Progress on the causes and management of bone tunnel enlargement after anterior cruciate ligament reconstruction
10.3760/cma.j.cn121113-20230507-00274
- VernacularTitle:前十字韧带重建术后骨隧道扩大的原因及应对研究进展
- Author:
Jianhao FENG
1
;
Yihong XU
;
Weidong XU
Author Information
1. 同济大学附属同济医院骨科，上海 200065
- Keywords:
Knee joint;
Anterior cruciate ligament reconstruction;
Arthroscopy;
Review
- From:
Chinese Journal of Orthopaedics
2023;43(18):1241-1247
- CountryChina
- Language:Chinese
-
Abstract:
Anterior cruciate ligament (ACL) injury is a common sports injury of the knee joint, which can lead to knee instability, dyskinesia and secondary traumatic osteoarthritis, which seriously affects the quality of life of patients. As it is difficult to self-heal after ACL injury, arthroscopic ACL reconstruction is commonly used as a clinical treatment to restore knee stability and motion function. However, more and more studies have found that bone tunnel enlargement is common after ACL reconstruction. A variety of biological (such as immunological rejection, local inflammation) and mechanical (such as offset bone tunnel positioning, improper graft fixation, and aggressive rehabilitation) factors are considered to be important causes of bone tunnel enlargement. It is still controversial whether the enlargement of bone tunnels affects clinical outcomes, but most researchers believe that the enlargement of bone tunnels is detrimental to the creation of bone tunnels and the fixation of grafts in revision surgery. Therefore, minimizing postoperative bone tunnel enlargement has positive clinical implications. The existing methods mainly include the selection of autografts, the use of independent bone tunnel positioning technology, modified bone tunnel drilling method, the use of remnant preservation technique and all-inside technique, the development of progressive individualized rehabilitation programs, and biological methods such as platelet-rich plasma and autogenous periosteum wrapping graft to enhance graft tendon-bone healing. This article reviews the causes and countermeasures of bone tunnel enlargement after ACL reconstruction to provide theoretical basis and help reduce or avoid bone tunnel enlargement after ACL reconstruction.
