Background

During anterior cruciate ligament (ACL) reconstruction, even when a posterior wall of the femoral bone tunnel is identified, computed tomography (CT) occasionally demonstrates a breach of the posterior femoral cortex of the femoral bone tunnel, i.e., posterior wall blowout, after ACL reconstruction (posterior wall blowout-like phenomenon). This study aimed to investigate the influence of the posterior wall blowout-like phenomenon on clinical outcomes after ACL reconstruction using hamstring tendon.

Methods

A total of 105 patients who underwent CT examination two weeks after ACL reconstruction were enrolled. A cortical suspension device was used for femoral side fixation in all cases. Posterior wall was identified in all cases during the surgery. The side-to-side difference in anterior knee laxity, pivot shift test, Lysholm knee score, the International Knee Documentation Committee (IKDC) subjective form, and the Knee Injury and Osteoarthritis Outcome Score (KOOS) were evaluated one year after the surgery. A second CT examination was performed 6–12 months after the surgery, if a posterior wall blowout-like phenomenon was identified in the first CT examination.

Results

Two weeks after the surgery, 16 of the 105 patients showed a posterior wall blowout-like phenomenon. Twelve of the 16 cases demonstrated a regenerated posterior femoral cortex of the femoral bone tunnel on their second CT images. There were no significant differences between the posterior wall blowout-like phenomenon group and the normal posterior wall group in terms of a side-to-side difference in anterior knee laxity (0.4 ± 1.5 mm and 0.1 ± 1.6 mm, respectively), pivot shift test, Lysholm knee score, IKDC score, and KOOS at one year after surgery. The length and diameter of the femoral bone tunnel were not significantly different between the two groups.

Conclusions

Posterior wall blowout-like phenomenon after ACL reconstruction using a cortical suspension device did not negatively influence clinical outcomes.

Level of evidence

III – retrospective comparative clinical study.

中文翻译：

---

前十字韧带重建后计算机断层扫描显示后壁爆裂

背景

在前交叉韧带（ACL）重建过程中，即使识别出股骨隧道后壁，计算机断层扫描（CT）偶尔也会显示股骨隧道后股骨皮质的破裂，即ACL后后壁爆裂重建（后壁爆裂样现象）。本研究旨在探讨后壁爆裂样现象对腘绳肌腱重建 ACL 后临床结果的影响。

方法

共纳入105例在ACL重建后两周接受CT检查的患者。所有病例均使用皮质悬吊装置进行股骨侧固定。在手术过程中，所有病例均发现了后壁。术后一年评估膝关节前部松弛度、枢轴移位测试、Lysholm 膝关节评分、国际膝关节文献委员会 (IKDC) 主观评分以及膝关节损伤和骨关节炎结果评分 (KOOS)的左右差异。如果第一次CT检查发现后壁爆裂样现象，术后6-12个月再进行第二次CT检查。

结果

术后两周，105名患者中有16名出现后壁爆裂样现象。16 例中有 12 例在第二次 CT 图像上显示股骨隧道的股骨后皮质再生。后壁爆裂样现象组与正常后壁组在膝关节前部松弛度（分别为0.4±1.5mm和0.1±1.6mm）、枢轴移位的左右差异方面无显着差异。术后一年的测试、Lysholm 膝关节评分、IKDC 评分和 KOOS。两组股骨骨隧道的长度和直径没有显着差异。

结论

使用皮质悬吊装置重建 ACL 后的后壁爆裂现象不会对临床结果产生负面影响。

证据级别

III – 回顾性比较临床研究。