骨付き膝蓋腱を用いた前十字靭帯再建術における前方および回旋不安定性評価 ―Open MRIによる定量的検討
【目的】解剖学的設置を目指したACL再建術が近年注目されているが，骨付き膝蓋腱（BTB）でのACL再建術について回旋不安定性を含めた報告は少ない．我々はOpen MRIを用いた方法で，回旋安定性を定量的に評価しており，BTB-ACL再建術後の臨床成績，前方および回旋安定性について検討した．【対象と方法】術後1年以上のBTB-ACL再建18膝を対象とした．平均年齢は25（17～47）歳，全例男性で，脛骨孔はACL stamp中央，大腿骨孔はResident's ridgeの後方，右膝で10時～10時半の位置に設置した．臨床評価，KT-2000に加え，Open MRIを用いて回旋ストレス...
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| Published in | 整形外科と災害外科 Vol. 59; no. 1; pp. 174 - 177 |
|---|---|
| Main Authors | , , , , , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
西日本整形・災害外科学会
2010
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0037-1033 1349-4333 |
| DOI | 10.5035/nishiseisai.59.174 |
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| Abstract | 【目的】解剖学的設置を目指したACL再建術が近年注目されているが，骨付き膝蓋腱（BTB）でのACL再建術について回旋不安定性を含めた報告は少ない．我々はOpen MRIを用いた方法で，回旋安定性を定量的に評価しており，BTB-ACL再建術後の臨床成績，前方および回旋安定性について検討した．【対象と方法】術後1年以上のBTB-ACL再建18膝を対象とした．平均年齢は25（17～47）歳，全例男性で，脛骨孔はACL stamp中央，大腿骨孔はResident's ridgeの後方，右膝で10時～10時半の位置に設置した．臨床評価，KT-2000に加え，Open MRIを用いて回旋ストレス負荷下に脛骨外顆の前方移動量（ALRI）を計測し，安定性を評価した．【結果】再受傷1膝を除くとLysholm score平均96点，Tegner scoreは術前平均へ改善し，KT-2000患健差1.8mm，ALRI患健差0.1mmと良好な安定性を示した．【結論】BTBによるACL再建術では，良好な前方・回旋安定性の獲得が期待できると考えられた． |
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| AbstractList | 【目的】解剖学的設置を目指したACL再建術が近年注目されているが，骨付き膝蓋腱（BTB）でのACL再建術について回旋不安定性を含めた報告は少ない．我々はOpen MRIを用いた方法で，回旋安定性を定量的に評価しており，BTB-ACL再建術後の臨床成績，前方および回旋安定性について検討した．【対象と方法】術後1年以上のBTB-ACL再建18膝を対象とした．平均年齢は25（17～47）歳，全例男性で，脛骨孔はACL stamp中央，大腿骨孔はResident's ridgeの後方，右膝で10時～10時半の位置に設置した．臨床評価，KT-2000に加え，Open MRIを用いて回旋ストレス負荷下に脛骨外顆の前方移動量（ALRI）を計測し，安定性を評価した．【結果】再受傷1膝を除くとLysholm score平均96点，Tegner scoreは術前平均へ改善し，KT-2000患健差1.8mm，ALRI患健差0.1mmと良好な安定性を示した．【結論】BTBによるACL再建術では，良好な前方・回旋安定性の獲得が期待できると考えられた． 【目的】解剖学的設置を目指したACL再建術が近年注目されているが, 骨付き膝蓋腱(BTB)でのACL再建術について回旋不安定性を含めた報告は少ない. 我々はOpen MRIを用いた方法で, 回旋安定性を定量的に評価しており, BTB-ACL再建術後の臨床成績, 前方および回旋安定性について検討した. 【対象と方法】術後1年以上のBTB-ACL再建18膝を対象とした. 平均年齢は25(17～47)歳, 全例男性で, 脛骨孔はACL stamp中央, 大腿骨孔はResident's ridgeの後方, 右膝で10時～10時半の位置に設置した. 臨床評価, KT-2000に加え, Open MRIを用いて回旋ストレス負荷下に脛骨外顆の前方移動量(ALRI)を計測し, 安定性を評価した. 【結果】再受傷1膝を除くとLysholm score平均96点, Tegner scoreは術前平均へ改善し, KT-2000患健差1.8mm, ALRI患健差0.1mmと良好な安定性を示した. 【結論】BTBによるACL再建術では, 良好な前方・回旋安定性の獲得が期待できると考えられた. |
| Author | 田上, 和夫 松田, 秀一 安永, 武史 井澤, 敏明 富川, 盛雅 西村, 須磨子 岡崎, 賢 深川, 真吾 岩本, 幸英 田代, 泰隆 三浦, 裕正 橋爪, 誠 |
| Author_FL | YASUNAGA Takeshi NISHIMURA Sumako MIURA Hiromasa TASHIRO Yasutaka MATSUDA Shuichi OKAZAKI Ken IZAWA Toshiaki HASHIZUME Makoto TANOUE Kazuo IWAMOTO Yukihide TOMIKAWA Morimasa FUKAGAWA Shingo |
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| References | 5) Järvelä, T., et al.: Double-bundle anterior cruciate ligament reconstruction using hamstring autografts and bioabsorbable interference screw fixation: prospective, randomized, clinical study with 2-year results. Am. J. Sports Med., 36: 290-297, 2008. 1) Bach, B. R. Jr., et al.: Arthroscopically assisted anterior cruciate ligament reconstruction using patellar tendon autograft: five- to nine-year follow-up evaluation. Am. J. Sports Med., 26: 20-29, 1998. 9) Petersen, W., et al.: Biomechanical evaluation of two techniques for double-bundle anterior cruciate ligament reconstruction: one tibial tunnel versus two tibial tunnels. Am. J. Sports Med., 35: 228-234, 2007. 3) Georgoulis, A. D., et al.: Tibial rotation is not restored after ACL reconstruction with a hamstring graft. Clin. Orthop. Relat. Res., 454: 89-94, 2007. 10) Ristanis, S., et al.: The effects of anterior cruciate ligament reconstruction on tibial rotation during pivoting after descending stairs. Knee Surg. Sports Traumatol. Arthrosc., 11: 360-365, 2003. 11) Shino, K., et al.: Anatomically oriented anterior cruciate ligament reconstruction with a bone-patellar tendon-bone graft via rectangular socket and tunnel: a snug-fit and impingement-free grafting technique. Arthroscopy, 21: 1402. e1-e5, 2005. 2) Daniel, D. M., et al.: Fate of the ACL-injured patient: a prospective outcome study. Am. J. Sports Med., 22: 632-644, 1994. 6) Loh, J. C., et al.: Knee stability and graft function following anterior cruciate ligament reconstruction: comparison between 11 o'clock and 10 o'clock femoral tunnel placement. Arthroscopy, 19: 297-304, 2003. 17) Zantop, T., et al.: The role of the anteromedial and posterolateral bundles of the anterior cruciate ligament in anterior tibial translation and internal rotation. Am. J. Sports Med., 35: 223-227, 2007. 7) Muneta, T., et al.: A prospective randomized study of 4-strand semitendinosus tendon anterior cruciate ligament reconstruction comparing single-bundle and double-bundle techniques. Arthroscopy, 23: 618-628, 2007. 13) Tashiro, Y., et al.: Quantitative assessment of rotatory instability after anterior cruciate ligament reconstruction. Am. J. Sports Med., 37: 909-916, 2009. 4) Iwahashi, T., et al.: Assessment of the "functional length" of the three bundles of the anterior cruciate ligament. Knee Surg. Sports Traumatol. Arthrosc., 16: 167-174, 2008. 8) Okazaki, K., et al.: Assessment of anterolateral rotatory instability in the anterior cruciate ligament-deficient knee using an open magnetic resonance imaging system. Am. J. Sports Med., 35: 1091-1097, 2007. 14) Woo, S. L., et al.: The effectiveness of reconstruction of the anterior cruciate ligament with hamstrings and patellar tendon: a cadaveric study comparing anterior tibial and rotational loads. J. Bone Joint Surg. Am., 84: 907-914, 2002. 15) Yagi, M., et al.: Double-bundle ACL reconstruction can improve rotational stability. Clin. Orthop. Relat. Res., 454: 100-107, 2007. 16) Yasuda, K., et al.: Clinical evaluation of anatomic double-bundle anterior cruciate ligament reconstruction procedure using hamstring tendon grafts: comparisons among 3 different procedures. Arthroscopy, 22: 240-251, 2006. 12) Slocum, D. B., et al.: Clinical test for anterolateral rotary instability of the knee. Clin. Orthop. Relat. Res., 118: 63-69, 1976. |
| References_xml | – reference: 5) Järvelä, T., et al.: Double-bundle anterior cruciate ligament reconstruction using hamstring autografts and bioabsorbable interference screw fixation: prospective, randomized, clinical study with 2-year results. Am. J. Sports Med., 36: 290-297, 2008. – reference: 7) Muneta, T., et al.: A prospective randomized study of 4-strand semitendinosus tendon anterior cruciate ligament reconstruction comparing single-bundle and double-bundle techniques. Arthroscopy, 23: 618-628, 2007. – reference: 3) Georgoulis, A. D., et al.: Tibial rotation is not restored after ACL reconstruction with a hamstring graft. Clin. Orthop. Relat. Res., 454: 89-94, 2007. – reference: 4) Iwahashi, T., et al.: Assessment of the "functional length" of the three bundles of the anterior cruciate ligament. Knee Surg. Sports Traumatol. Arthrosc., 16: 167-174, 2008. – reference: 13) Tashiro, Y., et al.: Quantitative assessment of rotatory instability after anterior cruciate ligament reconstruction. Am. J. Sports Med., 37: 909-916, 2009. – reference: 10) Ristanis, S., et al.: The effects of anterior cruciate ligament reconstruction on tibial rotation during pivoting after descending stairs. Knee Surg. Sports Traumatol. Arthrosc., 11: 360-365, 2003. – reference: 2) Daniel, D. M., et al.: Fate of the ACL-injured patient: a prospective outcome study. Am. J. Sports Med., 22: 632-644, 1994. – reference: 9) Petersen, W., et al.: Biomechanical evaluation of two techniques for double-bundle anterior cruciate ligament reconstruction: one tibial tunnel versus two tibial tunnels. Am. J. Sports Med., 35: 228-234, 2007. – reference: 11) Shino, K., et al.: Anatomically oriented anterior cruciate ligament reconstruction with a bone-patellar tendon-bone graft via rectangular socket and tunnel: a snug-fit and impingement-free grafting technique. Arthroscopy, 21: 1402. e1-e5, 2005. – reference: 8) Okazaki, K., et al.: Assessment of anterolateral rotatory instability in the anterior cruciate ligament-deficient knee using an open magnetic resonance imaging system. Am. J. Sports Med., 35: 1091-1097, 2007. – reference: 15) Yagi, M., et al.: Double-bundle ACL reconstruction can improve rotational stability. Clin. Orthop. Relat. Res., 454: 100-107, 2007. – reference: 14) Woo, S. L., et al.: The effectiveness of reconstruction of the anterior cruciate ligament with hamstrings and patellar tendon: a cadaveric study comparing anterior tibial and rotational loads. J. Bone Joint Surg. Am., 84: 907-914, 2002. – reference: 6) Loh, J. C., et al.: Knee stability and graft function following anterior cruciate ligament reconstruction: comparison between 11 o'clock and 10 o'clock femoral tunnel placement. Arthroscopy, 19: 297-304, 2003. – reference: 17) Zantop, T., et al.: The role of the anteromedial and posterolateral bundles of the anterior cruciate ligament in anterior tibial translation and internal rotation. Am. J. Sports Med., 35: 223-227, 2007. – reference: 12) Slocum, D. B., et al.: Clinical test for anterolateral rotary instability of the knee. Clin. Orthop. Relat. Res., 118: 63-69, 1976. – reference: 16) Yasuda, K., et al.: Clinical evaluation of anatomic double-bundle anterior cruciate ligament reconstruction procedure using hamstring tendon grafts: comparisons among 3 different procedures. Arthroscopy, 22: 240-251, 2006. – reference: 1) Bach, B. R. Jr., et al.: Arthroscopically assisted anterior cruciate ligament reconstruction using patellar tendon autograft: five- to nine-year follow-up evaluation. Am. J. Sports Med., 26: 20-29, 1998. |
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| Snippet | 【目的】解剖学的設置を目指したACL再建術が近年注目されているが，骨付き膝蓋腱（BTB）でのACL再建術について回旋不安定性を含めた報告は少ない．我々はOpen MRIを用いた方... 【目的】解剖学的設置を目指したACL再建術が近年注目されているが, 骨付き膝蓋腱(BTB)でのACL再建術について回旋不安定性を含めた報告は少ない. 我々はOpen MRIを用いた方... |
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| SubjectTerms | anterior cruciate ligament bone-patellar tendon-bone graft rotatory instability 前十字靭帯 回旋不安定性 骨付き膝蓋腱 |
| Title | 骨付き膝蓋腱を用いた前十字靭帯再建術における前方および回旋不安定性評価 ―Open MRIによる定量的検討 |
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