Tecame A, Buschini F, Dini F, Zampogna B, Ampollini A, Papalia R, Adravanti P
Department of Orthopaedic and Trauma Surgery, "Città di Parma" Clinic, Parma, Italy.
Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy.
Knee. 2022 Mar;35:45-53. doi: 10.1016/j.knee.2022.02.010. Epub 2022 Feb 23.
To analyze two different femoral tunnel positions and to evaluate their correlation with clinical, functional outcomes and surgical revision rate in patients who underwent primary arthroscopic anterior cruciate ligament (ACL) reconstruction with anteromedial (AM) portal technique.
From January 2015 to October 2018, we recruited 244 patients that underwent primary single-bundle ACL reconstruction, using four strand-semitendinosus graft and AM portal technique for femoral tunnel placement. Patients were divided into two groups based on the different femoral tunnel positions: 117 patients of group A had ACL footprint center femoral tunnel position compared with 127 patients of group B, with femoral tunnel placement close to the AM bundle footprint. Preoperatively and at last follow up, all patients were assessed subjectively by Lysholm, Tegner, and International Knee Documentation Committee (IKDC) scores, while Lachman, Pivot-shift, and KT-1000 tests were performed to evaluate knee joint stability.
Group B patients showed significantly better results in Lysholm, objective, and subjective IKDC scores compared with patients of group A (P < 0.001). A significantly higher surgical failure rate was found in group A than in group B (10.26% vs. 2.3%; P < 0.001). A higher anterior knee laxity was recorded in patients of group A than in patients of group B (1.9 ± 1.1 vs. 1.3 ± 1 mm; P < 0.001); a reduction in mean anterior tibial translation from preoperative to final follow up was found in group B compared with group A (3.5 ± 1.2 vs. 2.7 ± 1.1 mm; P < 0.001). No significant differences in the Tegner scale were found between the two groups.
ACL reconstruction performed using the AM portal technique showed better and more satisfactory clinical and functional outcomes associated with a lower failure rate when the femoral tunnel had been placed more eccentrically in the footprint, in the AM bundle center position.
分析两种不同的股骨隧道位置，并评估其与采用前内侧（AM）入路技术进行初次关节镜下前交叉韧带（ACL）重建患者的临床、功能结果及手术翻修率之间的相关性。
2015年1月至2018年10月，我们招募了244例行初次单束ACL重建的患者，使用四股半腱肌移植物及AM入路技术进行股骨隧道定位。根据不同的股骨隧道位置将患者分为两组：A组117例患者的股骨隧道位于ACL足迹中心，B组127例患者的股骨隧道位置靠近AM束足迹。术前及末次随访时，所有患者均采用Lysholm、Tegner和国际膝关节文献委员会（IKDC）评分进行主观评估，同时进行Lachman试验、轴移试验和KT-1000测试以评估膝关节稳定性。
与A组患者相比，B组患者在Lysholm、客观及主观IKDC评分方面结果显著更好（P < 0.001）。A组的手术失败率显著高于B组（10.26% 对2.3%；P < 0.001）。A组患者的膝关节前侧松弛度高于B组（1.9 ± 1.1对1.3 ± 1 mm；P < 0.001）；与A组相比，B组从术前到末次随访时平均胫骨前移减少（3.5 ± 1.2对2.7 ± 1.1 mm；P < 0.001）。两组在Tegner量表上无显著差异。
采用AM入路技术进行ACL重建时，当股骨隧道置于足迹中更偏心的AM束中心位置时，临床和功能结果更好、更令人满意，且失败率更低。
