Karampinas Panagiotis, Vlamis John, Galanis Athanasios, Vavourakis Michail, Sakellariou Evangelos, Varsamos Iordanis, Spyrou Ioannis, Pneumaticos Spiros
3rd Department of Orthopedic Surgery, National & Kapodistrian University of Athens, KAT General Hospital, Athens, Greece.
Adv Orthop. 2024 Oct 26;2024:2371242. doi: 10.1155/2024/2371242. eCollection 2024.
The development of less invasive all-inside techniques regarding anterior cruciate ligament (ACL) reconstruction surgery has been associated with various advantages, including fewer complications and reduced postoperative pain. Silva et al. described a quadruple semitendinosus graft construct and suspensory button fixation for ACL reconstruction as an alternative technique. At the end of this technique, the tibial tunnel is filled with a bone autograft plug. This paper aims to examine the incorporation of the autograft and thus evaluate whether the "Silva technique" provides the same benefits as all-inside techniques. A prospective study assessed 31 patients undergoing ACL reconstruction surgery using the "Silva technique." The cases involved in the study were skeletally mature patients with no previous history of ACL surgery or multiligamentous instability. All patients followed the same rehabilitation program and were examined at three standardized follow-up visits: 4 months, 8 months, and 1 year postoperatively. Tegner-Lysholm knee score (TLKS), visual analog score (VAS) for pain, and the IKDC subjective knee score were completed at every visit. A knee MRI scan was performed at every scheduled visit to assess bone graft incorporation and remodeling. TLKS scores revealed a considerable improvement compared to preoperative figures, from 57.2 points preoperatively to an average of 99.4 at the 12-month follow-up ( < 0.0001). VAS scores were substantially ameliorated after the operation and until the second follow-up visit, from 5 before surgery to zero 8 months after the operation, with no noteworthy alterations afterward ( < 0.0001). IKDC subjective knee score outcomes were found to have increased at the last follow-up, from 59.3 prior to surgery to 99.8 12 months postoperatively ( < 0.0001). Regarding the MRI features of the bone autograft, the tibial tunnel was entirely filled by bone formation at the last MRI scan, suggesting complete integration of the autograft in all patients. Bone autograft employed to seal the tibial tunnel was completely incorporated in all cases 1 year postoperatively. The "Silva technique" appears to feature all the avails of all-inside techniques, whilst it seems to be simpler and easier than them after the surgeon is familiarized with its particular aspects. It is a robust option in orthopedic surgeons' arsenal. However, further large-scale pertinent research is requisite to confirm the findings of this study.
前交叉韧带（ACL）重建手术中微创全内置技术的发展带来了诸多优势，包括并发症更少和术后疼痛减轻。席尔瓦等人描述了一种用于ACL重建的四重半腱肌移植物构建和悬吊纽扣固定术作为替代技术。在该技术结束时，胫骨隧道用自体骨移植栓填充。本文旨在研究自体骨移植的融合情况，从而评估“席尔瓦技术”是否能提供与全内置技术相同的益处。一项前瞻性研究评估了31例行“席尔瓦技术”ACL重建手术的患者。该研究纳入的病例为骨骼成熟患者，既往无ACL手术史或多韧带不稳定病史。所有患者遵循相同的康复计划，并在术后4个月、8个月和1年这三个标准化随访时间点接受检查。每次随访时均完成Tegner-Lysholm膝关节评分（TLKS）、疼痛视觉模拟评分（VAS）以及IKDC主观膝关节评分。每次预定随访时均进行膝关节MRI扫描，以评估骨移植的融合和重塑情况。TLKS评分显示与术前相比有显著改善，从术前的57.2分提高到12个月随访时的平均99.4分（<0.0001）。术后直至第二次随访时VAS评分有显著改善，从术前的5分降至术后8个月的零分，此后无明显变化（<0.0001）。IKDC主观膝关节评分结果在最后一次随访时有所提高，从术前的59.3分提高到术后12个月的99.8分（<0.0001）。关于自体骨移植的MRI特征，在最后一次MRI扫描时胫骨隧道完全被骨形成填充，表明所有患者的自体骨移植均完全融合。用于封闭胫骨隧道的自体骨移植在术后1年的所有病例中均完全融合。“席尔瓦技术”似乎具备全内置技术的所有优点，而且在外科医生熟悉其特定方面后，似乎比全内置技术更简单易行。它是骨科医生武器库中的一个有力选择。然而，需要进一步的大规模相关研究来证实本研究的结果。
