| Objective:To investigate the characteristics of early bone tunnel changes in patients with different lateral posterior tibial slope(LPTS)after double-bundle anterior cruciate ligament reconstruction(ACL)and to analyze the relationship between bone tunnel with its function.Methods:Patients underwent Double-bundle ACL reconstruction after ACL acute injury between June 2017 and June 2019 at Dalian University Affiliated Zhongshan Hospital were retrospectively reviewed.A total of 40 patients with complete relevant data and meeting the inclusion and exclusion criteria were included in this study,including 35 males and 5 females.Patients were divided into two groups by LPTS according to MRI,21 for group A:6°≤LPTS<13°(10.3±2.3°),and 19 for group B:LPTS≥13°(15.1±1.4°).The clinical status of the patients were assessed by IKDC、Lysholm score preoperativly and 12 month follow-up.Tunnel changes were measured by CT three days after surgery and 12 month follow-up.Results: Follow-up data were available for all 40 patients and no surgery-related significant complications such as bone tunnel repture or infection during were detected during this period.39(97.5%)patients achieved good clinical effects,and only 1patient in group B had mild pain in the affected knee joint.Bone tunnel widening was found among all patinets especially in anterior medial bone tunnel in group B(P<0.05)at 12 months follow-up.The AM bone tunnel at tibial side in group A increased from7.1±0.5mm to 8.7±0.8mm,and the ΔTW was 1.6±0.5 while the AM bone tunnel in group B increased from 7.0±0.4mm to 9.3±1.0mm,ΔTW was 2.3±0.8(P<0.05),and there was no statistical difference between the other bone tunnels.4(19.0%)and 6(31.5%)patients were detected with bone tunnel communication in tibia of each group respectivly while only 1 patient was found in femur of group B.The stability of knee joint and average Lysholm、IKDC scores of both groups were significantly improved at12 month follow-up compared with preoperatively(P<0.05)while no significant difference was found between groups.In the preoperative physical examination,12cases(57.1%)and 14 cases(73.6%)in the two groups of A and B respectively reached grade II and above of the Pivot-shift test(P<0.05)and both groups have 10 cases reached grade II in the Lachman test.(P>0.05).At 12 month follow-up,the number of cases reached grade II and above in the Pivot-shoft test and Lachman test were 0(0%),1(5.2%)in group A and 0(0%),0(0%)in group B.The difference was statistically significant(P<0.05),and The total positive rate was significantly lower than preoperativly(P<0.05)while no statistical difference was found between groups.The IKDC score increased from 68.1±10.4 to 84.2±10.3 and 67.8±13.3 increased to86.2±18.9 at 12 months follow-up respectively.Lysholm score increased from 74.3±9.2to 90.2±14.5 and 69.1±13.8 increased to 88.6±16.7 at 12 months respectively.The knee joint stability and subjective feelings of both groups were significantly improved(P<0.05),but there was no statistical difference between groups(P>0.05).Conclusion: Arthroscopic double-bundle ACL reconstruction is one kind of safe and effective method for treating acute ACL injury.Patients with steeper lateral posterior tibial slope(LPTS≥13°)can lead to early expansion of bone tunnels especially in the anterior medial side of tibia during the early postoperative period.The expansion of bone tunnels increase the incidence of graft re-injury and the difficulty of revision surgery to a certain extent,but has no significant effect on the early functional rehabilitation and stability of the knee joint. |
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