Koga Hideyuki, Muneta Takeshi, Yagishita Kazuyoshi, Watanabe Toshifumi, Mochizuki Tomoyuki, Horie Masafumi, Nakamura Tomomasa, Otabe Koji, Sekiya Ichiro
Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan.
Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan.
Knee. 2015 Jun;22(3):249-55. doi: 10.1016/j.knee.2015.02.017. Epub 2015 Mar 17.
To evaluate a novel approach for femoral tunnel creation, a behind-remnant approach, in remnant-preserving double-bundle anterior cruciate ligament (ACL) reconstruction through comparison with a standard approach.
Sixty patients who underwent remnant-preserving double-bundle ACL reconstruction were included. Thirty patients with a standard approach were classified as the standard group, and 30 patients with a behind-remnant approach as the behind-remnant (BR) group. The anteromedial bundle (AMB) and posterolateral bundle (PLB) were provisionally fixed at 20° and 45° of flexion to a graft tensioning system during surgery. Bundle tension was recorded during knee flexion-extension and in response to anterior or rotatory loads. Femoral tunnel positions were then assessed using the quadrant method.
During flexion-extension, the BR group showed equivalent tension curves between AMB and PLB, while the standard group showed reciprocal tension curves. The tension on the PLB was lower than the AMB in response to anterior or rotatory loads in the BR group, while the AMB and PLB shared equivalent loads in the standard group. Tunnel position of the AMB in the BR group was lower and deeper, with smaller variances, than that in the standard group. Tunnel position of the PLB in the BR group was lower than that in the standard group.
In remnant-preserving double-bundle ACL reconstruction, a behind-remnant approach can be achieved without any removal of the remnant tissue, and could create a deeper and lower AMB tunnel and a lower PLB tunnel with higher reproducibility, showing equivalent tension curves between the AMB and PLB.
通过与标准方法进行比较，评估一种用于股骨隧道创建的新方法——残端后方入路，用于保留残端的双束前交叉韧带（ACL）重建。
纳入60例行保留残端双束ACL重建的患者。30例行标准入路的患者被归为标准组，30例行残端后方入路的患者被归为残端后方（BR）组。手术过程中，在屈膝20°和45°时将前内侧束（AMB）和后外侧束（PLB）临时固定于移植物张紧系统。在膝关节屈伸过程中以及对前向或旋转负荷作出反应时记录束的张力。然后使用象限法评估股骨隧道位置。
在屈伸过程中，BR组AMB和PLB之间的张力曲线相等，而标准组显示出相反的张力曲线。在BR组中，对前向或旋转负荷作出反应时，PLB上的张力低于AMB，而在标准组中AMB和PLB承受相等的负荷。BR组中AMB的隧道位置比标准组更低、更深，且方差更小。BR组中PLB的隧道位置低于标准组。
在保留残端的双束ACL重建中，采用残端后方入路无需切除任何残端组织，可创建更深、更低的AMB隧道和更低的PLB隧道，且重复性更高，AMB和PLB之间的张力曲线相等。
