Gabr Ayman, Khan Mohsin, Kini Sunil G, Haddad Fares
Department of Orthopaedics, The University College of London Hospitals NHS Trust, London, United Kingdom.
J Knee Surg. 2023 Nov;36(13):1309-1315. doi: 10.1055/s-0042-1755358. Epub 2022 Sep 8.
The aim of this study was to compare the functional and radiographic outcomes of arthroscopic single-bundle anterior cruciate ligament reconstruction (ACLR) using either the anteromedial (AM) portal technique or transtibial (TT) technique. We identified 404 patients who underwent arthroscopic ACLR by a single surgeon between January 2006 and December 2016 at our institution. The TT portal was utilized in femoral tunnel drilling in 202 patients (TT group) while the AM portal was used in 202 patients (AM group). The mean postoperative follow-up duration was 26 months (range: 24-33 months). Postoperative radiographic femoral and tibial tunnel positions were assessed by two independent observers. Functional outcomes were evaluated with Tegner, Lysholm, and Knee Injury and Osteoarthritis Outcome score (KOOS) scores. On the anteroposterior plain radiographs, the mean femoral tunnel position relative to the lateral femoral condyle was 46.8% for the AM group versus 48.6% in the TT group, respectively (=0.003). The mean graft inclination angle was 31.9° and 22° in the AM and TT groups, respectively (<0.0001). On the lateral radiographs, the mean femoral tunnel placement across Blumensaat's line in relation to the anterior femoral cortex was 84% in the AM group while it was 78% in the TT group (<0.0001). At 2 years postoperatively, there were no significant differences in the mean Tegner, Lysholm, and KOOS scores between the two patient groups. The graft failure rate at 2 years follow-up was 4.5% (=9) in the AM group while it was 2.5% (=5) in the TT group (=0.2). Femoral tunnel placement was more anatomical with the AM portal technique compared with the TT technique. However, there was no significant difference in postoperative functional outcomes between the two patient groups. The AM portal technique appears to have a higher graft failure rate. This might be attributed to increased graft loading in an anatomical position.
本研究的目的是比较采用前内侧（AM）入路技术或经胫骨（TT）技术进行关节镜下单束前交叉韧带重建（ACLR）的功能和影像学结果。我们确定了2006年1月至2016年12月期间在本机构由同一位外科医生进行关节镜下ACLR的404例患者。202例患者在股骨隧道钻孔时采用TT入路（TT组），202例患者采用AM入路（AM组）。术后平均随访时间为26个月（范围：24 - 33个月）。术后影像学上股骨和胫骨隧道位置由两名独立观察者评估。功能结果采用Tegner、Lysholm和膝关节损伤与骨关节炎疗效评分（KOOS）进行评估。在前后位X线片上，AM组相对于外侧股骨髁的平均股骨隧道位置分别为46.8%，而TT组为48.6%（P = 0.003）。AM组和TT组的平均移植物倾斜角度分别为31.9°和22°（P < 0.0001）。在侧位X线片上，AM组相对于股骨前皮质穿过Blumensaat线的平均股骨隧道位置为84%，而TT组为78%（P < 0.0001）。术后2年，两组患者的平均Tegner、Lysholm和KOOS评分无显著差异。AM组2年随访时移植物失败率为4.5%（9例），而TT组为2.5%（5例）（P = 0.2）。与TT技术相比，AM入路技术的股骨隧道放置更符合解剖结构。然而，两组患者术后功能结果无显著差异。AM入路技术似乎有更高的移植物失败率。这可能归因于在解剖位置上移植物负荷增加。
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