Stone Austin V, Chahla Jorge, Manderle Brandon J, Beletsky Alexander, Bush-Joseph Charles A, Verma Nikhil N
Department of Orthopaedic Surgery, University of Kentucky, Lexington, KY USA.
Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, 1611 W Harrison St., Chicago, IL 60616 USA.
HSS J. 2020 Dec;16(Suppl 2):256-263. doi: 10.1007/s11420-019-09707-w. Epub 2019 Aug 9.
The importance of creating an anatomic anterior cruciate ligament (ACL) reconstruction has been receiving significant attention. The best technique by which to achieve this anatomic reconstruction continues to be debated. The two most common methods are the transtibial (TT) and anteromedial (AM) techniques. Each has its advantages and disadvantages, and the literature comparing the two remains uncertain.
QUESTIONS/PURPOSES: In this prospective comparative study, we aimed to compare the ACL graft and tunnel angles achieved using the anatomic transtibial (TT) and anteromedial (AM) techniques; compare the ACL graft and tunnel angles in knees that have undergone ACL reconstruction and knees with intact ACLs; and determine whether differences in the graft or tunnel angle produce differences in clinical outcomes, as measured using both physical exam and patient-reported outcomes, after ACL reconstruction.
Patients who underwent primary ACL reconstruction with bone-tendon-bone grafts using a TT or AM technique were included. Femoral graft angle (FGA), tibial graft angle (TGA), and sagittal orientation of the reconstructed ACL and contralateral native ACL were measured on post-operative magnetic resonance imaging. Post-operatively, patients underwent measurement of knee stability and completed the Knee Injury and Osteoarthritis Outcome Score (KOOS) survey.
Twenty-nine patients were enrolled (AM group, 14; TT group, 15); at follow-up, KOOS data were available for 26 patients (13 in each group). There were no differences in sagittal ACL graft angle between groups or in comparison with the normal knee. The FGA was more vertical after TT reconstructions; the TGA was comparable between groups. There were no significant differences in 2-year post-operative physical exam measurements or in KOOS scores.
Anatomic ACL angle was restored after reconstruction with both the TT and AM techniques, despite different FGAs. No significant differences in clinical outcome were noted between groups on physical exam or KOOS at 2 years after surgery. These results suggest that TT reconstruction results in a graft position similar to that seen in AM reconstruction and that the location of the intra-articular tunnel aperture matters more than the orientation of the tunnel.
创建解剖学前交叉韧带（ACL）重建的重要性一直备受关注。实现这种解剖学重建的最佳技术仍在争论中。两种最常见的方法是经胫骨（TT）和前内侧（AM）技术。每种方法都有其优缺点，比较两者的文献尚无定论。
问题/目的：在这项前瞻性比较研究中，我们旨在比较使用解剖学经胫骨（TT）和前内侧（AM）技术获得的ACL移植物和隧道角度；比较接受ACL重建的膝关节和ACL完整的膝关节中的ACL移植物和隧道角度；并确定移植物或隧道角度的差异是否会在ACL重建后通过体格检查和患者报告的结果测量产生临床结果的差异。
纳入使用TT或AM技术进行骨-肌腱-骨移植物初次ACL重建的患者。在术后磁共振成像上测量股骨移植物角度（FGA）、胫骨移植物角度（TGA）以及重建的ACL和对侧天然ACL的矢状位方向。术后，对患者进行膝关节稳定性测量并完成膝关节损伤和骨关节炎结局评分（KOOS）调查。
共纳入29例患者（AM组14例；TT组15例）；随访时，26例患者（每组13例）有KOOS数据。两组之间以及与正常膝关节相比，矢状位ACL移植物角度无差异。TT重建后FGA更垂直；两组之间TGA相当。术后2年的体格检查测量或KOOS评分无显著差异。
尽管FGA不同，但使用TT和AM技术重建后解剖学ACL角度均得以恢复。术后2年，两组在体格检查或KOOS方面的临床结果无显著差异。这些结果表明，TT重建导致的移植物位置与AM重建相似，并且关节内隧道开口的位置比隧道的方向更重要。
