Sports Orthopaedic Center, Yukioka Hospital, 2-2-3 Ukita, Kita-ku, Osaka, Osaka, 530-0021, Japan.
Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan.
Knee Surg Sports Traumatol Arthrosc. 2019 Aug;27(8):2680-2690. doi: 10.1007/s00167-018-5300-0. Epub 2018 Nov 20.
To elucidate tunnel locations and clinical outcomes after anatomic rectangular tunnel (ART) anterior cruciate ligament reconstruction (ACLR) using a bone-patellar tendon-bone (BTB) graft.
Sixty-one patients with a primary unilateral ACL injury were included. Tunnels were created inside the ACL attachment areas after carefully removing the ACL remnant and clearly identifying the bony landmarks. Using 3-dimensional computed tomography (3-D CT) images, the proportion of the tunnel apertures to the anatomical attachment areas was evaluated at 3 weeks. The clinical outcomes were evaluated at 2 years postoperatively.
Geographically, the 3-D CT evaluation showed the entire femoral tunnel aperture; at least 75% of the entire tibial tunnel aperture area was consistently located inside the anatomical attachment areas surrounded by the bony landmarks. In the International Knee Documentation Committee (IKDC) subjective assessment, all patients were classified as 'normal' or 'nearly normal'. The Lachman test and pivot-shift test were negative in 98.4% and 95.1% of patients, respectively. The mean side-to-side difference of the anterior laxity at the maximum manual force with a KT- 1000 Knee Arthrometer was 0.2 ± 0.9 mm, with 95.1% of patients ranging from - 1 to + 2 mm.
By identifying arthroscopic landmarks, the entire femoral tunnel aperture and at least 75% of the entire tibial tunnel aperture area were consistently located inside the anatomical attachment areas. With properly created tunnels inside the anatomical attachment areas, the ART ACLR using a BTB graft could provide satisfactory outcomes both subjectively and objectively in more than 95% of patients.
Case series, Level IV.
阐明使用骨-髌腱-骨（BTB）移植物进行解剖矩形隧道（ART）前交叉韧带重建（ACLR）后的隧道位置和临床结果。
纳入 61 例单侧初次 ACL 损伤患者。在仔细清除 ACL 残端并清楚识别骨性标志后，在 ACL 附着区域内创建隧道。使用三维 CT（3-D CT）图像，在 3 周时评估隧道开口与解剖附着区域的比例。术后 2 年评估临床结果。
从地理上看，3-D CT 评估显示整个股骨隧道开口；至少 75%的整个胫骨隧道开口区域始终位于由骨性标志包围的解剖附着区域内。在国际膝关节文献委员会（IKDC）主观评估中，所有患者均被归类为“正常”或“接近正常”。98.4%的患者 Lachman 试验和枢轴移位试验均为阴性，95.1%的患者分别为阴性。KT-1000 膝关节关节计的最大手动力下的前向松弛的侧-侧差值平均为 0.2±0.9mm，95.1%的患者范围为-1 至+2mm。
通过识别关节镜标志，可以始终将整个股骨隧道开口和至少 75%的整个胫骨隧道开口区域定位在解剖附着区域内。在解剖附着区域内正确创建隧道后，使用 BTB 移植物进行 ART ACLR 可以在 95%以上的患者中提供主观和客观上都令人满意的结果。
病例系列，IV 级。
