Hong Ian S, Ifarraguerri Anna M, Berk Alexander N, Trofa David P, Piasecki Dana P, Saltzman Bryan M
OrthoCarolina Sports Medicine Center, Charlotte, North Carolina, USA.
Atrium Health Musculoskeletal Institute, Charlotte, North Carolina, USA.
Orthop J Sports Med. 2024 Jun 4;12(6):23259671241242778. doi: 10.1177/23259671241242778. eCollection 2024 Jun.
A novel hybrid transtibial (HTT) approach to femoral tunnel drilling in anterior cruciate ligament reconstruction (ACLR) has been developed that circumvents the need for knee hyperflexion and orients the graft in the most anatomic position without sacrificing the tunnel length or aperture.
Patients who underwent ACLR utilizing the HTT technique would achieve excellent patient-reported outcome scores and experience low rates of graft failure and reoperations.
Case series; Level of evidence, 4.
Patients who underwent primary ACLR at a single institution between 2005 and 2020 were retrospectively reviewed. Patients treated with the HTT, anteromedial portal (AMP), and transtibial (TT) approaches were matched based on age, sex, and body mass index ±3 kg/m. Demographic and surgical data as well as femoral tunnel angle measurements on anteroposterior and lateral radiographs were collected for the 3 groups. However, clinical outcomes were only reported for the HTT group because of concerns of graft heterogeneity.
A total of 170 patients (median age, 26.5 years [interquartile range (IQR), 18.0-35.0 years]) who underwent ACLR using the HTT approach were included. The median coronal- and sagittal-plane femoral tunnel angles were 47° (IQR, 42°-53°) and 40° (IQR, 34°-46°), respectively. The sagittal-plane femoral tunnel angles in the HTT group were significantly more horizontal compared with those in the TT group ( < .0001), whereas the coronal-plane femoral tunnel angles in the HTT group were found to be significantly more vertical compared with those in the AMP group ( = .001) and more horizontal compared with those in the TT group ( < .0001). The graft failure and reoperation rates in the HTT group at a minimum 2-year follow-up were 1.8% (3/170) and 4.7% (8/170), respectively. The complication rate was 6.5% (11/170), with the most common complication being subjective stiffness in 7 patients. The median Lysholm score was 89.5 (IQR, 79.0-98.0); the median International Knee Documentation Committee score was 83.9 (IQR, 65.5-90.8); and the median Veterans RAND 12-Item Health Survey physical and mental component summary scores were 55.0 (IQR, 52.6-55.9) and 56.2 (IQR, 49.1-59.3), respectively.
ACLR using the HTT technique was associated with low graft retear and revision surgery rates and good patient-reported outcome scores at medium-term follow-up and demonstrated femoral tunnel obliquity on postoperative radiographs that correlated with optimal parameters previously reported in cadaveric and biomechanical studies.
一种用于前交叉韧带重建（ACLR）中股骨隧道钻孔的新型混合经胫骨（HTT）方法已被开发出来，该方法避免了膝关节过度屈曲的需要，并将移植物置于最解剖学的位置，同时不牺牲隧道长度或孔径。
采用HTT技术进行ACLR的患者将获得优异的患者报告结局评分，且移植物失败率和再次手术率较低。
病例系列；证据等级，4级。
对2005年至2020年间在单一机构接受初次ACLR的患者进行回顾性分析。根据年龄、性别和体重指数±3kg/m²，对采用HTT、前内侧入路（AMP）和经胫骨（TT）入路治疗的患者进行匹配。收集三组患者的人口统计学和手术数据以及前后位和侧位X线片上的股骨隧道角度测量值。然而，由于担心移植物异质性，仅报告了HTT组的临床结局。
共有170例采用HTT入路进行ACLR的患者（中位年龄26.5岁[四分位间距（IQR），18.0 - 35.0岁]）纳入研究。股骨隧道在冠状面和矢状面的中位角度分别为47°（IQR，42° - 53°）和40°（IQR，34° - 46°）。与TT组相比，HTT组矢状面股骨隧道角度明显更水平（P <.0001）；与AMP组相比，HTT组冠状面股骨隧道角度明显更垂直（P =.001），与TT组相比更水平（P <.0001）。HTT组至少2年随访时的移植物失败率和再次手术率分别为1.8%（3/170）和4.7%（8/170）。并发症发生率为6.5%（11/170），最常见的并发症是7例患者出现主观僵硬。Lysholm评分中位数为89.5（IQR，79.0 - 98.0）；国际膝关节文献委员会评分中位数为83.9（IQR，65.5 - 90.8）；退伍军人兰德12项健康调查身体和心理成分总结评分中位数分别为55.0（IQR，52.6 - 55.9）和56.2（IQR，49.1 - 59.3）。
采用HTT技术进行ACLR在中期随访时与低移植物再撕裂率和翻修手术率以及良好的患者报告结局评分相关，并且术后X线片显示股骨隧道倾斜度与先前尸体和生物力学研究中报道的最佳参数相关。
