Department of Orthopaedic Surgery, Kangwon National University Hospital, South Korea.
Arthroscopy. 2013 May;29(5):882-90. doi: 10.1016/j.arthro.2013.01.025. Epub 2013 Mar 26.
The purpose of this study was to compare clinical outcomes after single-bundle anterior cruciate ligament (ACL) reconstruction with a free Achilles tendon allograft using either a transtibial or an anteromedial portal technique and then to quantify the difference in femoral tunnel position between these 2 approaches. This assessment was to be performed with a new method using conventional magnetic resonance imaging (MRI) with a digital imaging system.
In this prospective randomized comparative study, 53 young male patients with ACL rupture underwent ACL reconstruction with the transtibial technique (group 1) or the anteromedial portal technique (group 2). We assessed clinical outcomes with the Lachman test, pivot shift test, International Knee Documentation Committee (IKDC) classification, Lysholm score, Tegner activity scale, and single leg hop (SLH) test. Radiologic assessments included the position of the femoral tunnel aperture and the posterior cruciate ligament (PCL) index on conventional MRI and the side-to-side difference (SSD) on stress radiographs.
Sixty-one participants had follow-up. The mean follow-up period was 30.2 months. At the last follow-up, there were no significant differences between the 2 groups in results from the Lachman test, pivot shift test, IKDC classification, Tegner activity scale, and SLH test. The Lysholm score and SSD results in group 2 were superior to those in group 1 (P < .001). The femoral tunnel aperture was positioned more posteriorly in group 2 than in group 1 (P < .001). Changes in the PCL index were greater in group 1 than in group 2 (P < .001).
The position of the femoral tunnel aperture created with the anteromedial portal technique was more posterior than that made with the transtibial technique. Knees reconstructed with the anteromedial portal technique were more stable in Telos testing, and were 3 points higher on the Lysholm score. However, there were no statistically significant differences in the Tegner activity scale or IKDC classification between the 2 groups.
Therapeutic level I, randomized controlled clinical trial.
本研究旨在比较使用经胫骨或前内侧入路的同种异体跟腱重建单束前交叉韧带（ACL）后的临床结果，并定量分析这两种方法在股骨隧道位置上的差异。使用传统磁共振成像（MRI）结合数字成像系统的新方法进行评估。
在这项前瞻性随机对照研究中，53 名年轻男性 ACL 断裂患者接受 ACL 重建，采用经胫骨技术（组 1）或前内侧入路技术（组 2）。我们使用 Lachman 试验、前抽屉试验、国际膝关节文献委员会（IKDC）分级、Lysholm 评分、Tegner 活动量表和单腿跳（SLH）试验评估临床结果。影像学评估包括常规 MRI 上股骨隧道开口的位置和后交叉韧带（PCL）指数，以及应力位 X 线片上的侧-侧差值（SSD）。
61 名参与者获得了随访。平均随访时间为 30.2 个月。末次随访时，两组 Lachman 试验、前抽屉试验、IKDC 分级、Tegner 活动量表和 SLH 试验结果无显著差异。组 2 的 Lysholm 评分和 SSD 结果优于组 1（P <.001）。组 2 的股骨隧道开口位置较组 1更靠后（P <.001）。组 1 的 PCL 指数变化大于组 2（P <.001）。
前内侧入路技术所创建的股骨隧道开口位置比经胫骨技术更靠后。Telos 测试中，前内侧入路重建的膝关节更稳定，Lysholm 评分高 3 分。然而，两组间 Tegner 活动量表或 IKDC 分级无统计学差异。
治疗水平 I，随机对照临床试验。
