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Abstract：
BACKGROUND: Previous studies have shown that surgical technique errors especially the wrong bone tunnel position are the primary reason for the failure of anterior cruciate ligament (ACL) reconstruction. In this study, we aimed to compare the femoral tunnel position and impact on knee function during the ACL reconstruction using measuring combined with fluoroscopy method and bony marker method for femoral tunnel localization.
METHODS: A retrospective cohort study of patients undergoing ACL reconstruction using the bony marker method or measuring combined with fluoroscopy for femoral tunnel localization was conducted between January 2015 and January 2020. A second arthroscopic exploration was performed more than 1 year after surgery. Data regarding patient demographics, the femoral tunnel position, results of the Lysholm score, the International Knee Documentation Committee (IKDC) score, KT-1000 side-to-side difference, pivot shift grade, and Lachman grade of the knee were collected.
RESULTS: A total of 119 patients were included in the final cohort. Of these, 42 cases were in the traditional method group, and 77 cases were in the measuring method group. The good tunnel position rate was 26.2% in the traditional method group and 81.8% in the measuring method group (p < 0.001). At the final follow-up, the Lysholm and IKDC scores were significantly greater in the measuring method group than the traditional method group (IKDC: 84.9 ± 8.4 vs. 79.6 ± 6.4, p = 0.0005; Lysholm: 88.8 ± 6.4 vs. 81.6 ± 6.4, p < 0.001). Lachman and pivot shift grades were significantly greater in the measuring method group (p = 0.01, p = 0008). The results of KT-1000 side-to-side differences were significantly better in the measuring method group compared with those in the traditional method group (p < 0.001).
CONCLUSIONS: The combination of the measuring method and intraoperative fluoroscopy resulted in a concentrated tunnel position on the femoral side, a high rate of functional success, improved knee stability, and a low risk of tunnel deviation. This approach is particularly suitable for surgeons new to ACL reconstructive surgery.
METHODS: A retrospective cohort study of patients undergoing ACL reconstruction using the bony marker method or measuring combined with fluoroscopy for femoral tunnel localization was conducted between January 2015 and January 2020. A second arthroscopic exploration was performed more than 1 year after surgery. Data regarding patient demographics, the femoral tunnel position, results of the Lysholm score, the International Knee Documentation Committee (IKDC) score, KT-1000 side-to-side difference, pivot shift grade, and Lachman grade of the knee were collected.
RESULTS: A total of 119 patients were included in the final cohort. Of these, 42 cases were in the traditional method group, and 77 cases were in the measuring method group. The good tunnel position rate was 26.2% in the traditional method group and 81.8% in the measuring method group (p < 0.001). At the final follow-up, the Lysholm and IKDC scores were significantly greater in the measuring method group than the traditional method group (IKDC: 84.9 ± 8.4 vs. 79.6 ± 6.4, p = 0.0005; Lysholm: 88.8 ± 6.4 vs. 81.6 ± 6.4, p < 0.001). Lachman and pivot shift grades were significantly greater in the measuring method group (p = 0.01, p = 0008). The results of KT-1000 side-to-side differences were significantly better in the measuring method group compared with those in the traditional method group (p < 0.001).
CONCLUSIONS: The combination of the measuring method and intraoperative fluoroscopy resulted in a concentrated tunnel position on the femoral side, a high rate of functional success, improved knee stability, and a low risk of tunnel deviation. This approach is particularly suitable for surgeons new to ACL reconstructive surgery.
摘要：
背景：先前的研究表明，手术技术错误，尤其是错误的骨隧道位置是前交叉韧带（ACL）重建失败的主要原因。在这项研究中,我们的目的是通过测量结合透视法和骨标记法进行股骨隧道定位，比较ACL重建过程中股骨隧道的位置和对膝关节功能的影响。
方法：在2015年1月至2020年1月期间，对接受ACL重建的患者进行了回顾性队列研究，使用骨标记方法或测量结合透视检查进行股骨隧道定位。手术后1年多进行了第二次关节镜探查。有关患者人口统计的数据，股骨隧道位置，Lysholm评分的结果,国际膝关节文献委员会（IKDC）评分，KT-1000侧面差异，枢轴换档等级，并收集了膝盖的拉赫曼等级。
结果：共有119名患者被纳入最终队列。其中,传统法组42例,测量方法组77例。传统方法组的良好隧道位置率为26.2％，测量方法组为81.8％（p<0.001）。在最后的后续行动中，测量方法组的Lysholm和IKDC评分明显高于传统方法组（IKDC：84.9±8.4vs.79.6±6.4，p=0.0005；Lysholm：88.8±6.4vs.81.6±6.4，p<0.001）。Lachman和枢轴移位等级在测量方法组中明显更大（p=0.01，p=0008）。与传统方法组相比，测量方法组的KT-1000侧方差异结果明显更好（p<0.001）。
结论：测量方法和术中透视的结合导致股骨侧的隧道位置集中，功能成功率很高，改善膝盖稳定性，和隧道偏差的低风险。这种方法特别适用于ACL重建手术的新外科医生。
方法：在2015年1月至2020年1月期间，对接受ACL重建的患者进行了回顾性队列研究，使用骨标记方法或测量结合透视检查进行股骨隧道定位。手术后1年多进行了第二次关节镜探查。有关患者人口统计的数据，股骨隧道位置，Lysholm评分的结果,国际膝关节文献委员会（IKDC）评分，KT-1000侧面差异，枢轴换档等级，并收集了膝盖的拉赫曼等级。
结果：共有119名患者被纳入最终队列。其中,传统法组42例,测量方法组77例。传统方法组的良好隧道位置率为26.2％，测量方法组为81.8％（p<0.001）。在最后的后续行动中，测量方法组的Lysholm和IKDC评分明显高于传统方法组（IKDC：84.9±8.4vs.79.6±6.4，p=0.0005；Lysholm：88.8±6.4vs.81.6±6.4，p<0.001）。Lachman和枢轴移位等级在测量方法组中明显更大（p=0.01，p=0008）。与传统方法组相比，测量方法组的KT-1000侧方差异结果明显更好（p<0.001）。
结论：测量方法和术中透视的结合导致股骨侧的隧道位置集中，功能成功率很高，改善膝盖稳定性，和隧道偏差的低风险。这种方法特别适用于ACL重建手术的新外科医生。
