Chhabra Anikar, Kline Alex J, Nilles Kathy M, Harner Christopher D
Canyon Orthopaedics Division for Sports Medicine, Phoenix, Arizona, USA.
Arthroscopy. 2006 Oct;22(10):1107-12. doi: 10.1016/j.arthro.2006.05.019.
The purpose of this study was to evaluate the effects of 2 techniques of drilling the femoral tunnel in anterior cruciate ligament (ACL) reconstruction (medial portal v transtibial) on tunnel expansion.
Autogenous hamstring ACL reconstructions performed by the senior author between July 1998 and July 2004, with a minimum 6-month radiographic follow-up, using the transtibial technique (41 patients) and the medial portal technique (34 patients), were evaluated. All procedures were performed via an endoscopic technique with identical postoperative rehabilitation and graft fixation. Lateral and 45 degrees posteroanterior (PA) radiographs were obtained for each patient at a minimum of 6 months postoperatively. The sclerotic margins of the femoral and tibial tunnels were measured at the widest dimension of the tunnel by 2 physicians and were compared with the initially drilled tunnel size after correction for radiographic magnification. Statistical analysis was performed to compare the 2 groups by use of the independent-samples t test, with significance set at .05.
The mean percentage increase in the femoral tunnel was 38.20% +/- 17.76% for the medial portal technique and 53.96% +/- 21.72% for the transtibial technique on the PA view and 23.80% +/- 16.50% for the medial portal technique and 50.07% +/- 26.98% for the transtibial technique on the lateral view. This difference was statistically significant on both PA and lateral views. The mean percentage increase in the tibial tunnel was 31.81% +/- 14.39% for the medial portal technique and 36.31% +/- 17.81% for the transtibial technique on the PA view and 27.70% +/- 15.25% for the medial portal technique and 30.11% +/- 18.98% for the transtibial technique on the lateral view; however, these increases failed to reach statistical significance on either view.
Femoral tunnel expansion for hamstring autologous ACL reconstructions is significantly lower for the medial portal technique when compared with the conventional transtibial technique.
Level III, retrospective, comparative therapeutic study.
本研究旨在评估前交叉韧带（ACL）重建中两种股骨隧道钻孔技术（内侧入路与经胫骨入路）对隧道扩大的影响。
对资深作者在1998年7月至2004年7月期间进行的自体腘绳肌ACL重建手术进行评估，这些患者术后至少有6个月的影像学随访资料，其中采用经胫骨技术的患者有41例，采用内侧入路技术的患者有34例。所有手术均通过关节镜技术进行，术后康复和移植物固定方式相同。在术后至少6个月时，为每位患者拍摄外侧位和45度后前位（PA）X线片。由两名医生在隧道最宽处测量股骨和胫骨隧道的硬化边缘，并在矫正影像学放大率后与最初钻孔的隧道尺寸进行比较。采用独立样本t检验对两组进行统计学分析，显著性水平设定为0.05。
在PA位片上，内侧入路技术的股骨隧道平均扩大百分比为38.20%±17.76%，经胫骨技术为53.96%±21.72%；在外侧位片上，内侧入路技术为23.80%±16.50%，经胫骨技术为50.07%±26.98%。在PA位片和外侧位片上，这种差异均具有统计学意义。在PA位片上，内侧入路技术的胫骨隧道平均扩大百分比为31.81%±14.39%，经胫骨技术为36.31%±17.81%；在外侧位片上，内侧入路技术为27.70%±15.25%，经胫骨技术为30.11%±18.98%；然而，这些扩大在两种位片上均未达到统计学意义。
与传统的经胫骨技术相比，内侧入路技术用于自体腘绳肌ACL重建时，股骨隧道的扩大明显更小。
III级，回顾性、对比性治疗研究。
