Monaco Edoardo, Fabbri Mattia, Redler Andrea, Iorio Raffaele, Conteduca Jacopo, Argento Giuseppe, Ferretti Andrea
Orthopaedic Department and "Kirk Kilgour" Sports Injury Center, Sant' Andrea Hospital, "La Sapienza", University of Rome, Via di Grottarossa, 1035-1039, Rome, Italy.
J Orthop Traumatol. 2017 Dec;18(4):335-341. doi: 10.1007/s10195-017-0458-7. Epub 2017 May 8.
Several studies have recently shown better restoration of normal knee kinematics and improvement of rotator knee stability after reconstruction with higher femoral tunnel obliquity. The aim of this study is to evaluate tunnel obliquity, length, and posterior wall blowout in single-bundle anterior cruciate ligament (ACL) reconstruction, comparing the transtibial (TT) technique and the out-in (OI) technique.
Forty consecutive patients operated on for ACL reconstruction with hamstrings were randomly divided into two groups: group A underwent a TT technique, while group B underwent an OI technique. At mean follow-up of 10 months, clinical results and obliquity, length, and posterior wall blowout of femoral tunnels in sagittal and coronal planes using computed tomography (CT) scan were assessed.
In sagittal plane, femoral tunnel obliquity was 38.6 ± 10.2° in group A and 36.6 ± 11.8° in group B (p = 0.63). In coronal plane, femoral tunnel obliquity was 57.8 ± 5.8° in group A and 35.8 ± 8.2° in group B (p = 0.009). Mean tunnel length was 40.3 ± 1.2 mm in group A and 32.9 ± 2.3 mm in group B (p = 0.01). No cases of posterior wall compromise were observed in any patient of either group. Clinical results were not significantly different between the two groups.
The OI technique provides greater obliquity of the femoral tunnel in coronal plane, along with satisfactory length of the tunnel and lack of posterior wall compromise.
II, prospective study.
最近的几项研究表明，在采用更高的股骨隧道倾斜度进行重建后，膝关节正常运动学的恢复更好，旋转性膝关节稳定性也有所改善。本研究的目的是评估单束前交叉韧带（ACL）重建中隧道的倾斜度、长度和后壁爆裂情况，比较经胫骨（TT）技术和由外向内（OI）技术。
连续40例接受腘绳肌ACL重建手术的患者被随机分为两组：A组采用TT技术，B组采用OI技术。在平均随访10个月时，评估临床结果以及使用计算机断层扫描（CT）扫描在矢状面和冠状面测量的股骨隧道倾斜度、长度和后壁爆裂情况。
在矢状面，A组股骨隧道倾斜度为38.6±10.2°，B组为36.6±11.8°（p = 0.63）。在冠状面，A组股骨隧道倾斜度为57.8±5.8°，B组为35.8±8.2°（p = 0.009）。A组平均隧道长度为40.3±1.2 mm，B组为32.9±2.3 mm（p = 0.01）。两组患者均未观察到后壁受损情况。两组临床结果无显著差异。
OI技术在冠状面提供了更大的股骨隧道倾斜度，同时隧道长度令人满意且无后壁受损情况。
II级，前瞻性研究。
