Yoon Kyoung Ho, Kim Jung-Suk, Park Jae-Young, Park Soo Yeon, Kiat Raymond Yeak Dieu, Kim Sang-Gyun
Department of Orthopaedic Surgery, Kyung Hee University Hospital, Seoul, Republic of Korea.
Department of Physical Education, Graduate School of Education, Yongin University, Yongin-si, Gyeongki-do, Republic of Korea.
Orthop J Sports Med. 2021 Feb 23;9(2):2325967120985153. doi: 10.1177/2325967120985153. eCollection 2021 Feb.
There is currently no consensus on the optimal placement of the tibial tunnel for remnant-preserving posterior cruciate ligament (PCL) reconstruction.
PURPOSE/HYPOTHESIS: The purpose of this study was to compare the clinical and radiologic outcomes of remnant-preserving PCL reconstruction using anatomic versus low tibial tunnels. We hypothesized that the outcomes of low tibial tunnel placement would be superior to those of anatomic tibial tunnel placement at the 2-year follow-up after remnant-preserving PCL reconstruction.
Cohort study; Level of evidence, 3.
We retrospectively reviewed the data for patients who underwent remnant-preserving PCL reconstruction between March 2011 and January 2018 with a minimum follow-up of 2 years (N = 63). On the basis of the tibial tunnel position on postoperative computed tomography, the patients were divided into those with anatomic placement (group A; n = 31) and those with low tunnel placement (group L; n = 32). Clinical scores (International Knee Documentation Committee subjective score, Lysholm score, and Tegner activity level), range of motion, complications, and stability test outcomes at follow-up were compared between the 2 groups. Graft signal on 1-year follow-up magnetic resonance imaging scans was compared between 22 patients in group A and 17 patients in group L.
There were no significant differences between groups regarding clinical scores or incidence of complications, no between-group differences in posterior drawer test results, and no side-to-side difference on Telos stress radiographs (5.2 ± 2.9 mm in group A vs 5.1 ± 2.8 mm in group L; = .900). Postoperative 1-year follow-up magnetic resonance imaging scans showed excellent graft healing in both groups, with no significant difference between them.
The clinical and radiologic outcomes and complication rate were comparable between anatomic tunnel placement and low tibial tunnel placement at 2-year follow-up after remnant-preserving PCL reconstruction. The findings of this study suggest that both tibial tunnel positions are clinically feasible for remnant-preserving PCL reconstruction.
目前对于保留残端的后交叉韧带（PCL）重建术中胫骨隧道的最佳位置尚无共识。
目的/假设：本研究的目的是比较使用解剖学胫骨隧道与低位胫骨隧道进行保留残端的PCL重建的临床和影像学结果。我们假设在保留残端的PCL重建术后2年随访时，低位胫骨隧道置入的结果优于解剖学胫骨隧道置入的结果。
队列研究；证据等级，3级。
我们回顾性分析了2011年3月至2018年1月期间接受保留残端的PCL重建且随访至少2年的患者数据（N = 63）。根据术后计算机断层扫描上的胫骨隧道位置，将患者分为解剖学置入组（A组；n = 31）和低位隧道置入组（L组；n = 32）。比较两组随访时的临床评分（国际膝关节文献委员会主观评分、Lysholm评分和Tegner活动水平）、活动范围、并发症及稳定性测试结果。比较A组22例患者和L组17例患者1年随访磁共振成像扫描上的移植物信号。
两组在临床评分或并发症发生率方面无显著差异，后抽屉试验结果无组间差异，Telos应力X线片上也无侧方差异（A组为5.2±2.9 mm；L组为5.1±2.8 mm；P = 0.900）。术后1年随访磁共振成像扫描显示两组移植物愈合均良好，且两组间无显著差异。
在保留残端的PCL重建术后2年随访时，解剖学隧道置入和低位胫骨隧道置入的临床和影像学结果及并发症发生率相当。本研究结果表明，两种胫骨隧道位置在保留残端的PCL重建中在临床上都是可行的。
