Hughes Jonathan D, Gabrielli Alexandra S, Dalton Jonathan F, Raines Benjamin T, Dewald Daniel, Musahl Volker, Lesniak Bryson P
Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, UPMC Freddie Fu Sports Medicine Center, 3200 S. Water St, Pittsburgh, PA, 15203, USA.
Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
J Exp Orthop. 2023 Jun 30;10(1):66. doi: 10.1186/s40634-023-00630-y.
The purpose of this study was to investigate the relationship between tunnel position in ACL reconstruction (ACL-R) and postoperative meniscus tears.
This was a single institution, case-control study of 170 patients status-post ACL-R (2010-2019) separated into two matched groups (sex, age, BMI, graft type). Group 1-symptomatic, operative meniscus tears (both de novo and recurrent) after ACL-R. Group 2-no postoperative meniscus tears. Femoral and tibial tunnel positions were measured by 2 authors via lateral knee radiographs that were used to measure two ratios (a/t and b/h). Ratio a/t was defined as distance from the tunnel center to dorsal most subchondral contour of the lateral femoral condyle (a) divided by total sagittal diameter of the lateral condyle along Blumensaat's line (t). The ratio b/h was defined as distance between the tunnel and Blumensaat's line (b) divided by maximum intercondylar notch height (h). Wilcoxon sign-ranks paired test was used to compare measurements between groups (alpha set at p < 0.05).
Group 1 had average follow up of 45 months and Group 2 had average follow up of 22 months. There were no significant demographic differences between Groups 1 and 2. Group 1-a/t was 32.0% (± 10.2), which was significantly more anterior than group 2, 29.3% (± 7.3; p < 0.05). There was no difference in average femoral tunnel ratio b/h or tibial tunnel placement between groups.
A relationship exists between more anterior/less anatomic femoral tunnel position and the presence of recurrent or de novo, operative meniscus tears after ACL-R. Surgeons performing ACL-R should strive for recreation of native anatomy via proper tunnel placement to maximize postoperative outcomes.
Level III.
本研究旨在探讨前交叉韧带重建术（ACL-R）中隧道位置与术后半月板撕裂之间的关系。
这是一项单机构的病例对照研究，对170例接受ACL-R手术（2010 - 2019年）的患者进行研究，将其分为两个匹配组（性别、年龄、体重指数、移植物类型）。第1组为ACL-R术后出现有症状的手术性半月板撕裂（包括新发和复发性）。第2组为术后无半月板撕裂。由两名作者通过膝关节侧位X线片测量股骨和胫骨隧道位置，用于测量两个比率（a/t和b/h）。比率a/t定义为隧道中心到外侧股骨髁最背侧软骨下轮廓的距离（a）除以沿布卢姆萨线的外侧髁矢状径总和（t）。比率b/h定义为隧道与布卢姆萨线之间的距离（b）除以髁间窝最大高度（h）。采用威尔科克森符号秩配对检验比较两组测量值（α设定为p < 0.05）。
第1组平均随访45个月，第2组平均随访22个月。第1组和第2组在人口统计学上无显著差异。第1组的a/t为32.0%（±10.2），显著比第2组靠前，第2组为29.3%（±7.3；p < 0.05）。两组之间股骨隧道比率b/h的平均值或胫骨隧道位置无差异。
在ACL-R术后，股骨隧道位置更靠前/解剖位置欠佳与复发性或新发的手术性半月板撕裂的发生之间存在关联。进行ACL-R手术的外科医生应通过正确的隧道放置努力恢复天然解剖结构，以最大化术后效果。
三级。
