Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-Daero, Seocho-Gu, Seoul, 06591, South Korea.
Department of Orthopaedic Surgery, St. Paul's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
Knee Surg Sports Traumatol Arthrosc. 2019 Nov;27(11):3505-3512. doi: 10.1007/s00167-019-05446-x. Epub 2019 Feb 28.
The purpose of this study was to compare the accuracy and precision of femoral tunnel placement by expert and novice surgeons using an offset guide for single-bundle ACL reconstruction via the anteromedial (AM) portal.
Twenty-five single-bundle ACL reconstructions performed by a novice surgeon were matched with 25 ACL reconstructions performed by an expert surgeon, based on one-to-one propensity score matching. The same technique was used by both groups for femoral tunnel placement using a 7-mm offset guide through the AM portal. Using the Bernard and Hertel grid method for postoperative three-dimensional reconstructed computed tomography, the accuracy and precision of various tunnel positions were compared.
No differences were found between the proximal-distal and anterior-posterior femoral tunnel placements by the two groups (proximal-distal; 30.5% involving experts, and 32.5% by novices, n.s) (anterior-posterior; 32.6% involving experts, and 31.6% by novice, n.s). The accuracy of the femoral tunnel positions, based on the average distance from the tunnel center to the center of ACL direct insertion, was similar between the two groups (n.s). No differences were found between the groups in terms of precision of femoral tunnel positions (n.s).
Novice surgeons can achieve accuracy and precision comparable to experts in creating femoral tunnels via single-bundle ACL reconstruction through the AM portal using a femoral offset guide. We recommend the use of a femoral offset guide for ACL reconstruction during the learning phase of a novice surgeon for effective tunnel placement to reduce the learning curve required to perform accurate and reproducible ACL reconstruction.
Case-control study, Level III.
本研究旨在比较使用前内侧（AM）入路偏距导板进行单束 ACL 重建时，专家和新手外科医生放置股骨隧道的准确性和精确性。
根据一对一倾向评分匹配，将 25 例由新手外科医生进行的单束 ACL 重建与 25 例由专家外科医生进行的 ACL 重建相匹配。两组均采用 7mm 偏距导板通过 AM 入路进行股骨隧道放置。使用 Bernard 和 Hertel 网格法对术后三维重建 CT 进行分析，比较了两种隧道位置的准确性和精确性。
两组股骨隧道的近远侧和前后位置无差异（近远侧；专家涉及 30.5%，新手涉及 32.5%，n.s）（前后；专家涉及 32.6%，新手涉及 31.6%，n.s）。根据隧道中心与 ACL 直接插入中心的平均距离，两组股骨隧道位置的准确性相似（n.s）。两组股骨隧道位置的精确性无差异（n.s）。
新手外科医生可以通过使用前内侧入路股骨偏距导板进行单束 ACL 重建，达到与专家相似的准确性和精确性。我们建议在新手外科医生的学习阶段使用股骨偏距导板进行 ACL 重建，以有效放置隧道，减少进行准确和可重复的 ACL 重建所需的学习曲线。
病例对照研究，III 级。
