Transtibial Versus Anteromedial Portal Technique in Single-Bundle Anterior Cruciate Ligament Reconstruction Outcomes of Knee Joint Kinematics During Walking
Transtibial Versus Anteromedial Portal Technique in Single-Bundle Anterior Cruciate Ligament Reconstruction Outcomes of Knee Joint Kinematics During Walking
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DOI：
10.1177/0363546513490663
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发表时间：
2013-08-01
影响因子：
4.8
通讯作者：
Zheng, Naiquan (Nigel)
中科院分区：
文献类型：
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作者：
Wang, Hongsheng;Fleischli, James E.;Zheng, Naiquan (Nigel)
背景资料：在前交叉韧带（ACL）重建中，经胫骨（TT）技术通常会创建非解剖位置的股骨隧道，这是手术失败和术后膝关节不稳定的常见原因。几项研究报道，与TT技术相比，通过前内侧入路（AMP）钻取股骨隧道可获得更解剖的隧道位置。目的：比较这两种手术技术在生理负荷情况下恢复完整膝关节运动学的有效性。研究设计：对照实验室研究。方法：24例患者（TT，n = 12; AMP，n = 12;性别、体重和身高匹配，其中一半涉及优势腿），由同一外科医生进行单侧单束ACL重建。选择20例无下肢损伤史的健康体检者作为对照组。通过使用基于最小均方的优化算法确定水平行走期间6个自由度（3个平移和3个旋转）的胫股关节运动。使用冗余标记集来提高运动分析的准确性。膝关节运动学以及时空参数之间进行了比较，这两个technology.Results：AMP技术恢复了膝关节的前后平移，而TT技术导致显着更大的（TT，22.2毫米与对照组，13.2毫米; P < .01）前股骨平移比健康对照组在摆动阶段。在使用TT技术重建的膝关节中，在站立中期发现股骨过度外旋（胫骨内旋）（3.8度; P <0.05）;使用AMP技术，在站立期外旋偏移大大减少。然而，在后期站立阶段，使用AMP技术修复的膝关节与对照组的膝关节相比伸展程度显著降低（5度; P <0.05）。结论：AMP技术较TT技术能更好地恢复摆动期前后平移和站立中期股骨外旋。然而，AMP技术也与伸展损失在后期stance phase.Clinical Relevance：AMP股骨隧道钻孔技术可以提高整体膝关节的稳定性，但可能需要考虑增加的难度与充分伸展。
Background: In anterior cruciate ligament (ACL) reconstruction, the transtibial (TT) technique often creates a nonanatomically placed femoral tunnel, which is a frequent cause of surgical failure and postsurgical knee instability. Several studies reported that drilling the femoral tunnel through an anteromedial portal (AMP) yields a more anatomic tunnel position compared with the TT technique.Purpose: To compare the effectiveness of these two surgical techniques in restoring the intact knee joint kinematics during a physiological loading situation.Study Design: Controlled laboratory study.Methods: Twenty-four patients (TT, n = 12; AMP, n = 12; sex, weight, and height matched, and half with dominant leg involved) who underwent unilateral single-bundle ACL reconstruction by the same surgeon were recruited. Twenty healthy patients with no history of lower limb injuries were recruited as the control group. Tibiofemoral joint motion in 6 degrees of freedom (3 translations and 3 rotations) was determined during level walking by using a least mean square-based optimization algorithm. A redundant marker set was used to improve the accuracy of the motion analysis. Knee joint kinematics as well as spatiotemporal parameters were compared between these two techniques.Results: The AMP technique restored the anterior-posterior translation of the knee joint, while the TT technique resulted in significantly greater (TT, 22.2 mm vs controls, 13.2 mm; P < .01) anterior femoral translations than in the healthy controls during the swing phase. Excessive femoral external (tibial internal) rotation (3.8 degrees; P < .05) was found at midstance in the knees that were reconstructed using the TT technique; using the AMP technique, the external rotation offset was greatly reduced during the stance phase. However, knees repaired using the AMP technique were significantly less extended (5 degrees; P < .05) compared with the knees of the controls during the late stance phase. Neither surgical technique restored the superior-inferior femoral translation to the intact level during the swing phase.Conclusion: The AMP technique better restores the anterior-posterior translation during the swing phase and femoral external rotation at midstance than the TT technique does. However, the AMP technique is also correlated with an extension loss during the late stance phase.Clinical Relevance: The AMP femoral tunnel drilling technique can improve overall knee joint stability, but the increased difficulty with full extension may need to be considered.