Sports Medicine and Shoulder Surgery, Hospital for Special Surgery, New York, NY, USA.
Knee Surg Sports Traumatol Arthrosc. 2013 Apr;21(4):846-50. doi: 10.1007/s00167-012-1988-4. Epub 2012 Apr 4.
The purpose of this study is to compare femoral tunnel positions after ACL reconstruction by the transtibial (TT) approach versus the low anteromedial approach using radiographs from a single surgeon.
The standard postoperative knee radiographs of 50 patients with an ACL reconstruction were studied. Two groups were determined according to the technique used. The low anteromedial portal group and the transtibial portal group. The femoral bone tunnel was identified radiographically, and its position determined in the lateral and A-P view. Coronal and sagittal obliquity of the tunnel was measured and compared among both groups.
In the sagittal plane, femoral bone tunnels averaged 54° ± 6° for the TT technique and 59° ± 12° (p = 0.07) for the low anteromedial portal technique. In the coronal plane, the bone tunnels drilled through the low anteromedial portal showed a significantly more oblique femoral tunnel position (50° ± 6°) compared to TT drilling (58° ± 9°), p ≤ 0.05.
Drilling the femoral tunnel through the low anteromedial portal resulted in a more oblique femoral tunnel position compared to the TT technique. Clinically, the low anteromedial portal may allow to better restore the anatomic orientation of the ACL.
本研究旨在比较经胫骨（TT）入路与低位前内侧入路重建 ACL 后股骨隧道的位置，使用同一位外科医生的影像学资料。
研究了 50 例 ACL 重建患者的标准术后膝关节 X 线片。根据使用的技术将患者分为两组，即低位前内侧入路组和经胫骨入路组。X 线片上识别股骨骨隧道，并在侧位和前后位确定其位置。比较两组之间隧道的冠状面和矢状面倾斜度。
在矢状面，TT 技术的股骨骨隧道平均为 54°±6°，低位前内侧入路技术为 59°±12°（p=0.07）。在冠状面，经低位前内侧入路钻取的骨隧道显示出明显更倾斜的股骨隧道位置（50°±6°），与 TT 钻取（58°±9°）相比，p≤0.05。
与 TT 技术相比，经低位前内侧入路钻取股骨隧道可导致股骨隧道位置更倾斜。临床上，低位前内侧入路可能更有利于恢复 ACL 的解剖方位。
