Kumar N Naveen, Halbhavi Manjush Ramesh, Gouthamraj H, Kumar T N Santhosh, Shivanna Harish Y, Sahana V K
Department of Orthopaedics, Employee's State Insurance Corporation MC, PGIMSR and Model Hospital, Bengaluru, Karnataka, India.
J Orthop Case Rep. 2024 May;14(5):166-175. doi: 10.13107/jocr.2024.v14.i05.4472.
Arthroscopic anterior cruciate ligament (ACL) reconstruction is a very commonly done procedure in recent times. There is a need for a long-term outcome study of ACL reconstruction with a comparison between different types of fixation techniques. The graft fixation methods vary from aperture fixation (interference screws) to suspensory fixation methods (endobutton). Failure of graft incorporation and the development of tunnel widening (TW) after ACL reconstruction have been frequently reported in the long term in present literature. TW especially complicates revision ACL surgery. This is a prospective non-randomized clinical study of arthroscopic ACL reconstruction comparing the functional results between aperture fixation and suspensory fixation.
Two groups of 14 patients who underwent autogenous hamstring ACL reconstruction with a minimum of 2-year follow-up evaluation were included in the study. The first group underwent aperture fixation with bioabsorbable interference screw at tibial and femoral side. The second group underwent suspensory fixation with endobutton fixation on the femoral side and biointerference screw on the tibial side. Both group patients were examined clinically before surgery, and at 3 months, 6 months, 1 year, and at 2 years. They were compared for functional outcome with Tegner Lysholm knee score.
There was a significant improvement in functional outcome in both the groups for base and at 3 months, also for 3 months and 6 months but for 6 months-1 year. Group 2 is almost significant. This improvement in outcome in Group 2 is consistent from 1 year to 2 years.
In our prospective study comparing the outcomes of functional outcomes of ACL reconstruction with aperture fixation versus suspensory fixation on the femur, which was evaluated using Tegner Lysholm knee score over a period of 2 years, suspensory fixation was found to be better. However, further studies involving a larger series of cases are required for a better evaluation of the outcome.
关节镜下前交叉韧带（ACL）重建术是近年来非常常见的手术。需要对ACL重建进行长期疗效研究，并比较不同类型固定技术之间的差异。移植物固定方法从孔径固定（干涉螺钉）到悬吊固定方法（纽扣钢板）各不相同。目前的文献长期以来经常报道ACL重建术后移植物整合失败和隧道增宽（TW）的发生。TW尤其使ACL翻修手术复杂化。这是一项前瞻性非随机临床研究，比较关节镜下ACL重建采用孔径固定和悬吊固定的功能结果。
两组各14例接受自体腘绳肌ACL重建的患者纳入研究，随访评估至少2年。第一组在胫骨和股骨侧采用生物可吸收干涉螺钉进行孔径固定。第二组在股骨侧采用纽扣钢板悬吊固定，在胫骨侧采用生物干涉螺钉固定。两组患者在手术前、术后3个月、6个月、1年和2年进行临床检查。采用Tegner Lysholm膝关节评分比较两组的功能结果。
两组在基线时、术后3个月、3个月至6个月时功能结果均有显著改善，但在6个月至1年时，第二组几乎有显著改善。第二组从1年到2年的结果改善是一致的。
在我们的前瞻性研究中，比较了ACL重建采用孔径固定与股骨悬吊固定的功能结果，使用Tegner Lysholm膝关节评分在2年期间进行评估，发现悬吊固定效果更好。然而，需要进一步开展涉及更多病例系列的研究，以更好地评估结果。
