Department of Orthopedics and Traumatology, Adana City Training and Research Hospital, Adana, Turkey.
Department of Orthopedics and Traumatology, Baskent University Hospital, Adana, Turkey.
J Knee Surg. 2020 Sep;33(9):938-946. doi: 10.1055/s-0040-1710363. Epub 2020 May 11.
This study compared the clinical and radiological findings of nonanatomic transtibial (TT) technique with intraspongious fixation and anatomical anteromedial portal (AMP) technique with extracortical button implant in anterior cruciate ligament (ACL) reconstruction. A total of 54 patients with isolated ACL rupture were included in this prospective study. The patients who had the intraspongious fixation by nonanatomical TT technique were allocated to Group 1 ( = 27). The patients with extracortical fixation by anatomical AMP technique were placed in Group 2 ( = 27). The clinical scores of the patients were evaluated with the International Knee Documentation Committee Evaluation Form, Tegner activity score, and Lysholm II Functional Scoring. The tibial and femoral tunnels were evaluated with three-dimensional computed tomography. The kinematic examinations were performed with a Biodex System 3 Pro isokinetic dynamometer. There was no significant difference between the groups in terms of demographic data ( > 0.05). The postoperative clinical scores improved significantly in both the groups compared with the preoperative levels ( = 0.001), but there was no significant difference in the postoperative clinical scores between the groups ( > 0.05). In the extension and flexion of 60 to 180 degrees/s, the peak torque and the peak torque/body weight values of the repaired knee to intact knee ratios showed significant differences in favor of Group 2 ( = 0.001). In both the groups, no significant difference was found between the mean extent of the tunnel enlargement ( > 0.05). The mean tunnel height was significantly greater in Group 1 (45% ± 9.86 vs. 34.11% ± 10.0%) ( = 0.001). When the localization of the tunnel enlargements (proximal-middle-distal) was examined, a significant difference was found between the groups ( = 0.001). Although the AMP technique, which is a more anatomic reconstruction, had an advantage with regard to tunnel enlargement and the isokinetic muscle studies, there was no difference between the two techniques in terms of the clinical results.
本研究比较了非解剖胫骨隧道（TT）技术伴海绵内固定与解剖前内侧入路（AMP）技术伴皮质外纽扣植入在前交叉韧带（ACL）重建中的临床和影像学发现。共有 54 例 ACL 撕裂的患者纳入本前瞻性研究。采用非解剖 TT 技术行海绵内固定的患者分入第 1 组（n=27），采用解剖 AMP 技术行皮质外固定的患者分入第 2 组（n=27）。采用国际膝关节文献委员会评分（IKDC）、Tegner 活动评分和 Lysholm II 功能评分评估患者的临床评分。通过三维 CT 评估胫骨和股骨隧道。使用 Biodex System 3 Pro 等速测力计进行运动学检查。两组间的人口统计学数据无显著差异（ > 0.05）。与术前相比，两组术后的临床评分均显著改善（ = 0.001），但组间术后临床评分无显著差异（ > 0.05）。在 60 至 180 度/秒的伸展和屈曲运动中，患侧与健侧的峰值扭矩和峰值扭矩/体重比显示出明显差异，有利于第 2 组（ = 0.001）。两组的隧道扩大平均程度无显著差异（ > 0.05）。第 1 组的平均隧道高度显著较高（45% ± 9.86 比 34.11% ± 10.0%）（ = 0.001）。当检查隧道扩大的位置（近-中-远）时，两组间存在显著差异（ = 0.001）。尽管 AMP 技术是一种更具解剖学的重建方法，在隧道扩大和等速肌肉研究方面具有优势，但两种技术在临床结果方面无差异。
