全内侧前交叉韧带重建术后1年腓骨长肌自体移植物未成熟：前瞻性扩散张量成像研究
简介
该前瞻性研究对50例行全内ACL重建、采用腓骨长肌自体移植物的患者，于术后1年行DTI成像评估移植物成熟度，并与常规MRI Figueroa评分及功能评分对比。结果显示，尽管患者功能恢复良好，但FA及ADC值仍异于正常ACL，多数移植物（35/50）仅达到“充分但未完全成熟”状态，且DTI参数与Figueroa评分无显著相关性。DTI等先进影像学手段可能有助…
英文摘要
PURPOSE: This study evaluated the maturation of the peroneus longus (PL) tendon autograft by quantifying the key diffusion tensor imaging (DTI) parameters: fractional anisotropy (FA) and apparent diffusion coefficient (ADC) at 1 year of follow-up in patients undergoing all-inside anterior cruciate ligament (ACL) reconstruction surgery. METHODS: Magnetic resonance imaging (MRI) of the knee with DTI sequences was done at 1 year of follow-up for 50 patients (mean age 26.6 ± 8.5 years; 41 males + 9 females), who underwent ACL reconstruction using PL tendon autograft. FA and ADC at different parts of the graft (femoral, mid-substance and tibial) were determined with regions of interest (ROI)-based measurements after assessing the fibre morphology on the proton density fat-saturated (PDFS) images. Figueroa scores using the conventional MRI sequences were also calculated at 1 year of follow-up and compared with the DTI parameters. The Tegner-Lysholm and knee society scores were used to evaluate functional outcomes. RESULTS: At 1 year, mean FA and ADC values were 0.2 ± 0.1 and 1.7 ± 0.1 × 10-3 mm²/s, both different from the reported values for native ACL. The majority of patients (35/50) had a Figueroa score of 4, indicating adequate but incomplete graft maturation. The FA and ADC values of the three individual regions of the graft, as well as the overall mean value, did not show any significant difference between the three Figueroa score groups (Figueroa score 3 vs. 4 vs. 5). There was a significant improvement (p < 0.001) in the patient-reported outcome measures at the final follow-up. CONCLUSION: DTI and conventional MRI parameters showed substantial but incomplete graft maturation, despite excellent functional recovery, at 1 year of follow-up. Our study supports the use of PL tendon as a reliable graft option, demonstrating acceptable graft maturation and favourable functional outcomes. Advanced imaging may assist in individualised return-to-sport decision-making. LEVEL OF EVIDENCE: Level II.