Wang Fan, Wang Guoliang, Li Yanlin, Li Hua, Shi Qinglü, Li Li
Department of Sports Medicine, the First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, 650032, P. R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2024 Aug 15;38(8):987-994. doi: 10.7507/1002-1892.202402029.
To compare the effectiveness of I.D.E.A.L technique and transtibial (TT) technique in anterior cruciate ligament (ACL) reconstruction.
A clinical data of 60 patients with ACL injury, who were admitted and met the selection criteria between January 2020 and September 2022, was retrospectively analyzed. All patients underwent arthroscopic ACL reconstruction with autologous tendon. During operation, the femoral tunnel was prepared by using I.D.E.A.L technique in 30 cases (I.D.E.A.L group) and using TT technique in 30 cases (TT group). There was no significant difference in baseline data such as age, gender, body mass index, cause of injury, injured side, interval from injury to operation, constituent ratio of combined cartilage and meniscus injury, and preoperative Lysholm score, International Knee Documentation Committee (IKDC) score, visual analogue scale (VAS) score, anterior tibial translation difference, and Blumensaat angle between the two groups ( >0.05). The length of hospital stay and the occurrence of early and late complications were recorded. During follow-up, the Lysholm score, IKDC score, and VAS score were used to evaluate knee joint function and pain degree, and the anterior tibial translation difference was measured. MRI reexamination was performed to observe the healing of the graft, and the signal to noise quotient (SNQ) values of the femoral end, middle section, and tibial end of the graft, as well as the Blumensaat angle of the knee joint were measured. The differences in tibial anterior translation difference and Blumensaat angle before and after operation (change values) were calculated and compared between the two groups.
The incisions in both groups healed by first intention after operation, and there was no significant difference in the length of hospital stay between the two groups ( >0.05). All patients were followed up 12-18 months, with an average of 14.9 months. The Lysholm score and IKDC score of the knee joint in both groups after operation increased when compared with those before operation, and the VAS score decreased. Compared to preoperative scores, except for the VAS score of the TT group at 1 week after operation ( >0.05), there were significant differences in all scores at different time points postoperatively in the two groups ( <0.05). The above scores in both groups showed a further improvement trend with the prolongation of time after operation. There were significant differences in Lysholm score and VAS score among 1 week, 1 month, 3 months, 6 months, and 12 months after operation in the two groups ( <0.05). The IKDC score of both groups at 1 month after operation was significantly different from that at 1 week after operation ( <0.05). At 1 week after operation, the Lysholm score and IKDC score in the I.D.E.A.L group were significantly higher than those in the TT group ( <0.05), and the VAS score was significantly lower ( <0.05); there was no significant difference between the two groups at 1, 3, 6, and 12 months after operation ( >0.05). At 12 months after operation, the anterior tibial translation differences in both groups were significantly lower than those before operation ( <0.05); and the change value in the I.D.E.A.L group was significantly higher than that in the TT group ( <0.05). The incidences of early and late complications in the I.D.E.A.L group were significantly lower than those in the TT group ( <0.05). At 12 months after operation, MRI examination showed that the grafts of the knee joint in both groups survived well, and the Blumensaat angles of both groups were significantly smaller than those before operation ( <0.05). The change value of the Blumensaat angle in the I.D.E.A.L group was significantly higher than that in the TT group ( <0.05). The SNQ values of the femoral end, middle section, and tibial end of the graft in the I.D.E.A.L group were significantly higher than those in the TT group ( <0.05).
The early effectiveness of ACL reconstruction by using the I.D.E.A.L technique is better, the knee joint is more stable, and the incidence of postoperative complication is lower. However, the maturity of the graft after reconstruction using the TT technique is higher.
比较IDEAL技术与经胫骨（TT）技术在前交叉韧带（ACL）重建中的有效性。
回顾性分析2020年1月至2022年9月收治的60例符合入选标准的ACL损伤患者的临床资料。所有患者均采用自体肌腱行关节镜下ACL重建术。术中，30例采用IDEAL技术制备股骨隧道（IDEAL组），30例采用TT技术制备股骨隧道（TT组）。两组患者的年龄、性别、体重指数、损伤原因、患侧、受伤至手术间隔时间、合并软骨及半月板损伤构成比、术前Lysholm评分、国际膝关节文献委员会（IKDC）评分、视觉模拟量表（VAS）评分、胫骨前移差异及Blumensaat角等基线资料比较，差异均无统计学意义（P>0.05）。记录住院时间及早、晚期并发症发生情况。随访期间，采用Lysholm评分、IKDC评分及VAS评分评估膝关节功能及疼痛程度，并测量胫骨前移差异。术前行MRI复查观察移植物愈合情况，测量移植物股骨端、中段及胫骨端的信噪比（SNQ）值以及膝关节的Blumensaat角。计算并比较两组手术前后胫骨前移差异及Blumensaat角的差值（变化值）。
两组患者术后切口均一期愈合，两组住院时间比较，差异无统计学意义（P>0.05）。所有患者均随访12～18个月，平均14.9个月。两组患者术后膝关节Lysholm评分及IKDC评分均较术前升高，VAS评分降低。与术前评分比较，除TT组术后1周VAS评分差异无统计学意义（P>0.05）外，两组术后不同时间点各项评分差异均有统计学意义（P<0.05）。两组上述评分均随术后时间延长呈进一步改善趋势。两组术后1周、1个月、3个月、6个月及12个月Lysholm评分及VAS评分比较，差异均有统计学意义（P<0.05）。两组术后1个月IKDC评分与术后1周比较，差异有统计学意义（P<0.05）。术后1周，IDEAL组Lysholm评分及IKDC评分均显著高于TT组（P<0.05），VAS评分显著低于TT组（P<0.05）；术后1、3、6及12个月两组比较，差异无统计学意义（P>0.05）。术后12个月，两组胫骨前移差异均显著低于术前（P<0.05）；且IDEAL组变化值显著高于TT组（P<0.05）。IDEAL组早、晚期并发症发生率均显著低于TT组（P<0.05）。术后12个月，MRI检查显示两组膝关节移植物存活良好，两组Blumensaat角均显著小于术前（P<0.05）。IDEAL组Blumensaat角变化值显著高于TT组（P<0.05）。IDEAL组移植物股骨端、中段及胫骨端的SNQ值均显著高于TT组（P<0.05）。
采用IDEAL技术进行ACL重建早期效果较好，膝关节更稳定，术后并发症发生率较低。然而，采用TT技术重建后移植物的成熟度较高。
