Department of Orthopedic Surgery, Korea University College of Medicine, Guro Hospital, Seoul, South Korea.
Arthroscopy. 2012 Nov;28(11):1682-94. doi: 10.1016/j.arthro.2012.05.884.
To compare femoral graft bending angles and femoral tunnel geometries between the transportal (TP) and outside-in (OI) techniques after anatomic double-bundle (DB) anterior cruciate ligament (ACL) reconstruction.
Thirty-nine patients underwent DB ACL reconstruction with the TP and OI techniques. They were randomized on the day of surgery to either the TP group (group I, 21 cases) or the OI group (group II, 18 cases). Femoral graft bending angle, femoral tunnel geometry, posterior wall breakage, and tunnel communication were assessed by computed tomography imaging with OsiriX imaging software (Pixmeo, Geneva, Switzerland).
The mean anteromedial (AM) and posterolateral (PL) femoral graft bending angles of group II (97.3° ± 8.3° and 97.4° ± 8.6°, respectively) were significantly more acute than those of group I (108.2° ± 8.4° and 109.9° ± 8.8°, respectively) (P < .001). The mean AM femoral tunnel length of group II (34.3 ± 3.9 mm) was significantly longer than that of group I (31.9 ± 2.7 mm) (P = .02). However, the mean PL femoral tunnel lengths did not differ between groups. In 7 cases-4 cases (19.0%) in group I and 3 cases (16.6%) in group II-the femoral tunnel communication was found around the intra-articular aperture. Posterior wall breakage was observed in 5 cases (23.8%), which were all in AM femoral tunnels of group I.
The OI technique resulted in more acute femoral graft bending angles (difference of 10.9° and 12.5° for AM and PL, respectively) and longer mean AM femoral tunnel lengths (difference of 2.4 mm) than the TP technique after anatomic DB ACL reconstruction, even though these small differences might be unlikely to be of clinical significance. Femoral tunnel communication was found in both groups, and posterior wall breakage was observed in AM femoral tunnels with the TP technique.
Level I, prospective randomized trial.
比较经皮（TP）和经外（OI）技术在解剖双束（DB）前交叉韧带（ACL）重建后股骨移植物弯曲角度和股骨隧道形态。
39 例患者接受 DB ACL 重建，采用 TP 和 OI 技术。在手术当天，他们被随机分为 TP 组（I 组，21 例）或 OI 组（II 组，18 例）。通过计算机断层扫描成像和 OsiriX 成像软件（Pixmeo，日内瓦，瑞士）评估股骨移植物弯曲角度、股骨隧道形态、后侧壁破裂和隧道连通性。
II 组的前内侧（AM）和后外侧（PL）股骨移植物弯曲角度的平均值（97.3°±8.3°和 97.4°±8.6°）明显大于 I 组（108.2°±8.4°和 109.9°±8.8°）（P<.001）。II 组的 AM 股骨隧道长度平均值（34.3±3.9mm）明显长于 I 组（31.9±2.7mm）（P=.02）。然而，两组之间的 PL 股骨隧道长度平均值没有差异。在 7 例中-4 例（19.0%）在 I 组和 3 例（16.6%）在 II 组-在关节内开口周围发现股骨隧道连通。在后侧壁破裂方面，观察到 5 例（23.8%），均在 I 组的 AM 股骨隧道中。
与 TP 技术相比，OI 技术在后交叉韧带解剖重建后，股骨移植物弯曲角度（AM 和 PL 分别为 10.9°和 12.5°）和 AM 股骨隧道长度平均值（2.4mm）更明显，尽管这些小差异可能无临床意义。在两组中均发现股骨隧道连通，并且在 TP 技术中观察到 AM 股骨隧道后侧壁破裂。
I 级，前瞻性随机试验。
