SPORTS MEDICINE
Tunnel widening after ACL reconstruction with aperture screw fixation or all-inside reconstruction with suspensory cortical button fixation: Volumetric measurements on CT and MRI scans
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2018;6(2):15 Knee. 2017 Oct;24(5):1047-105433 patients scheduled for ACL reconstruction were included in this study to compare the effects of different fixation methods on postoperative tunnel widening. Patients were randomized to reconstruction using aperture screw fixation or suspensory cortical button fixation. Tunnel volume was measured over a 6 month period using MRI and CT scans. The results at 6 months indicated no differences between the two groups for tibial tunnel volume (117.7+/-24.1% button group vs. 113.9+/-10.3% screw group (p=0.565)). While the femoral tunnel volume at 6 months was significantly greater in the button group (143.2+/-34.4%) compared to the screw group (119.8+/-19.2%) (p=0.023).
Was the allocation sequence adequately generated?
Was allocation adequately concealed?
Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?
Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?
Blinding Patients: Was knowledge of the allocated interventions adequately prevented?
Was loss to follow-up (missing outcome data) infrequent?
Are reports of the study free of suggestion of selective outcome reporting?
Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?
Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?
Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?
はい = 1
不確実＝0.5
無関係 = 0
いいえ = 0
報告基準評価では、著者が出版物内で試験の方法論的特徴や試験特性を報告する際の透明性を評価します。評価は以下の5つのカテゴリーに分類されます。
4/4
Randomization
3/4
Outcome Measurements
4/4
Inclusion / Exclusion
4/4
Therapy Description
4/5
Statistics
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
Fragility Indexは、重要な所見の解釈を助けるツールで、結果の強さの尺度を提供します。Fragility Indexは、その所見が有意でなくなるために、二項対立の結果に追加する必要がある連続した事象の数を表します。数値が小さいほど弱い所見を表し、数値が大きいほど強い所見を表します。
なぜ今この研究が必要なのですか？
Anterior cruciate ligament (ACL) reconstruction is often undergone following a tear. Various methods of graft fixation are available in these procedures. Recently, there has been an interest in whether the type of graft fixation used influences widening of either the femoral or tibial bone tunnels.
主な研究課題は何ですか？
In ACL reconstruction, does change in tunnel volume after 6 months significantly differ between graft fixation with bioabsorbable interference screws and suspensory extra-cortical button fixation?
重要な知見は？
- On MRI, the percent change in tibial tunnel volume from baseline to 6 months did not significantly differ between the button group (96.4+/-19.0%) and the screw group (108.0+/-14.9%) (p=0.060). Similarly, on CT, the percent change in tibial tunnel volume from baseline to 6 months did not significantly differ between the button group (117.7+/-24.1%) and the screw group (113.9+/-10.3%) (p=0.565).
- On MRI, the percent change in femoral tunnel volume from baseline to 6 months was significantly greater in the button group (154.3+/-38.0%) compared to the screw groups (110.9+/-20.7%) (p<0.001). Similarly, on CT, the percent change in tibial tunnel volume from baseline to 6 months was significantly greater in the button group (143.2+/-34.4%) compared to the screw group (119.8+/-19.2%) (p=0.023).
最も覚えておくべきことは？
In ACL reconstruction, graft fixation with adjustable-length loop cortical buttons demonstrated significantly greater femoral tunnel volume increase within the first 6 months after surgery when compared to fixation with absorbable interference screws. Both types of fixation demonstrated similar degrees of tibial tunnel volume increase in the first 6 months after surgery.
それが私の患者ケアにどのように影響するか？
The results of this study suggest that short-term enlargement of the femoral tunnel may be larger with the use of an adjustable-length loop cortical button as opposed to a bioabsorbable interference screw in ACL reconstruction. Nevertheless, there is still considerable debate on the correlation between tunnel widening and clinical outcomes in these cases. Follow-up studies over the longer term are needed to determine if early tunnel enlargement is associated with latent complications after ACL reconstruction.
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