Lee Do Kyung, Kim Jun Ho, Lee Byung Hoon, Kim Hyeonsoo, Jang Min Jae, Lee Sung-Sahn, Wang Joon Ho
Department of Orthopedic Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea. .
Department of Orthopedic Surgery, Kyung Hee University Hospital at Gangdong, South Korea.
Orthop J Sports Med. 2021 Oct 22;9(10):23259671211035780. doi: 10.1177/23259671211035780. eCollection 2021 Oct.
Previous studies have suggested that increased mechanical stress due to acute graft bending angle (GBA) is associated with tunnel widening and graft failure after anterior cruciate ligament (ACL) reconstruction. Few studies have compared the GBA between the outside-in (OI) and the transportal (TP) techniques.
To evaluate the influence of GBA on clinical outcomes and tunnel widening after ACL reconstruction with OI versus TP technique.
Cohort study; Level of evidence, 3.
Included in the study were 56 patients who underwent double-bundle ACL reconstruction (n = 28 in the OI group and n = 28 in the TP group). Clinical outcomes (Lysholm, International Knee Documentation Committee, Tegner score, and knee laxity) 1 year postoperatively were evaluated. Computed tomography scans at 5 days and 1 year postoperatively were used for imaging measurements, and the femoral tunnel was divided into the proximal third, middle, and aperture sections. The GBA and cross-sectional area (CSA) were measured using image analysis software and were compared between groups. A correlation analysis was performed to determine if the GBA affected clinical outcomes or tunnel widening.
No significant difference was observed in clinical outcomes between the groups. The GBA of both the anteromedial (AM) and posterolateral bundles were more acute in the OI group compared with the TP group ( < .05). The CSA at the AM tunnel aperture increased significantly in the OI group (84.2% ± 64.3%) compared with the TP group (51.4% ± 36.7%) ( = .04). However, there were no differences in the other sections. In the Pearson correlation test, GBA was not correlated with tunnel widening or clinical outcomes.
Regardless of technique, the GBA did not have a significant influence on tunnel widening or clinical outcomes. Considering a wider AM tunnel aperture, a more proximal and posterior AM tunnel position might be appropriate with the OI technique.
先前的研究表明，前交叉韧带（ACL）重建术后，急性移植物弯曲角度（GBA）导致的机械应力增加与隧道增宽和移植物失败有关。很少有研究比较由外向内（OI）技术和经胫骨隧道（TP）技术之间的GBA。
评估采用OI技术与TP技术进行ACL重建后，GBA对临床疗效和隧道增宽的影响。
队列研究；证据等级，3级。
纳入本研究的56例患者均接受了双束ACL重建（OI组28例，TP组28例）。评估术后1年的临床疗效（Lysholm评分、国际膝关节文献委员会评分、Tegner评分和膝关节松弛度）。术后5天和1年的计算机断层扫描用于影像学测量，股骨隧道分为近端三分之一、中间段和开口段。使用图像分析软件测量GBA和横截面积（CSA），并在组间进行比较。进行相关性分析以确定GBA是否影响临床疗效或隧道增宽。
两组间临床疗效无显著差异。与TP组相比，OI组前内侧（AM）束和后外侧束的GBA更尖锐（P <.05）。与TP组（51.4%±36.7%）相比，OI组AM隧道开口处的CSA显著增加（84.2%±64.3%）（P =.04）。然而，其他节段无差异。在Pearson相关性检验中，GBA与隧道增宽或临床疗效无关。
无论采用何种技术，GBA对隧道增宽或临床疗效均无显著影响。考虑到AM隧道开口更宽，OI技术可能适合AM隧道位置更靠近近端和后方。
