股薄肌腱采集用于ACL重建损害股薄肌体积恢复并可能对邻近大腿肌肉组织产生不利影响：来自DOSTAR随机对照试验亚组患者的MRI结果
简介
这项II级证据的DOSTAR随机对照试验亚组分析纳入38例ACL重建患者，于术后6、12个月行双侧大腿MRI，比较股薄肌腱+半腱肌腱（STG，螺钉胫骨固定）与单纯半腱肌腱（ST，可调按钮胫骨固定）组的肌肉体积变化。STG组股薄肌6～12个月间体积变化为-1.6±4.6 cm³，ST组为+2.8±6.8 cm³（p=0.026）；长收肌分别为-2.4±12.0…
英文摘要
PURPOSE: Segmentation of magnetic resonance imaging (MRI) allows accurate calculation of muscle volumes. The Dual Or Single Tendon Anterior cruciate ligament Reconstruction (DOSTAR) study is a prospective randomized controlled trial investigating a semitendinosus (ST) graft with adjustable button tibial fixation versus a dual tendon semitendinosus and gracilis (STG) graft with screw tibial fixation in anterior cruciate ligament reconstruction (ACLR). The purpose of the present study is to investigate differences in thigh muscle volume at 6 and 12 months between these treatment groups. METHODS: Patients were randomized and underwent ACLR using either a ST or STG graft construct. MRI of bilateral thighs was completed at 6 and 12 months post-operatively. Muscle volumes were measured in both thighs at both time points in both groups. RESULTS: A total of 38 patients underwent MRI scanning at 6 and 12 months. There was a significant difference in the interval volume change of gracilis in the STG group compared to the ST group (-1.6 cm3 ± 4.6 vs. +2.8 cm3 ± 6.8, p = 0.026). Interval gracilis hypertrophy occurred in 35% (7/20) of cases in the STG group and 67% of cases (12/18) in the ST group (p = 0.103). Adductor longus (AddL) also demonstrated a significant difference in interval volume change between the STG and ST group (-2.4 cm3 ± 12.0 vs. +11.1 cm3 ± 21.2, p = 0.020). AddL hypertrophy occurred in 30% of cases (6/20) in the STG group and 72% (13/18) in the ST group (p = 0.022). All other muscles had no significant differences noted in muscle recovery between groups. Linear regression analysis demonstrated a significant positive relationship between interval changes in gracilis and AddL volumes (p < 0.001). CONCLUSIONS: The present study provides MRI evidence that gracilis tendon harvest was associated with persistent impairment of gracilis muscle recovery and may also adversely affect AddL. This adds to the growing body of evidence supporting the use of ST with adjustable button graft constructs for hamstring ACLR. LEVEL OF EVIDENCE: Level II, subgroup analysis of prospective, double-blinded, randomized controlled trial.