Anthropometric Measurement of Tunnel Lengths for Anterior Cruciate Ligament Reconstruction in Chinese: 在中國病患者進行前交叉韌帶重建隧道長度的測量結果

IntroductionThere is a lacking of tunnel length measurements data for primary anterior cruciate ligament (ACL) reconstruction in the Chinese population. Different tunnel lengths affect the security of the tendon graft fixation as well as bone–tendon healing. Long-term result may then be compromised. Double-bundle ACL reconstruction will work well if both grafts have good quality, size, and tendon–bone fixation. Proper rehabilitation is also an important element. However, the femoral tunnel length for posterolateral bundle will have a higher prevalence of inadequate graft bone contact because of its orientation, especially in the Chinese population with smaller knees compared with the Western population.MethodsFrom January 2009 to June 2011, 148 cases of ACL reconstruction have been performed in our hospital. After excluding cases with revision, isolated bundle (anteromedial or posterolateral), and four-strand hamstring graft single-bundle ACL reconstructions, we recruited 48 cases with primary double-bundle ACL reconstruction in the study of tunnel lengths. Hamstring tendon autografts (semitendinosus and gracilis) were used. A small cohort study with Level 3 evidence was carried out.ResultsIn 31.3% (15/48) of patients, inadequate graft–bone contact was observed in the posterolateral bundle using the available shortest Endobutton CL 15 (Endobutton continuous loop fixation device; Smith and Nephew, Andover, Massachusetts, USA) in femoral tunnel fixation.ConclusionACL reconstruction is a complex procedure that relies on good tendon graft length, graft size, tunnel length, and secure fixation method. Inadequate posterolateral tunnel length may contribute to short-term complications as well as long-term failure. Further refining of the choices of graft, better orientation of tunnels, and a better fixation method may be important, especially in the Chinese population with smaller knees.

中文摘要引言在中國人進行首次前交叉韌帶（ ACL ）重建術中,隧道長度的量度數據仍然很缺乏, 不同的隧道長度將影響肌腱固定以及骨肌腱癒合。長期的手術效果可能會受到.影響。ACL雙束重建術有赖良好的兩束韌帶移植質量，大小和腱骨固定方法。適當的康復治療也是一個重要因素。然而，後外側韌帶移植束（ PL ）的股骨隧道長度不夠將引致移植束和骨接合不足，更因為它的方向，尤其是在中國人群與西方人群相比，有較高的發病率。方法從2009年1月至2011年6月， 我院進行了148例ACL重建手術。除去翻修，單束(前內側或後外側）和四股膕繩肌腱單束移植ACL重建後，我們有48例首次進行ACL雙束重建街，使用膕繩肌腱（半腱肌，股薄肌）移植，並進行了一個3級證據的小隊列研究其股骨隧道的長度。結果有31.3％ （15/48）雖然使用了最短的內置紐扣 (Endobutton CL15)作股骨隧道固定，其後外側韌帶移植束(PL)和骨接合可能仍是不足夠。結論ACL重建是一個複雜的手術，它建基於良好的肌腱長度，移植束的大小，隧道長度和穩定的固定方法。 PL隧道長度不足，可能會導致短期的併發症，以及長期性失效。選擇更好的移植束，隧道方向和固定方法是很重要的，尤其是在中國人群中有較小的膝關節。