一种用于测量和解读ACL翻修术中胫骨隧道形态的新型分类系统
简介
回顾性分析75例失败ACL重建的术前CT，提出胫骨隧道形态分型：矢状面分为管状（39例）、铲状（4例）、气球状（16例）、双隧道（3例）和蘑菇状（13例）5型；轴位按隧道中心与解剖ACL足印中心距离分为I（<2.5 mm，56例）、II（2.5–12.5 mm，18例）、III（>12.5 mm，1例）3型，平均距离4.4±2.7 mm，ICC 0.84。C…
英文摘要
PURPOSE: The purpose of this study was to reproducibly measure computed tomography (CT) tibial tunnel features in failed anterior cruciate ligament reconstructions (ACLRs) and to propose a CT classification system for tibial tunnel morphology in the setting of evaluation for a one- versus two-stage revision ACLR surgery. METHODS: A retrospective study was performed on 75 patients presenting for ACLR graft failure between July 2019 and April 2023. Inclusion criteria comprised patients who underwent a revision ACLR by a single surgeon with preoperative knee CT imaging. The centre of the anatomic tibial ACL footprint and the centre and size of the previously drilled ACLR tibial tunnel were used for axial classification. The size of the tibial tunnel on sagittal images was used to develop the sagittal classification system. RESULTS: Five tibial tunnel sagittal CT morphologies were categorized according to uniform dilation, 'tubular' (Type A; n = 39); distal dilation, 'shovel' (Type B; n = 4); midpoint dilation, 'balloon' (Type C; n = 16); dual tunnel (Type D; n = 3) and proximal dilation, 'mushroom' (Type E; n = 13). On axial CT slices, tunnels were classified as Type I (< 2.5 mm between anatomic footprint and ACLR tunnel), Type II (2.5-12.5 mm) and Type III (>12.5 mm). The average distance between the tibial tunnel and the centre of the ACL footprint measured 4.4 ± 2.7 mm (interrater correlation coefficient [ICC] = 0.84; confidence interval [CI] = 4.0-4.8 mm). Overall, 56 (74.7%) were classified as Type I, 18 (24.0%) as Type II and 1 (1.3%) as Type III. CONCLUSIONS: This study found that there was a reproducible categorization of CT tibial tunnels by five sagittal CT morphologies and three axial CT scan categories. The study also found that relative offset of ACLR tibial tunnels to their native footprint can be reproducibly identified using CT, which may assist in the future diagnosis and identification of ACLR knees that are at greater risk of revision. LEVEL OF EVIDENCE: Level IV, retrospective cross-sectional study.