Artroscopia G.C., Hospital Quirón, Barcelona, Spain.
Knee Surg Sports Traumatol Arthrosc. 2010 Aug;18(8):1013-37. doi: 10.1007/s00167-009-0964-0. Epub 2009 Nov 10.
The transtibial (TT) drilling of the femoral tunnel in the bone-patellar tendon-bone (BPTB) anterior cruciate ligament (ACL) reconstruction was found to place the tunnel non-anatomically. The use of the anteromedial portal (AMP) for the femoral drilling would provide the surgeon with more freedom to anatomically place the tunnel in the real femoral ACL footprint. The purpose of this study was to compare the clinical outcomes of BPTB ACL reconstruction using the AMP or the TT technique for the femoral tunnel drilling. A Medline search was not able to identify any study directly comparing the clinical outcomes of the AMP and the TT techniques. The literature search identified experimental and quasi-experimental studies published from 1966 to March 2009 where at least one group underwent arthroscopic autologous BPTB ACL reconstructions using either the AMP or the TT technique for the femoral tunnel drilling. Overall IKDC, Lysholm score, activity level, range of motion, single-leg hoop test, Lachman test, Pivot shift sign test, KT-1000 arthrometer measurements, and radiographic assessments were indirectly compared between the two groups (AMP versus TT). Twenty-one studies, involving a total of 859 patients (257 in the AMP and 602 in the TT group), were included in this analysis. The AMP group demonstrated significantly earlier return to run and significantly greater range of motion, Lachman test values, and KT-1000 arthrometer measurements in the 1-2-year follow-up, although no differences were found for both the 3-5 and the 6-10-year follow-ups for any of these parameters. In contrast, the TT group demonstrated significantly higher activity level for the 3-5 and 6-10-year follow-up. The use of the AMP elicited greater knee stability and range of motion values, and earlier return to run compared to the TT technique. These results may indicate a potential benefit of the AMP over the TT technique. However, as the benefits of the AMP were not obtained in the mid and long-term follow-ups, overall there is no definitive evidence at this point to conclude that one technique is superior to the other. Randomized controlled trials directly comparing the use of both techniques with long-term follow-ups will help clarify which one, if any, provides best clinical outcomes.
经胫骨（TT）入路在骨-髌腱-骨（BPTB）前交叉韧带（ACL）重建中钻取股骨隧道被发现无法实现解剖学定位。采用前内侧入路（AMP）进行股骨钻孔，可使术者更自由地在真实的股骨 ACL 足迹中进行隧道的解剖学定位。本研究旨在比较使用 AMP 或 TT 技术进行股骨隧道钻孔的 BPTB ACL 重建的临床结果。对 Medline 数据库的检索未能发现任何直接比较 AMP 和 TT 技术临床结果的研究。文献检索确定了自 1966 年至 2009 年 3 月期间发表的实验和准实验研究，至少有一组患者接受了关节镜下自体 BPTB ACL 重建，股骨隧道钻孔分别采用 AMP 或 TT 技术。总体而言，IKDC、Lysholm 评分、活动水平、关节活动度、单腿提环试验、Lachman 试验、前抽屉试验、KT-1000 关节测量仪测量值和影像学评估在两组之间（AMP 与 TT）进行了间接比较。共纳入 21 项研究，总计 859 例患者（AMP 组 257 例，TT 组 602 例）。AMP 组在 1-2 年随访时，更早地恢复跑步，并且具有更大的关节活动度、Lachman 试验值和 KT-1000 关节测量仪测量值，尽管在 3-5 年和 6-10 年随访时，这些参数都没有差异。相比之下，TT 组在 3-5 年和 6-10 年随访时，活动水平更高。与 TT 技术相比，AMP 技术可获得更好的膝关节稳定性和关节活动度，并且能更早地恢复跑步。这些结果可能表明 AMP 技术相对于 TT 技术具有一定的优势。然而，由于 AMP 的优势在中期和长期随访中并未得到体现，因此目前总体上没有确凿的证据可以得出一种技术优于另一种技术的结论。直接比较两种技术并进行长期随访的随机对照试验将有助于阐明哪种技术（如果有的话）能提供最佳的临床结果。
