Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Pyeongchon-dong, Dongan-gu, Anyang-si, Gyeonggi-do, 431-070, South Korea.
Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehang-ro, Jongno-gu, Seoul, 110-744, South Korea. E-mail address for M.C. Lee:
J Bone Joint Surg Am. 2014 Apr 16;96(8):664-72. doi: 10.2106/JBJS.M.00088.
Anatomic anterior cruciate ligament (ACL) reconstruction is essential to the restoration of normal knee kinematics and to achieving successful results after ACL surgery. The purpose of this study was to evaluate whether anatomic single-bundle ACL reconstruction can be performed with use of the modified transtibial technique such that the tunnel characteristics are not substantially different from those of the anteromedial transportal technique, with comparable clinical results.
One hundred and four patients underwent single-bundle ACL reconstruction performed with use of either the modified transtibial technique or the anteromedial transportal technique. Each group included fifty-two patients retrospectively matched on the basis of age, sex, and body mass index. All patients had postoperative computed tomography (CT) and a minimum duration of follow-up of twenty-four-months. CT parameters, including tunnel position, tunnel length and shape, and graft obliquity, were evaluated. Clinical assessments were based on manual laxity tests, arthrometric analysis, and clinical scores recorded preoperatively and at the time of follow-up.
The femoral tunnel was placed at a slightly inferior and anterior position with use of the modified transtibial technique compared with the anteromedial transportal technique, but the difference was not significant (superior-inferior mean [and standard deviation], 35.7% ± 3.1% versus 33.9% ± 4.1%, p > 0.05, and anterior-posterior mean, 31.6 ± 6.8% versus 35.1 ± 6.9%, p > 0.05, as assessed with use of the quadrant method). The femoral tunnel length was significantly longer (p < 0.05) and the tibial tunnel length was significantly shorter (p < 0.05) with use of the modified transtibial technique compared with the anteromedial transportal technique (mean femoral tunnel length, 40.5 ± 4.2 mm versus 34.4 ± 2.6 mm and mean tibial tunnel length, 32.3 ± 3.1 mm versus 35.5 ± 2.7 mm); however, tunnel length was sufficient to allow for adequate fixation. There were no significant differences between the two groups in terms of tibial tunnel position, graft obliquity, tibial tunnel widening, and clinical results.
Tunnel characteristics including anatomic position, graft obliquity, and tunnel widening after single-bundle ACL reconstruction performed with use of the modified transtibial technique were not significantly different from those of the anteromedial transportal technique, and clinical results were comparable.
解剖学前交叉韧带（ACL）重建对于恢复正常膝关节运动学和实现 ACL 手术后的成功结果至关重要。本研究的目的是评估改良经胫骨技术是否可以进行解剖学单束 ACL 重建，使得隧道特征与前内侧经皮隧道技术基本不同，同时具有可比的临床结果。
104 例患者接受了单束 ACL 重建，其中 52 例采用改良经胫骨技术，52 例采用前内侧经皮隧道技术。每组均根据年龄、性别和体重指数进行了 52 例回顾性匹配。所有患者均接受了术后 CT（计算机断层扫描）检查，随访时间至少为 24 个月。评估了隧道位置、隧道长度和形状以及移植物倾斜度等 CT 参数。临床评估基于术前和随访时的手动松弛试验、关节测量分析和临床评分。
与前内侧经皮隧道技术相比，改良经胫骨技术的股骨隧道位置较低且靠前，但差异无统计学意义（象限法测量的上-下平均[和标准差]分别为 35.7%±3.1%比 33.9%±4.1%，p＞0.05，前-后平均为 31.6±6.8%比 35.1±6.9%，p＞0.05）。与前内侧经皮隧道技术相比，改良经胫骨技术的股骨隧道长度明显较长（p＜0.05），胫骨隧道长度明显较短（p＜0.05）（股骨隧道平均长度分别为 40.5±4.2mm 和 34.4±2.6mm，胫骨隧道平均长度分别为 32.3±3.1mm 和 35.5±2.7mm）；然而，隧道长度足以进行充分固定。两组在胫骨隧道位置、移植物倾斜度、胫骨隧道增宽和临床结果方面无显著差异。
改良经胫骨技术进行单束 ACL 重建后的隧道特征，包括解剖位置、移植物倾斜度和隧道增宽，与前内侧经皮隧道技术无显著差异，且临床结果相当。
