Exeter Knee Reconstruction Unit, Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Barrack Road, Exeter, EX2 5DW, Devon, UK.
Research and Development Department, Royal Devon and Exeter Hospital, Exeter, UK.
Knee Surg Sports Traumatol Arthrosc. 2021 Apr;29(4):1157-1163. doi: 10.1007/s00167-020-06125-y. Epub 2020 Jun 29.
Remnant preservation, in anterior cruciate ligament (ACL) reconstruction, has potential biological advantages. However, graft positioning remains vital to functional outcome and the prevention of failure. The aim of this study was to investigate the accuracy and precision of tibial tunnel positioning in remnant preservation single-bundle hamstring reconstruction.
Fifty consecutive adult patients, with isolated ACL rupture, were recruited to a prospective study. Remnant preservation was performed in all cases where > 25% of the native ACL was present. Three-dimensional computer tomography was preformed 3-6 months post-operatively to assess tibial tunnel position (using a grid-based measurement). Accuracy and precision of this technique were assessed against published anatomical data in direct comparison with the group where remnant preservation could not be performed.
Two patients withdrew following surgery. In the remaining groups (31 remnant preservation; 17 non-remnant preservation), no difference was demonstrated in tunnel position (40.4 ± 6.7% (anterior-to-posterior) and 47.4 ± 1.5% (medial-to-lateral) vs. 38.8 ± 4.9% and 46.7 ± 1.5%, respectively; n.s.), accuracy (6.1% vs. 4.8%; n.s.) or precision (3.9% vs. 2.8%; n.s.).
Remnant preservation can be safely performed without compromising tunnel position. Therefore, the potential benefits of this technique can be utilised, in clinical practice, without sacrificing the ability to optimize tibial tunnel positioning.
III.
在前交叉韧带（ACL）重建中保留残端具有潜在的生物学优势。然而，移植物的定位对于功能结果和防止失败仍然至关重要。本研究旨在探讨保留残端的单束腘绳肌腱重建中胫骨隧道定位的准确性和精密度。
连续招募了 50 例 ACL 完全撕裂的成年患者进行前瞻性研究。如果存在 > 25%的原 ACL，所有病例均进行保留残端。术后 3-6 个月行三维 CT 检查，评估胫骨隧道位置（采用网格测量法）。将该技术的准确性和精密度与无法进行残端保留的组进行直接比较，以评估与已发表的解剖学数据的一致性。
手术后有 2 例患者退出研究。在剩余的两组（31 例保留残端；17 例不保留残端）中，隧道位置（前-后 40.4 ± 6.7%和内-外 47.4 ± 1.5%与 38.8 ± 4.9%和 46.7 ± 1.5%，n.s.）、准确性（6.1%与 4.8%，n.s.）或精密度（3.9%与 2.8%，n.s.）均无差异。
在不影响隧道位置的情况下，可以安全地进行保留残端操作。因此，在临床实践中，可以利用该技术的潜在益处，而不会牺牲优化胫骨隧道定位的能力。
III。
