de Paula Leite Cury Ricardo, Simabukuro Artur Mistieri, de Marques Oliveira Victor, Escudeiro Diego, Jorge Pedro Baches, Severino Fabrício Roberto, Guglielmetti Luiz Gabriel Betoni
Orthopedics and Traumatology Department, Faculdade de Ciências Médicas da Santa Casa de Misericórdia de São Paulo, R. Dr. Cesário Mota Júnior, 61 - Vila Buarque, São Paulo, 01221-020, Brazil.
J Exp Orthop. 2020 Mar 7;7(1):11. doi: 10.1186/s40634-020-00225-x.
The aim of the study is to compare the risk of revision of single-bundle hamstring anterior cruciate ligament (ACL) reconstruction between the anteromedial, transtibial and outside-in techniques.
This cohort study was based on data from a single surgeon's registry. Patients who underwent primary single-bundle ACL reconstruction with hamstring tendon using the anteromedial portal, transtibial and outside-in technique, operated between 1 November 2003 to 31 December 2016, were eligible for inclusion. A minimum follow-up of 2 years was used, and the end-point of the study was revision surgery.
The total number of registered surgeries identified was 665; 109 were excluded, and 556 was the final sample. The overall revision rate was 8.7%. The transtibial technique presented 14/154 [9.9%] of revisions, the transportal 11/96 [11.4%] and the outside-in 22/306 [7.2%]. Separating the outside-in group into central outside-in and anteromedial (AM) outside-in, 18/219 [8.2%] was found for the central outside-in and 4/87 [4.5%] for the AM outside-in technique. Statistical evaluation of the first comparison (transtibial vs. transportal vs. outside-in) obtained p = (n.s.) The second comparison (transtibial vs. central transportal vs. central outside-in vs. AM outside-in, p = (n.s). Placement was also evaluated: high anteromedial placement (transtibial) vs. central (transportal and central outside-in technique) vs. AM placement (AM outside-in). The high AM placement presented 14/154 [9.9%] of revision, the central placement 29/315 [9.2%] and the AM placement 4/87 [4.5%], p = (n.s.) The AM placement was also compared with the other placements (high and central AM), p = (n.s.) CONCLUSION: Based on the registry of a single surgeon during 14 years of ACL reconstruction, the placement of the femoral tunnel in the high anteromedial region was associated with a rupture rate of 9.9%, central placement with 9.2% and anteromedial placement with 4.5%.
本研究旨在比较单束腘绳肌前交叉韧带（ACL）重建术中经胫骨、经内侧入路和由外向内技术翻修的风险。
本队列研究基于一位外科医生的登记数据。纳入2003年11月1日至2016年12月31日期间采用经内侧入路、经胫骨和由外向内技术行初次单束腘绳肌ACL重建的患者。采用至少2年的随访，研究终点为翻修手术。
确定的登记手术总数为665例；排除109例，最终样本为556例。总体翻修率为8.7%。经胫骨技术的翻修率为14/154 [9.9%]，经内侧入路为11/96 [11.4%]，由外向内为22/306 [7.2%]。将由外向内组分为中央由外向内和前内侧（AM）由外向内，中央由外向内的翻修率为18/219 [8.2%]，AM由外向内技术为4/87 [4.5%]。第一次比较（经胫骨与经内侧入路与由外向内）的统计学评估p =（无统计学意义）。第二次比较（经胫骨与中央经内侧入路与中央由外向内与AM由外向内，p =（无统计学意义）。还评估了股骨隧道的位置：高位前内侧位置（经胫骨）与中央位置（经内侧入路和中央由外向内技术）与AM位置（AM由外向内）。高位AM位置的翻修率为14/154 [9.9%]，中央位置为29/315 [9.2%]，AM位置为4/87 [4.5%]，p =（无统计学意义）。还将AM位置与其他位置（高位和中央AM）进行比较，p =（无统计学意义）。结论：基于一位外科医生14年ACL重建的登记数据，股骨隧道置于高位前内侧区域的破裂率为9.9%，中央位置为9.2%，前内侧位置为4.5%。
