■股骨插入的位置对ACLR后膝关节的松弛有很大影响,尤其是旋转松弛。
■比较关节镜前交叉韧带重建(ACLR)后不同股骨隧道位置对膝关节稳定性的影响。
■对165例自体ACLR术后患者的临床结果进行回顾性分析。根据股骨隧道的位置将患者分为三组,如下:低中心(LC)组,53例;高中心(HC)组,45例患者;前内侧高(HAM)组,67名患者。比较三组之间使用KT-2000关节仪和枢轴移位试验(PST)测量的前后膝关节松弛度的左右差异(SSD),并进行分析。
■术后5年,三组膝关节前后松弛的SSD较术前明显降低;3组的PST阴性率显著升高。与LC和HAM组相比,HC组术后膝关节前后松弛的SSD明显增加(1.5±1.3VS1.0±1.1VS1.0±1.0,P<0.05)。LC和HAM组术后PST阴性率高于HC组(84.9%VS91.0%VS71.1%,P<0.05),LC和HAM组之间的PST阴性率没有显着差异(84.9%VS91.0%,P>0.05)。术前松弛程度高的患者,HAM组术后PST阴性率明显高于LC和HC组(31.3%VS3.3%VS14.4%,P>0.05)。
■HAM组患者表现出对前后松弛的更好控制,旋转松弛,术后与其他组相比,主观膝关节功能。因此,HAM点最接近I.D.E.A.L点概念,建议将其作为ACLR中股骨隧道的首选位置。
The position of the femoral insertion has a great influence on the
laxity of the knee joint after ACLR, especially for rotational
laxity.
To compare the effects of different femoral tunnel positions on knee stability after arthroscopic anterior cruciate ligament reconstruction (ACLR).
The clinical outcomes of 165 patients after autograft ACLR were analyzed retrospectively. The patients were separated into three groups according to the position of the femoral tunnel, as follows: low center (LC) group, 53 patients; high center (HC) group, 45 patients; and high anteromedial (HAM) group, 67 patients. The side-to-side differences (SSDs) in anteroposterior knee
laxity measured using a KT-2000 arthrometer and the pivot shift test (PST) pre- and postoperatively were compared among the three groups and analyzed.
After 5 years postoperatively, the SSD in the anteroposterior knee
laxity in the three groups was significantly decreased postoperatively compared with preoperatively in knees; meanwhile, the negative PST rate was significantly increased in the three groups. The postoperative SSD in anteroposterior knee laxity was significantly increased in the HC group compared with the LC and HAM groups (1.5 ± 1.3 VS 1.0 ± 1.1 VS 1.0 ± 1.0, P<0.05). The negative postoperative PST rate was higher in both the LC and HAM groups than in the HC group (84.9% VS 91.0% VS 71.1%, P<0.05), and there was no significant difference in the negative PST rate between the LC and HAM groups (84.9% VS 91.0%, P>0.05). The negative postoperative PST rate was significantly higher in the HAM group than in the LC and HC groups for patients with a high degree of laxity preoperatively (31.3% VS 3.3% VS 14.4%, P>0.05).
Patients in HAM group showed better control over anteroposterior
laxity, rotational
laxity, and subjective knee function compared to other groups post operation. Therefore, the HAM point is the closest to the I.D.E.A.L point concept, and is recommended as the preferred location for the femoral tunnel in ACLR.