Middlemore Hospital, Auckland, New Zealand.
Aarhaus University Hospital, Aarhaus, Denmark.
Knee Surg Sports Traumatol Arthrosc. 2019 Jan;27(1):124-129. doi: 10.1007/s00167-018-5036-x. Epub 2018 Jul 12.
It is proposed that central femoral ACL graft placement better controls rotational stability. This study evaluates the consequence of changing the femoral tunnel position from the AM position drilled transtibially to the central position drilled transportally. The difference in ACL graft failure is reported.
This prospective consecutive patient single surgeon study compares the revision rates of 1016 transtibial hamstring ACL reconstructions followed for 6-15 years with 464 transportal hamstring ACL reconstructions followed for 2-6 years. Sex, age, graft size, time to surgery, meniscal repair and meniscectomy data were evaluated as contributing factors for ACL graft failure to enable a multivariate analysis. To adjust for the variable follow-up a multivariate hazard ratio, failure per 100 graft years and Kaplan-Meier survivorship was determined.
With transtibial ACLR 52/1016 failed (5.1%). With transportal ACLR 32/464 failed (6.9%). Significant differences between transportal and transtibial ACLR were seen for graft diameter, time to surgery, medial meniscal repair rates and meniscal tissue remaining after meniscectomy. Adjusting for these the multivariate hazard ratio was 2.3 times higher in the transportal group (p = 0.001). Central tunnel placement resulted in a significantly 3.5 times higher revision rate compared to an anteromedial tunnel placement per 100 graft years (p = 0.001). Five year survival was 980/1016 (96.5%) for transtibial versus 119/131 (90.5%) for transportal. Transportal ACLR also showed a significantly higher earlier failure rate with 20/32 (61%) of the transportal failing in the first year compared with 14/52 (27%) for transtibial. (p = 0.001.) CONCLUSION: Transportal central femoral tunnel ACLR has a higher failure rate and earlier failure than transtibial AM femoral tunnel ACLR.
Level II-prospective comparative study.
有人提出，中央股骨 ACL 移植物的放置能更好地控制旋转稳定性。本研究评估了从经胫骨隧道的 AM 位置改变到经皮隧道的中央位置对 ACL 移植物失败的影响。报告了 ACL 移植物失败的差异。
这项前瞻性连续患者单外科医生研究比较了随访 6-15 年的 1016 例经胫骨隧道腘绳肌 ACL 重建和随访 2-6 年的 464 例经皮隧道腘绳肌 ACL 重建的翻修率。评估了性别、年龄、移植物大小、手术时间、半月板修复和半月板切除术的数据，作为 ACL 移植物失败的影响因素，以便进行多变量分析。为了调整随访时间的变量，确定了多变量风险比、每 100 个移植物年的失败率和 Kaplan-Meier 生存率。
在经胫骨 ACLR 中，有 52/1016 例失败（5.1%）。在经皮 ACLR 中，有 32/464 例失败（6.9%）。在移植物直径、手术时间、内侧半月板修复率和半月板切除术后剩余半月板组织方面，经皮 ACLR 与经胫骨 ACLR 之间存在显著差异。调整这些因素后，经皮组的多变量风险比高出 2.3 倍（p=0.001）。与经前内侧隧道放置相比，中央隧道放置每 100 个移植物年的翻修率显著高出 3.5 倍（p=0.001）。5 年生存率为经胫骨 1016/1016（96.5%），经皮 131/131（90.5%）。经皮 ACLR 在前一年的失败率也明显更高，其中 32/32（61%）的经皮失败，而经胫骨只有 14/52（27%）失败（p=0.001）。
与经胫骨 AM 股骨隧道 ACLR 相比，经皮中央股骨隧道 ACLR 的失败率更高，且失败时间更早。
II 级-前瞻性比较研究。
