MRI Assessment Of The Tendon-to-bone Heal Ing After Anterior Cruciate Ligament Reconstruction And Related Factors Analysis

ObjectiveExplore the tendon-to-bone healing and the related factors after anterior cruciate ligament reconstruction with MRI,enriching the tendon-to-bone healing theory postoperation,and providing certain clinical data and experience for excellent outcomes after anterior cruciate ligament reconstruction.MethodsA retrospective study was conducted on 747 patients with anterior cruciate ligament reconstruction in the first affiliated hospital of Guangzhou University of Traditional Chinese Medicine from January 2011 to December 2016.Based on the results of the data from the patient's MRI,measure the size of the bone tunnel after anterior cruciate ligament reconstruction,and analyze the relationships between the patient's bone tunnel changes and the age,gender,degree of education,the physique of Traditional Chinese Medicine,the state of the sport(TEGNER score),the function of the knee(the LYSHOLM score and IKDC score),the body mass index(BMI),the amount of alcohol drinking and cigaretee smoking per week,and the stability of the person's knee(the KNEELEX test).ResultsA total of 129 patients were included in the study,and the follow-up period was 12 to 54 months,with an average of 20.02±10.09 months,among which 104 males,25 females,63 left knees,66 right knees with an average age of 32.19±10.40 years old,average BMI 23.05±1.96(19-27).The expanding of of the bone tunnel was-11.50±-24.10%persents on average.There were 67 cases follow-up whose bone tunnels were larger than surgery bone tunnel,62 cases were smaller than surgery bone tunnel,125 patients with autologous hamstring tendon whose average expanding rate was-11.74±23.08 persents and 4 patients with allogeneic tibial tendon,whose average expanding rate was-3.80±51.77%persents.There were 3 cases with transplanted ligament teared again whose TEGNER score were all 8,1 case of allograft patients at 18 months after anterior cruciate ligament renconstruction in femoral attachment points whose bone tunnel expanded by 26.67%,2 cases for autologous hamstring graft patients,at 18 months in the femur transplanted ligament attachment points and at 24 months in the tibial attachment points postoperatively respectively,whose bone tunnel expanding rate was 13.33%,33.97%,respectively.Among them,there were 3 patients with graduate degree,63 with college degree,58 with secondary education,5 with primary school and below.The rates enrolled maximum of workers and students in the study were 29.46%,27.91%respectively,and doctors at least 1.55%.There were 104 patients in peace physical constitution,and others biased constitution.There are 33 patients with complete KNEELAX testing,failing to get the correct statistical result of relationship between the stability of the knee and bone marrow expanding.Among the 129 patients,94 usually did recreational activities,31 patients did simple daily life activities,and 4 patients usually participated in competitive sports,and no patient was unable to exercise.Patients with LYSHOLM scored an average of 89.91+9.10,and the IKDC score averaged 86.00±9.95,with a BMI of 23.05±1.96,with a weekly smoking rate of 4.51 ± 15.80,and the average weekly alcohol consumption was 1.51±4.27,with an average economic level of 9.845±6.24 million yuan/year.There isnot correlation between patients' age,gender,education,the traditional Chinese medicine physique,occupation,body mass index(BMI),the function of the knee,weekly drinking and smoking and the bone tunnel enlargement(p>0.05),but there is correlation between patients motion(TEGNER score),economic levels and bone tunnel expanding statistically(p<0.05).ConclusionThe bone tunnels of the patients after anterior cruciate ligament reconstruction were expanded or reduced to different extents,and the bone tunnels in the patients with the ligament ruptures again were all enlarged,meaning poor bone-tunnel healing.The patient's tendon bone healing is related to physical activity,economic level,and the higher the intensity of the knee movement,the lower the economic level,the more likely the bone marrow is to be enlarged,and the bone-to-tendon healing worse.The patient needs to regularly review the MRI to assess the healing of the tendon-to-bone healing,combining the symptoms,the stability function of the knee,to adjust the recovery regimen and sports state,avoiding secondary damage.