背景:目前比较股骨隧道技术的文献经常报道前交叉韧带重建(ACLR)后的短期结果,但只有少数研究分析了长期结果。此外,许多研究比较了经胫骨和前内侧门静脉技术,但没有区分使用刚性或柔性扩孔。这使得很难推断这些技术是如何真正相互比较的。
目的:本研究旨在检测采用三种不同股骨隧道钻孔技术治疗的患者报告结果评分的差异。
方法:本研究为前瞻性队列研究。
方法:650例ACLR治疗前交叉韧带(ACL)损伤的患者,350人手术后5年以上。在这些病人中,111项完成的患者报告结果调查(PRO)。Kruskal-WallisH检验用于检测使用三种股骨隧道钻孔技术之一治疗的患者之间的差异:经胫骨(TT),带有刚性扩孔的前内侧入口(AMP-RR),或带柔性扩孔的前内侧入口(AMP-FR)。将Bonferroni校正应用于p值以降低产生1型错误的风险。
结果:三组在人口统计学或术后PRO方面没有发现差异。然而,术前和术后PRO之间有显著变化.TT,与AMP-RR相比,患者的满意度和从手术前到手术后上下楼梯的能力有了更大的提高。AMP-FR,与TT相比,有更大的改善患者的膝盖僵硬/肿胀。AMP-FR,与AMP-RR相比,在楼梯期间膝盖疼痛和下楼梯的能力方面有了更大的改善。回归体育没有差异,在受影响的膝盖上进行额外的手术(半月板手术或环管病变切除术),或翻修手术率被发现。
结论:总体而言,术后PROs在三种股骨隧道钻孔技术之间无统计学差异.差异,然而,在对PRO调查具体问题的答复中确定,否则可能会被忽视。重要的是要认识到TT之间的差异,AMP-RR,和AMP-FR在楼梯爬升和肿胀/僵硬方面的改善,因为这些可能直接影响患者从ACLR前到ACLR后的满意度。
BACKGROUND: The current literature comparing femoral tunnel techniques often reports on short-term outcomes after anterior cruciate ligament reconstruction (ACLR), but only a few studies have analyzed long-term outcomes. In addition, many studies have compared
transtibial to anteromedial portal techniques without differentiating whether rigid or flexible reaming is used, making it difficult to infer how the techniques truly compare to one another.
OBJECTIVE: This study aimed to detect differences in patient-reported outcome scores in those treated with three different femoral tunnel drilling techniques.
METHODS: This study is a prospective cohort study.
METHODS: Of 650 patients treated for anterior cruciate ligament (ACL) injuries with ACLR, 350 were 5+ years out from surgery. Of these patients, 111 completed patient-reported outcome surveys (PROs). The Kruskal-Wallis H test was used to detect differences between patients treated with either of the three femoral tunnel drilling techniques:
transtibial (TT), anteromedial portal with rigid reaming (AMP-RR), or anteromedial portal with flexible reaming (AMP-FR). Bonferroni correction was applied to the p-values to reduce the risk of making a type 1 error.
RESULTS: No differences were found between the three groups in demographics or postoperative PROs. However, there was a significant change between pre-surgery and post-surgery PROs. TT, when compared to AMP-RR, had a greater increase in satisfaction and greater improvement in a patient\'s ability to go up and down the stairs from pre-surgery to post-surgery. AMP-FR, when compared to TT, had greater improvement of the patient\'s knee stiffness/swelling. AMP-FR, when compared to AMP-RR, had greater improvement in knee pain during stairs and the ability to go down the stairs. No differences in return to sport, additional procedures on the affected knee (meniscal surgeries or cyclops lesion excisions), or revision surgery rates were found.
CONCLUSIONS: Overall, postoperative PROs did not show statistically significant differences between the three femoral tunnel drilling techniques. Differences, however, were identified in the responses to specific questions on PRO surveys, which may have otherwise been overlooked. It is important to recognize the differences between TT, AMP-RR, and AMP-FR in the improvement of stair climbing and swelling/stiffness as these likely directly affect a patient\'s satisfaction from pre-ACLR to post-ACLR.