| Objective: In the arthroscopic anterior cruciate ligament(ACL)reconstruction,it is still controversial whether the remnant preservation affect the tunnel enlargement of tibia and the stability of knee joint.In this study,The differences between the preserving-remnant group and removing-remnant group were determined by measuring the diameter of the posterior tibial tunnel and the postoperative joint functional score.The aim of the present study was to investigate the effect of remnant preserving on tibial tnnnel and graft function.It can also provide opportunities for secondary revision surgery for surgical failure and guide clinical surgical treatment.Methods: Patients who underwent surgical treatment for anterior cruciate ligament injury were included in the study.Routine X-ray and MRI were used to confirm the diagnosisand.The guideline of inclusion and exclusion criteria was estabished.A total of 70 patients who met the below inclusion criteria were enrolled in the study.There were 54 males and 16 females,aged from 19 to 54 years.The patients were randomly divided into preserving-remnant group and removing-remnant group according to the randomized contro principel.All patients were treated with autologous hamatring tendon for graft preparation.The X-ray radiography was reviewed 1 week,3 months,and 6 months,and the distance between the inner margins of the bone tunnel perpendicular to the axis of the tibial tunnel at the widest point of the bone tunnel was measured.The distance between the coronal and the sagittal at 2 cm below the surface was measured by CT at 1 week and 6 months.The diameter of the bones at 1 week after surgery was used as a reference value to calculate the difference of the corresponding parameters in different time periods.The two groups of patients underwent 3 months and 6 months of Lysholm score and IKDC grading after operation.The postoperative function scores and the differences of tunnel enlargement were analyzed to evaluate the stability of the knee joint.Results: 56 patients were followed up and were availabie for the serial radiographic and clinical evaluations.The follow-up rate was 80.0%.The patients were followed up for 6 to 12 months with an average of(9.16±2.54)months.29 patients were in the preserving-remnant group and 27 patients were in the removing-remnant group.There were no significant differences in preoperative gender,age,side,and injury to surgery time between the two groups.The diameter of the tibial tunnel at 1 week postoperatively was larger than the diameter of the dilator used to make it.All the tibia tunnel increased at different levels at 3 and 6 months after surgery.The diameter of preserving-remnant group at 3 and 6 months after operation was smaller than that of removing-remnant group,and the difference was statistically significant(P<0.05).Compared with 1 week postoperation,the difference of the tibial tunnel at 6 months was statistically significant measured by CT.Positive enlargement was observed in 5 patients(17.24%)in the preserving-remnant group and 13 cases(48.15%)in the removing-remnant group.Compared with the two groups,the proportion of bone enlargement in the preserving-remnant group was smaller than that in the removing-remnant group,and the difference was statistically significant(P<0.05).The knee function scores of both groups were significantly improved over the time.Although the preserving-remnant group in the ACL reconstruction had a higher score in the Lysholm score and the IKDC grades than the removing-remnant group,there were no significant difference between the two groups(P>0.05).Conclusion:(1)After the ACL reconstruction,the tibial tunnel will increase with time.(2)The preserving-remnant can reduce the degree of tibial tunnel enlargement in ACL reconstruction,which is more conducive to the revision surgery in the future.(3)Whether to preserve the remnant does not affect the score and the short-term clinical effect of the joint. |
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