Lin Lin, Wang Haijun, Wang Jian, Wang Yongjian, Chen Yourong, Yu Jiakuo
Sports Medicine Department, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing 100191, China.
Peking University Institute of Sports Medicine, Beijing 100191, China.
Chin Med J (Engl). 2024 Feb 20;137(4):465-472. doi: 10.1097/CM9.0000000000002948. Epub 2024 Jan 19.
To perform anatomical anterior cruciate ligament reconstruction (ACLR), tunnels should be placed relatively higher in the femoral anterior cruciate ligament (ACL) footprint based on the findings of direct and indirect femoral insertion. But the clinical results of higher femoral tunnels (HFT) in double-bundle ACLR (DB-ACLR) remain unclear. The purpose was to investigate the clinical results of HFT and lower femoral tunnels (LFT) in DB-ACLR.
From September 2014 to February 2016, 83 patients who underwent DB-ACLR and met the inclusion and exclusion criteria were divided into HFT-ACLR (group 1, n = 37) and LFT-ACLR (group 2, n = 46) according to the position of femoral tunnels. Preoperatively and at the final follow-up, clinical scores were evaluated with International Knee Documentation Committee (IKDC), Tegner activity, and Lysholm score. The stability of the knee was evaluated with KT-2000, Lachman test, and pivot-shift test. Cartilage degeneration grades of the International Cartilage Repair Society (ICRS) were evaluated on magnetic resonance imaging (MRI). Graft tension, continuity, and synovialization were evaluated by second-look arthroscopy. Return-to-sports was assessed at the final follow-up.
Significantly better improvement were found for KT-2000, Lachman test, and pivot-shift test postoperatively in group 1 ( P >0.05). Posterolateral bundles (PL) showed significantly better results in second-look arthroscopy regarding graft tension, continuity, and synovialization ( P <0.05), but not in anteromedial bundles in group 1. At the final follow-up, cartilage worsening was observed in groups 1 and 2, but it did not reach a stastistically significant difference ( P >0.05). No statistically significant differences were found in IKDC subjective score, Tegner activity, and Lysholm score between the two groups. Higher return-to-sports rate was found in group 1 with 86.8% (32/37) vs. 65.2% (30/46) in group 2 ( P = 0.027).
The HFT-ACLR group showed better stability results, better PL, and higher return-to-sports rate compared to the LFT-ACLR group.
为进行解剖学前交叉韧带重建术（ACLR），根据股骨直接和间接附着点的研究结果，隧道应相对较高地置于股骨前交叉韧带（ACL）附着区。但双束ACL重建术（DB - ACLR）中较高股骨隧道（HFT）的临床效果仍不明确。本研究目的是探讨DB - ACLR中HFT和较低股骨隧道（LFT）的临床效果。
2014年9月至2016年2月，83例行DB - ACLR且符合纳入和排除标准的患者，根据股骨隧道位置分为HFT - ACLR组（第1组，n = 37）和LFT - ACLR组（第2组，n = 46）。术前及末次随访时，采用国际膝关节文献委员会（IKDC）评分、Tegner活动度评分和Lysholm评分评估临床疗效。采用KT - 2000、Lachman试验和轴移试验评估膝关节稳定性。通过磁共振成像（MRI）评估国际软骨修复协会（ICRS）的软骨退变分级。通过二次关节镜检查评估移植物张力、连续性和滑膜化情况。在末次随访时评估恢复运动情况。
第1组术后KT - 2000、Lachman试验和轴移试验的改善明显更好（P > 0.05）。在二次关节镜检查中，第1组后外侧束（PL）在移植物张力、连续性和滑膜化方面显示出明显更好的结果（P < 0.05），但前内侧束情况并非如此。在末次随访时，第1组和第2组均观察到软骨退变，但差异无统计学意义（P > 0.05）。两组在IKDC主观评分、Tegner活动度评分和Lysholm评分方面无统计学差异。第1组恢复运动率更高，为86.8%（32/37），而第2组为65.2%（30/46）（P = 0.027）。
与LFT - ACLR组相比，HFT - ACLR组显示出更好的稳定性结果、更好的PL以及更高的恢复运动率。
