Department of Orthopaedics, Chonnam National University Hwasun Hospital, Jeonnam, South Korea.
Am J Sports Med. 2011 Jan;39(1):127-33. doi: 10.1177/0363546510377417. Epub 2010 Sep 16.
Several biomechanical studies have supported placing the femoral tunnel at a low position (10 or 2 o'clock) to achieve anterior and rotational knee stabilities after anterior cruciate ligament (ACL) reconstruction. However, no firm consensus has been reached regarding the merits and demerits of ACL reconstruction using a low femoral tunnel versus a high femoral tunnel (11 or 1 o'clock).
A low femoral tunnel position during ACL reconstruction provides better intraoperative stability (especially, rotational stability) and clinical outcomes than does a high femoral tunnel position.
Cohort study; Level of evidence 2.
Sixty-two patients who underwent ACL reconstruction were equally allocated to low and high femoral tunnel groups; 58 were followed up for a minimum of 2 years (29 in the each group). After reconstruction and using a navigation system, the authors compared intraoperative anterior, internal rotational, and external rotational stabilities at 0°, 30°, 60°, and 90° of knee flexion and compared clinical outcomes, including Lysholm knee scores, Tegner activity scores, Lachman and pivot-shift test findings, and radiographic stabilities at final follow-up visits.
The low group showed significantly better intraoperative internal rotational stability at 0° and 30° of flexion but not at other angles (60° and 90°). Intraoperatively, no significant intergroup differences were found for anterior and external rotational stabilities at any flexion angle. Furthermore, clinical outcomes, including Lysholm knee and Tegner activity scores, showed no significant differences between the 2 groups at final follow-up visits (P > .05), and Lachman and pivot-shift test stability results and radiological stability data obtained at final follow-up were not significantly different between the 2 groups (P > .05).
The low femoral tunnel group showed better internal rotational stability at time zero during ACL reconstruction but similar anterior and external rotational stabilities. No significant differences were observed between the 2 groups in terms of clinical outcomes and stabilities after a minimum follow-up of 2 years.
多项生物力学研究支持在股骨隧道中放置较低的位置（10 点或 2 点），以在重建前交叉韧带（ACL）后实现膝关节的前向和旋转稳定性。然而，对于在 ACL 重建中使用低位（10 点或 2 点）与高位（11 点或 1 点）股骨隧道的优缺点，尚未达成明确共识。
在 ACL 重建过程中，股骨隧道的低位位置比高位位置提供更好的术中稳定性（尤其是旋转稳定性）和临床结果。
队列研究；证据等级 2。
62 例接受 ACL 重建的患者被平均分配到低位和高位股骨隧道组；每组有 58 例患者随访至少 2 年（每组 29 例）。重建后使用导航系统，作者比较了膝关节在 0°、30°、60°和 90°屈曲时的术中前向、内旋和外旋稳定性，并比较了临床结果，包括 Lysholm 膝关节评分、Tegner 活动评分、Lachman 和髌股关节滑动试验结果以及最终随访时的放射影像学稳定性。
低位组在 0°和 30°屈曲时显示出更好的内旋稳定性，但在其他角度（60°和 90°）则不然。在任何屈曲角度下，术中组间在前向和外旋稳定性方面均无显著差异。此外，在最终随访时，两组的临床结果，包括 Lysholm 膝关节评分和 Tegner 活动评分，无显著差异（P >.05），且最终随访时的 Lachman 和髌股关节滑动试验稳定性结果以及放射影像学稳定性数据在两组之间也无显著差异（P >.05）。
在 ACL 重建时，低位股骨隧道组在零时显示出更好的内旋稳定性，但在前向和外旋稳定性方面与高位组相似。在至少 2 年的随访后，两组在临床结果和稳定性方面无显著差异。
