ABSTRACT
Objective To analyse the graft impingement after anterior cruciate ligament (ACL) reconstruction based on three-dimensional graft and tunnel images of dual-source computer tomography (DSCT).Methods From November 2012 to November 2014,a consecutive 134 cases of ACL reconstruction with various techniques had their knees scanned by DSCT.Graft and femoral as well as tibial tunnel images were three-dimensionally reconstructed and carefully inspected if there was any impinging on the graft at knee extension,meanwhile the femoral and tibial tunnel location were measured.Of these 134 cases,a serial of 118 patients had been single-bundle reconstructed with same type of graft material.There were 83 males and 35 females aged from 15 to 64 years old (mean,32 years old).Special attention had been paid to examine if there was any graft impinging,and their origin and finally impingement types were identified and classified according to the position and origin of impingement.Bernard and Lorenz method were used to measure the relative locations of femoral and tibial tunnel respectively.Difference was statistically compared between impingement-free and impingement groups.Results Patients were divided into two groups,impingement-free group and impingement group according to graft impinging based on graft visible 3D-CT imaging postoperatively.Of 118 cases,39 (33％) were impingement-free and 79 (67％) existed various types of impingement.Impingement group was further divided into two subgroups according to different impingement location,outlet impingement of intercondylar notch group (77 cases,account for 65％ of total and 97％ of impingement group,respectively) and mid-way impingement of intercondylar notch group (2 cases,account for 2％ of total and 3％ of impingement group,respectively).The outlet impingement group was more further classified into three subtypes,bird beak impingement,10 cases (13％,10/77),tibial plateau impingement,46 cases (60％,46/77) and clamp impingement,21 cases (27％,21/77).Statistic analysis with NAONA revealed that no significant difference between impingement group and impingement-free group regardless of femoral or tibial tunnel placement.Conclusion Three new types of impingements are found based on visible 3D-CT graft imaging after ACL reconstruction which are mid-way impingement of intercondylar notch,tibial plateau impingement and clamp impingement.
ABSTRACT
Objective To investigate the risk factors of articular cartilage damage secondary to anterior cruciate ligament (ACL) rupture.Methods Clinical data of 490 patients sustaining ACL rupture from July 2008 to July 2014 were collected for a retrospective cohort study.The factors relating to the incidence and degree of the secondary articular carticular damage were analyzed,including gender,age,weight,blood group,places of residence,causes of injury,complication of meniscus tear,damage part and duration of disease.Results Factors associated with the incidence of secondary articular cartilage damage were blood type O (OR =0.605,95％ CI 0.381-0.960,P ＜ 0.05) and complication of meniscus tear(OR =2.241,95％ CI 1.378-3.643,P ＜0.01).Factors associated with the degree of articular cartilage damage were duration of disease (rs =0.168 7,P ＜0.01),damage part (Hc =53.237,P＜0.01),and complication of meniscus tear (x2 =16.944,P＜0.01).Conclusions Meniscus tear is the moderate risk factor for the incidence of secondary articular cartilage damage while blood type O has weak protective effect.Damage part,course of disease,and meniscus tear are factors associated with the degree of secondary articular cartilage damage.