Rai Pankaj, Kulshrestha Vikas, Sood Munish, Kumar Santhosh, Ali Mustajib, Kulshrestha Soma
Classified Spl Orthopaedics & Head of Department, 5 Air Force Hospital, India.
Department of Orthopaedics, Command Hospital Air Force Station Bangalore, India, 560007.
J Clin Orthop Trauma. 2024 Nov 7;59:102799. doi: 10.1016/j.jcot.2024.102799. eCollection 2024 Dec.
One of the key steps in arthroscopic Anterior Cruciate Ligament Reconstruction (ACLR) is getting the femoral tunnel at the right position to attach the graft. While the correct position has been described as a low and posterior position behind the bifurcate ridge on the medial surface of lateral femoral condyle, to reproducibly achieve it more than one technique is being used by surgeons. There are no randomized studies in literature which have evaluated the efficacy of these in a surgeon's hand. This study attempts to do that.
This randomized study was performed at a military sports injury centre by a single surgical team led by two sports fellowship-trained surgeons. One hundred fifty patients undergoing ACLR surgery were randomized to Anteromedial Portal technique e (AMP)group, Far Anteromedial portal technique (FAMP) group and Outside in drilling (OI) group. We used postoperative three-dimensional Computed Tomogram (3D CT) to study tunnel position (Magnussen method), length and orientation (Basdekis method).
80 % of femoral entry points were in satisfactory position using all three techniques. The ideal position was achieved more often using FAMP & OI technique which was better than AMP, however it was not below level of significance set at P < 0.025 (18, 13 & 5 respectively using FAMP, OI and AMP techniques, p-value 0.08 OI vs AMP & 0.07 AMP vs FAMP). The average femoral tunnel length was longest in OI group 34.72 ± 2.41 mm. The mean FAMP tunnel lengths were significantly smaller than the mean tunnel length of AMP and OI groups. (p-value <0.01 FAMP vs OI and p-value <0.01 FAMP vs AMP).
Our study showed that all three techniques achieved acceptable femoral tunnel placement in 80 % cases. However, FAMP and OI technique further improved accuracy of achieving ideal tunnel location and OI technique predictably achieved longer tunnel length preventing risk of lateral blow out while using suspensory fixation.
关节镜下前交叉韧带重建（ACLR）的关键步骤之一是将股骨隧道置于正确位置以附着移植物。虽然正确位置被描述为位于股骨外侧髁内侧面分叉嵴后方的低且靠后的位置，但外科医生使用了不止一种技术来可重复地实现这一目标。文献中没有随机研究评估这些技术在外科医生手中的疗效。本研究试图做到这一点。
本随机研究在一个军事运动损伤中心由一个由两名接受过运动 fellowship 培训的外科医生领导的单一手术团队进行。150 例接受 ACLR 手术的患者被随机分为前内侧入路技术（AMP）组、远前内侧入路技术（FAMP）组和经皮外向内钻孔（OI）组。我们使用术后三维计算机断层扫描（3D CT）来研究隧道位置（Magnussen 方法）、长度和方向（Basdekis 方法）。
使用所有三种技术，80%的股骨入口点位置令人满意。使用 FAMP 和 OI 技术更常实现理想位置，这比 AMP 更好，然而这并未低于设定为 P < 0.025 的显著性水平（分别使用 FAMP、OI 和 AMP 技术时为 18、13 和 5，OI 与 AMP 的 p 值为 0.08，AMP 与 FAMP 的 p 值为 0.07）。OI 组的平均股骨隧道长度最长，为 34.72 ± 2.41 毫米。FAMP 组的平均隧道长度明显小于 AMP 组和 OI 组的平均隧道长度。（FAMP 与 OI 的 p 值 < 0.01，FAMP 与 AMP 的 p 值 < 0.01）。
我们的研究表明，所有三种技术在 80%的病例中都实现了可接受的股骨隧道放置。然而，FAMP 和 OI 技术进一步提高了实现理想隧道位置的准确性，并且 OI 技术可预测地实现了更长的隧道长度，在使用悬吊固定时可防止外侧穿出的风险。
