前交叉韧带重建中残端保留与胫骨残端缝合可减少胫骨骨道扩大且不影响骨道位置：基于CT的随机对照试验
简介
这项前瞻性随机对照试验将179例初次ACL重建患者分为残端保留+胫骨残端缝合组（88例）与常规残端切除组（91例），于术后2周和1年行标准化三维CT测量骨道直径变化百分比。1年随访时，残端保留组的胫骨骨道扩大显著小于残端切除组（14.58±4.49% vs 19.74±4.36%，p<0.001），临床意义显著扩大（>20%）的发生率也更低（11.4% vs…
英文摘要
PURPOSE: Tunnel widening remains a concern following anterior cruciate ligament reconstruction because it may adversely affect graft incorporation and complicate revision surgery. Remnant preservation has been proposed as a strategy to reduce tunnel widening, but its effect on postoperative tunnel remodelling remains uncertain. This study aimed to determine whether remnant preservation with tibial stump suturing reduces tunnel widening without compromising tunnel placement accuracy. METHODS: In this prospective randomised controlled trial, 179 patients undergoing primary anterior cruciate ligament (ACL) reconstruction were randomised to remnant-preserving reconstruction with tibial stump suturing (n = 88) or conventional stump resection (n = 91). Standardised three-dimensional computed tomography was performed at 2 weeks and 1 year postoperatively. Tibial and femoral tunnel widening were calculated as the percentage change in tunnel diameter between scans, and tunnel placement accuracy was assessed using the computed tomography-based quadrant method. The incidence of clinically significant tunnel widening (>20%) was also compared. RESULTS: Baseline tunnel diameters were comparable between groups. At 1-year follow-up, remnant-preserving ACL reconstruction resulted in significantly less tibial tunnel widening than stump resection (14.58 ± 4.49% vs. 19.74 ± 4.36%, p < 0.001), with a lower incidence of clinically significant widening (>20%) (11.4% vs. 25.3%; relative risk, 0.45; p = 0.016). Femoral tunnel widening was similar between groups (18.23 ± 2.92% vs. 18.35 ± 2.59%, p = 0.766). No clinically relevant differences in tunnel placement were observed between groups. CONCLUSION: Remnant-preserving ACL reconstruction with tibial stump suturing selectively reduces tibial tunnel widening at 12 months without compromising anatomic tunnel placement accuracy. These findings support the use of remnant preservation when preservation of tibial tunnel integrity is a surgical consideration. LEVEL OF EVIDENCE: Level I. TRIAL REGISTRATION: ClinicalTrials.gov, NCT07236593; registration date: November 15, 2025 (retrospectively registered).