Kumar Sudeep, Kumar Anup, Kumar Ravi, Teja Kv Charan, Roshen Ar Mohammed, Venkata Bramesh Alapati Hari
Department of Orthopaedics, AIIMS-Patna, Patna, Bihar, India.
Cisro Hospital, Patna, Bihar, India.
Arthrosc Sports Med Rehabil. 2023 Feb 8;5(2):e331-e336. doi: 10.1016/j.asmr.2022.12.001. eCollection 2023 Apr.
To evaluate the accuracy in the femoral and tibial tunnel placement after the use of fluoroscopy along with an indigenously designed grid method to assist in arthroscopic anterior cruciate ligament reconstruction as compared with the tunnel placement without using them and to validate the findings with computed tomography scan performed postoperatively along with assessing the functional outcome at a minimum of 3 years of follow-up.
This was a prospective study conducted on patients who underwent primary anterior cruciate ligament reconstruction. Patients were included and segregated into a nonfluoroscopy (group B) and a fluoroscopy group (group A), and both had postoperative computed tomography scans so that femoral and tibial tunnel position could be evaluated. Scheduled follow-up occurred 3, 6, 12, 24, and 36 months' postoperatively. Patients were evaluated objectively with the Lachman test, measurement of range of motion, and functional outcome using patient-reported outcome measures, i.e., Tegner Lysholm Knee score, Knee injury and Osteoarthritis Outcome Score, and International Knee Documentation Committee subjective knee score.
A total of 113 subjects were included. There were 53 in group A and 60 in group B. The average location of femoral tunnel showed significant differences between the 2 groups. However, the variability in femoral tunnel location was significantly lower in group A as compared with group B for proximal-distal planes only. The average location of the tibial tunnel as per the grid of Bernard et al. showed significant differences in both the planes. The variability in tibial tunnel was greater in the medial-lateral plane as compared with the anterior-posterior plane. There was a statistically significant difference in mean value of the 3 scores among the 2 groups. The variability of the scores was greater in group B as compared with group A. None of the patient was reported as a failure.
The results of our study suggests that fluoroscopy-guided positioning using a grid technique increases the accuracy of anterior cruciate ligament tunnel positioning with decreased variability and is associated with better patient-reported outcomes 3 years after surgery compared with tunnel positioning using landmarks.
Level II, prospective, comparative therapeutic trial.
评估在关节镜下前交叉韧带重建术中，使用透视以及一种自主设计的网格方法辅助进行股骨和胫骨隧道定位的准确性，并与未使用这些方法时的隧道定位进行比较，同时通过术后计算机断层扫描验证结果，并在至少3年的随访中评估功能结果。
这是一项针对接受初次前交叉韧带重建术患者的前瞻性研究。患者被纳入并分为非透视组（B组）和透视组（A组），两组均进行术后计算机断层扫描，以便评估股骨和胫骨隧道位置。术后3、6、12、24和36个月进行定期随访。使用Lachman试验、活动范围测量以及患者报告的结果测量指标（即Tegner Lysholm膝关节评分、膝关节损伤和骨关节炎结果评分以及国际膝关节文献委员会主观膝关节评分）对患者进行客观评估。
共纳入113名受试者。A组53名，B组60名。两组之间股骨隧道的平均位置存在显著差异。然而，仅在近端-远端平面上，A组股骨隧道位置的变异性明显低于B组。根据Bernard等人的网格，胫骨隧道的平均位置在两个平面上均存在显著差异。与前后平面相比，胫骨隧道在内外侧平面的变异性更大。两组之间这3项评分的平均值存在统计学显著差异。B组评分的变异性大于A组。没有患者被报告为手术失败。
我们的研究结果表明，与使用体表标志进行隧道定位相比，采用网格技术的透视引导定位可提高前交叉韧带隧道定位的准确性，降低变异性，并与术后3年更好的患者报告结果相关。
II级，前瞻性、对比治疗试验。
