前十字靭帯再建術後の靭帯周囲滑膜被覆に影響を与える因子について

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  • Factors Influencing Synovialization on Second-Look Arthroscopy after Anterior Cruciate Ligament Reconstruction
  • ゼン ジュウジ ジンタイ サイケン ジュツゴ ノ ジンタイ シュウイカツマク ヒフク ニ エイキョウ オ アタエル インシ ニ ツイテ

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Objectives: We studied patients who underwent anterior cruciate ligament (ACL) reconstruction and second-look operation and evaluated the synovialization of the graft, and discussed the factors influencing this occurrence and the clinical results.<br>Methods: The study cohort consisted of 133 patients who underwent ACL reconstruction using single bundle multi-strand hamstring tendon graft, operated by a single surgeon, and 97 knees were eventually assessed which had a second-look operation. Re-injury, complex ligament injury, injury with fracture, infection, and bilateral injuries were excluded. Finally, 88 knees (46 male, 42 female) were examined, and the average age at the time of operation was 25.4 (range, 14-46) years old. Gender, age, body mass index (BMI), notch width index (NWI), Tegner activity score (TAS), duration from injury to reconstruction, duration from reconstruction to second-look operation, Lysholm score at second-look operation, anterior translation measured with a KT-2000 arthrometer, femoral tunnel angle (FA), tibial tunnel position (TP), and graft size were examined.<br>Results: Fifty-five knees (62.5%) had good synovialization of the graft, which were more than 80 percent covered by synovium. The patients were divided into two groups as follows: ‘good-group’ with synovialization and without partial tears for 51 knees and a ‘fair-group’ with synovialization for 37 knees, respectively. No significant differences could be found in gender, age, BMI, TAS, duration from injury to reconstruction, or duration from reconstruction to second-look operation. NWI was significantly higher in the good-group versus the fair-group (p = 0.029). Clinically, no significant differences could be seen in the Lysholm score, KT-2000, TP or graft size. FA was significantly larger in the fair-group than in the good-group (p = 0.049).<br>Conclusion: NWI and FA may be related to the synovialization, which suggests potential impingement could influence synovialization of the graft. Therefore, anatomical reconstruction and accurate tunnel position might be an advantage for better synovialization.

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