Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China.
The College of Clinical Medicine, Chongqing Medical University, Chongqing, People's Republic of China.
J Knee Surg. 2021 Sep;34(11):1243-1252. doi: 10.1055/s-0040-1702164. Epub 2020 May 5.
The ideal procedure for anterior cruciate ligament (ACL) reconstruction is one that can achieve anatomical restoration for a better ACL function. This retrospective comparative study was conducted to evaluate the objective and subjective clinical results of the conventional single-bundle femoral round (SBR) tunnel technique, the single-bundle femoral oval (SBO) tunnel technique, and the double-bundle (DB) surgical technique for anatomical ACL reconstruction with hamstring tendon autografts. Patients who underwent the SBO, SBR, and DB ACL reconstructions from January 2016 to August 2017 were included in this study. A total of 163 patients underwent different surgical techniques; 41 patients underwent the SBO procedure, 78 patients received SBR, and the remaining 44 patients underwent the DB procedure. The Lachman's test, pivot-shift test, Lysholm's score, International Knee Documentation Committee (IKDC) score, and Tegner's score were compared among groups postoperatively. KT-1000 was used to measure the anterior laxity of the knee. Magnetic resonance imaging was used to compare the ACL graft maturity. Second-look arthroscopy was conducted to compare the graft status and synovial coverage. Significant differences among groups were found with respect to the Lysholm's score, Tegner's score, and IKDC score. Patients in the SBO and DB groups acquired higher functional scores than the SBR group. More patients with positive pivot-shift test were observed in the SBR group than other groups at 12- and 24-month postoperative follow-ups. The postoperative KT-1000 was better in the SBO and DB groups than in the SBR group. The mean signal/noise quotient (SNQ) of the SBO group was 2.70 ± 0.92, significantly lower than 3.58 ± 1.21 of the SBR group. Despite a higher proportion of patients with grade B or C synovial coverage and partial graft injury found in the SBR group, there were no significant differences among the groups. The SBO and DB technique achieved better clinical results than the SBR technique. The SBO technique was indeed an ideal surgical procedure for ACL reconstruction provided that the shortcoming of DB technique must be taken into account. This is a Level III, retrospective comparative study.
前交叉韧带（ACL）重建的理想方法是能够实现解剖学恢复，以获得更好的 ACL 功能。本回顾性对比研究旨在评估采用自体腘绳肌腱进行解剖重建的常规单束股骨圆孔（SBR）隧道技术、单束股骨椭圆形（SBO）隧道技术和双束（DB）手术技术的客观和主观临床结果。本研究纳入了 2016 年 1 月至 2017 年 8 月期间接受 SBO、SBR 和 DB ACL 重建的患者。共有 163 例患者接受了不同的手术技术；41 例患者接受了 SBO 手术，78 例患者接受了 SBR，其余 44 例患者接受了 DB 手术。术后比较各组的 Lachman 试验、前抽屉试验、Lysholm 评分、国际膝关节文献委员会（IKDC）评分和 Tegner 评分。使用 KT-1000 测量膝关节的前向松弛度。磁共振成像（MRI）用于比较 ACL 移植物成熟度。进行二次关节镜检查以比较移植物状态和滑膜覆盖情况。在 Lysholm 评分、Tegner 评分和 IKDC 评分方面，各组之间存在显著差异。SBO 和 DB 组的患者获得的功能评分高于 SBR 组。在术后 12 个月和 24 个月的随访中，SBR 组中观察到更多的前抽屉试验阳性患者。术后 KT-1000 在 SBO 和 DB 组优于 SBR 组。SBO 组的平均信号/噪声比值（SNQ）为 2.70±0.92，明显低于 SBR 组的 3.58±1.21。尽管 SBR 组中发现有较高比例的 B 级或 C 级滑膜覆盖和部分移植物损伤的患者，但各组之间无显著差异。与 SBR 技术相比，SBO 和 DB 技术取得了更好的临床效果。SBO 技术确实是 ACL 重建的理想手术方法，但必须考虑到 DB 技术的缺点。这是一项 III 级回顾性对比研究。
