MRI scan cross-sectional area measurement after autologous hamstring tendon ACL. Knee 2003,10(1):87-91.
12. Nebelung W, Becker R, Merkel M et al Bone tunnel enlargement after anterior cruciate ligament reconstruction with semitendinous tendon using Endobutton fixation on the femoral side. Arthroscopy,1998,14(8):810-815.
1.Hoher J, Moller HD, Fu FH. Bone tunnel enlargement after anterior cruciate ligament reconstruction:fact or fiction? Knee Surg Sports Traumatol Arthrosc,1998,6(4):231-240.
2.Zysk SP, Fraunberger P, Veihelmann A. Tunnel enlargement and changes in synovial fluid cytokine profile following anterior cruciate ligament reconstruction with patellar tendon and hamstring tendon autografts. Knee Surg Sports Traumatol Arthrosc,2004,12(2):98-103.
3.Strobel MJ.Manual of Arthroscopic Surgery. Berlin-Heidelberg New York:Springer-Verlag,1998:409-412.
4.Fahey M, Indelicato PA. Bone tunnel enlargement after anterior cruciate ligament replacement.Am J Sports Med,1994,22(3):410-414.
5.Jackson DW, Windler GE, Simon TM. Intra-articular reaction associated with the use of freeze-dried, ethylene oxide-sterilized bone-patella tendon-bone allografts in the reconstruction of the anterior cruciate ligament. Am J Sports Med,1990,18(1):1-11.
6.Clatworthy MG, Annear P, Bulow JU, et al. Tunnel widening in anterior cruciate ligament reconstruction:a prospective evaluation of hamstring and patella tendon grafts. Knee Surg Sports Traumatol Arthrosc,1999,7:138-145.
7.L' Insalata JC, Klatt B, Fu FH, et al. Tunnel expansion following anterior cruciate ligament reconstruction:a comparison of hamstring and patellar tendon autografts.Knee Surg Sports Traumatol Arthrosc,1997,5:234-238.
8.Aglietti P, Giron F, Buzzi R, et al. Anterior cruciate ligament reconstruction:bone-patellar tendon-bone compared with double semitendinosus and gracilis tendon grafts:A prospective, randomized clinical trial. J Bone Joint Surg Am,2004,86-A:2143-2155.
9.Webster KE, Feller JA, Hameister KA. Bone tunnel enlargement following anterior cruciate ligament reconstruction:a randomized comparison of hamstring and patellar tendon grafts with 2-year follow-up. Knee Surg Sports Traumatol Arthrosc,2001,9(2):86-91.
10.Siebold R. Observations on bone tunnel enlargement after double-bundle anterior cruciate ligament reconstruction. Arthroscopy,2007,23(3):291-298.
11.Peter Fauno, S(?)ren Kaalund. Tunnel widening after hamstring anterior cruciate ligament reconstruction is influenced by the type of graft fixation used:a prospective randomized study. Arthroscopy,2005,21(11):1337-1341.
12.Joshua A, Baumfeld, David R, et al. Tunnel widening following anterior cruciate ligament reconstruction using hamstring autograft:a comparison between double cross-pin and suspensory graft fixation. Knee Surg Sports Traumatol Arthrosc,2008,16:1108-1113.
13.Kuskucu SM. Comparison of short-term results of bone tunnel enlargement between EndoButton CL and cross-pin fixation systems after chronic anterior cruciate ligament reconstruction with autologous quadrupled hamstring tendons.The Journal of International Medical Research,2008,36:23-30.
14.Hoher J, Scheffler SU, Withrow JD, et al. Mechanical behavior of two hamstring graft constructs for reconstruction of the anterior cruciate ligament. J Orthop Res,2000,18(3):456-461.
15.Wojcicki P, Kaczmarczyk J, Balcerkiewicz K. Anterior crucial ligament reconstruction with semitendineous tendons of Rigidfix and Intrafix anchorage. Chir Narzadow Ruchu Ortop Pol,2005,70(1):9-12.
16.Kousa P, Jarvinen TL, Vihavainen M, et al.The fixation strength of six harmstring tendon graft fixation devices in anterior cruciate ligament reconstruction. Part 1:femoral site.J Sports Med (Am),2003,31:174-181.
17.Buelow JU, Siebold R, Ellermann A.A prospective evaluation of tunnel enlargement in anterior cruciate ligament reconstruction with hamstrings: extra cortical versus anatomical fixation.Knee Surg Sports Traumatol Arthrosc, 2002,10:80-85.
18.Simonian PT, Erickson MS, Larson RV, et al.Tunnel expansion after hamstring anterior cruciate ligament reconstruction with 1-incision EndoButton femoral fixation.Arthroscopy 2000,16(7):707-714.
19.Jansson KA, Harilainen A, Sandelin J, et al. Bone tunnel enlargement after anterior cruciate ligament reconstruction with the hamstring autograft and endobutton fixation technique. A clinical, radiographic and magnetic resonance imaging study with 2 year s follow-up.Knee Surg Sports Traumatol Arthrosc,1999,7(5):290-295.
20.Wilson TC, Kantaras A, Atay A,et al. Tunnel enlargement after anterior ligament surgery. Am J Sports Med,2004,32(2):543-549.
21.Ma CB, Francis K, Towers J, et al. Hamstring anterior cruciate ligament recons ruction:a comparison of bioabsorbable interference screw and endobutton post fixation.Arthroscopy,2004; 20(2):122-128.
22.Fauno P, Kaalund S. Tunnel widening after hamstring anterior cruciate ligament reconstruction is influenced by the type of graft fixation used:a prospective randomized study. Arthroscopy,2005,21(11):1337-1341.
23. Hanters ME, Mastrokalos DS, Yu J, et al. The effect of early motion on tibial tunnel widening after anterior cruciate ligament replacement using hamstring tendon grafts.Arthroscopy,2004,20(6):572-580.
24.余家阔,Traumatol, Paessler HH.四股胭绳肌腱重建膝前交叉韧带后骨隧道增宽与术后康复程序的关系.中华外科杂志,2004,42(16)：984-988.
25.Vadala A, Iorio R, De Carli A, et al. The effect of accelerated, brace free, rehabilitation on bone tunnel enlargement after ACL reconstruction using hamstring tendons:a CT study. Knee Surg Sports Traumatol Arthrosc 2007,15(4):365-371.
26.Paessler HH, Mastrokalos DS. Anterior cruciate ligament reconstruction using semitendinosus and gracilis tendons,bone patellar tendon, or quadriceps tendon graft with press fit fixation without hardware. A new and innovative procedure. Orthop Clin North Am,2003,34(1):49-64.
27.Murty AN, el Zebdeh MY, Ireland J.Tibial tunnel enlargement following anterior cruciate reconstruction:does post-operative immobilisation make a difference? K nee,2001,8(1):39-43.
28.Weiler A, Hoffmann RF, Bail HJ, et al. Tendon healing in a bone tunnel. Part Ⅱ:Histologic analysis after biodegradable interference fit fixation in a model of anterior cruciate ligament reconstruction in sheep. Arthroscopy,2002,18(2):124-135.
29.Milano G, Mulas PD, Ziranu F, et al. Comparison between different femoral fixation devices for ACL reconstruction with doubled hamstring tendon graft:a biomechanical analysis. Arthroscopy,2006,22(6):660-668.
3O.Tetsumura S, Fujita A, Nakajima M, et al. Biomechanical comparison of different fixation methods on the tibial side in anterior cruciate ligament reconstruction:a biomechanical study in porcine tibial bone. J Orthop Sci,2006,11(3):278-282.
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