1st Department of Orthopaedics, ATTIKON University General Hospital, Haidari, Greece.
Orthopaedic Sports Medicine Center, Department of Orthopaedic Surgery, University of Ioannina, Ioannina, Greece.
Knee Surg Sports Traumatol Arthrosc. 2018 May;26(5):1367-1374. doi: 10.1007/s00167-017-4742-0. Epub 2017 Oct 24.
Anterior cruciate ligament (ACL) reconstruction (ACLR) aims to restore normal knee joint function, stability and biomechanics and in the long term avoid joint degeneration. The purpose of this study is to present the anatomic single bundle (SB) ACLR that emphasizes intraoperative correction of tibiofemoral subluxation that occurs after ACL injury. It was hypothesized that this technique leads to optimal outcomes and better restoration of pathological tibiofemoral joint movement that results from ACL deficiency (ACLD).
Thirteen men with unilateral ACLD were prospectively evaluated before and at a mean follow-up of 14.9 (SD = 1.8) months after anatomic SB ACLR with bone patellar tendon bone autograft. The anatomic ACLR replicated the native ACL attachment site anatomy and graft orientation. Emphasis was placed on intraoperative correction of tibiofemoral subluxation by reducing anterior tibial translation (ATT) and internal tibial rotation. Function was measured with IKDC, Lysholm and the Tegner activity scale, ATT was measured with the KT-1000 arthrometer and tibial rotation (TR) kinematics were measured with 3Dmotion analysis during a high-demand pivoting task.
The results showed significantly higher TR of the ACL-deficient knee when compared to the intact knee prior to surgery (12.2° ± 3.7° and 10.7° ± 2.6° respectively, P = 0.014). Postoperatively, the ACLR knee showed significantly lower TR as compared to the ACL-deficient knee (9.6°±3.1°, P = 0.001) but no difference as compared to the control knee (n.s.). All functional scores were significantly improved and ATT was restored within normal values (P < 0.001).
Intraoperative correction of tibiofemoral subluxation that results after ACL injury is an important step during anatomic SB ACLR. The intraoperative correction of tibiofemoral subluxation along with the replication of native ACL anatomy results in restoration of rotational kinematics of ACLD patients to normal levels that are comparable to the control knee. These results indicate that the reestablishment of tibiofemoral alignment during ACLR may be an important step that facilitates normal knee kinematics postoperatively.
Level II, prospective cohort study.
前交叉韧带（ACL）重建（ACLR）旨在恢复膝关节的正常功能、稳定性和生物力学，并在长期内避免关节退化。本研究的目的是介绍解剖学单束（SB）ACL 重建，强调在 ACL 损伤后纠正发生的胫骨股骨半脱位。假设该技术可带来最佳结果，并更好地恢复因 ACL 缺失（ACLD）导致的病理性胫骨股骨关节运动。
前瞻性评估 13 名单侧 ACLD 男性患者，在解剖学 SB ACLR 后平均随访 14.9（SD=1.8）个月，采用骨髌腱骨自体移植物。解剖学 ACLR 复制了 ACL 附着部位的解剖结构和移植物方向。通过减少胫骨前移（ATT）和胫骨内旋，重点纠正胫骨股骨半脱位。采用 IKDC、Lysholm 和 Tegner 活动量表评估功能，使用 KT-1000 关节测量仪测量 ATT，在高需求旋转任务中使用 3Dmotion 分析测量胫骨旋转（TR）运动学。
结果显示，与术前健侧膝关节相比，ACL 缺失膝关节的 TR 明显更高（分别为 12.2°±3.7°和 10.7°±2.6°，P=0.014）。术后 ACLR 膝关节的 TR 明显低于 ACL 缺失膝关节（9.6°±3.1°，P=0.001），但与健侧膝关节无差异（无统计学意义）。所有功能评分均显著改善，ATT 恢复至正常范围（P<0.001）。
ACL 损伤后胫骨股骨半脱位的术中纠正，是解剖学 SB ACLR 的重要步骤。术中纠正胫骨股骨半脱位，同时复制 ACL 解剖结构，可使 ACLD 患者的旋转运动学恢复至正常水平，与健侧膝关节相当。这些结果表明，ACL 重建过程中重建胫骨股骨对线可能是促进术后膝关节正常运动学的重要步骤。
Ⅱ级，前瞻性队列研究。
