Lansdown Drew A, Allen Christina, Zaid Musa, Wu Samuel, Subburaj Karupppasamy, Souza Richard, Feeley Brian T, Li Xiaojuan, Ma C Benjamin
Department of Orthopaedic Surgery, University of California, San Francisco, 500 Parnassus Ave., MU 320 W Box 0728, San Francisco, CA 94143, USA.
University of California, San Francisco School of Medicine, 521 Parnassus Ave., San Francisco, CA 94117, USA.
Knee. 2015 Dec;22(6):547-53. doi: 10.1016/j.knee.2014.12.005. Epub 2014 Dec 17.
Multiple techniques are used for femoral tunnel drilling in ACL reconstruction, including the Mini-two Incision Method (MT) and Anteromedial Portal Technique (AM). Both techniques allow for independent placement of the femoral tunnel, though there are no reports comparing kinematics and cartilage health after these reconstructions. We hypothesized that both techniques would result in the restoration of normal knee kinematics and show no evidence of early cartilage degeneration.
A total of 20 patients were evaluated one year after ACL reconstruction, including 10 patients after MT and 10 patients after AM. MR-imaging was acquired bilaterally with the knee loaded in extension and flexion to evaluate the kinematics of the reconstructed knee compared with the normal knee. Quantitative cartilage imaging was obtained and compared with 10 matched control subjects. The Marx Activity Rating Scale and KOOS survey were administered.
The tibia was positioned significantly more anteriorly in extension and flexion relative to the contralateral knee for the MT group. The tibial position in the AM group was not significantly different from the patient's contralateral knee. T1ρ values in the central-medial tibia were significantly elevated in the MT group compared with the Control group. KOOS Symptom scores were significantly better for the MT group compared with the AM group.
We have observed in vivo differences in knee kinematics and early cartilage degeneration between patients following MT and AM ACL reconstructions. Both techniques allow for anatomic ACL reconstruction, though the MT group shows significant early differences compared with the patient's normal knee.
在 ACL 重建中，多种技术用于股骨隧道钻孔，包括迷你双切口法（MT）和前内侧入路技术（AM）。这两种技术都允许独立放置股骨隧道，不过尚无关于这些重建术后运动学和软骨健康状况比较的报道。我们假设这两种技术都能恢复正常的膝关节运动学，且无早期软骨退变的迹象。
对 20 例 ACL 重建术后 1 年的患者进行评估，其中 10 例采用 MT 法，10 例采用 AM 法。在膝关节伸展和屈曲负重状态下双侧进行磁共振成像，以评估重建膝关节与正常膝关节相比的运动学情况。获取定量软骨成像并与 10 名匹配的对照受试者进行比较。采用马克思活动评分量表和膝关节损伤与骨关节炎疗效评分（KOOS）调查。
MT 组在伸展和屈曲时，胫骨相对于对侧膝关节显著更靠前。AM 组的胫骨位置与患者对侧膝关节无显著差异。与对照组相比，MT 组胫骨中央内侧的 T1ρ值显著升高。MT 组的 KOOS 症状评分显著优于 AM 组。
我们观察到 MT 法和 AM 法 ACL 重建术后患者膝关节运动学和早期软骨退变存在体内差异。两种技术都能实现解剖学 ACL 重建，不过与患者正常膝关节相比，MT 组显示出显著的早期差异。
