Observation Of Bone Tunnel Enlargement On The Influence Of Anterior Cruciate Ligament Reconstruction With Outside-in Technique And Anteromedial Tunnel Drilling Technique

Objective:To compare the effects of arthroscopic anterior cruciate ligament reconstruction using outside-in technique and trans-inferior anteromedial approach in arthroscopic anterior cruciate ligament reconstruction on postoperative bone tunnel enlargement.Methods:A retrospective analysis of 50 patients were diagnosed with anterior cruciate ligament injury in the Orthopedic Center of the First Affiliated Hospital of Xinjiang Medical University from March 2019 to October 2019 were divided into two groups with anterior cruciate ligament reconstruction.Twenty-five patients used the femoral tunnel from the outside-in technique to drill the femoral tunnel,and the remaining25 patients used the traditional anteromedial approach,and routinely recovered after the operation.The enlarged diameter of femoral and tibial tunnels and Lysholm scores were compared one year after operation.Results:All patients were followed up 1 year after surgery.The results of the postoperative follow-up showed that there were 13 patients with bone tunnel enlargement.There were 13 cases of bone tunnel enlargement in different degrees and different parts.Among them,8 cases of tibial and femoral tunnels had grade 1 expansion,1 case of tibial tunnel with grade 2 expansion and grade 1expansion of femoral tunnel,3 cases of simple tibial tunnel with grade 1 expansion,and 1case of femoral tunnel with grade 2 expansion and grade 1 expansion of tibial tunnel.There was no significant difference between the two groups(P > 0.05).The enlargement diameter of femoral tunnel from the outside-in group was(2.21 ± 0.69)mm,and the femoral tunnel for the anteromedial approach group The enlargement diameter was(1.54± 0.14)mm,and the difference was statistically significant(P < 0.05).The enlargement diameter of the tibial tunnel from the outside to the inside group was(1.61 ± 0.42)mm,and the anteromedial approach group was(1.70 ± 0.22)mm,the difference was not statistically significant(P > 0.05);Before operation,the Lysholm score of the outside-in group was(54.80 ± 2.02)points,and that of the anterior-medial group was(54.04 ± 2.03)points,with no significant difference(P > 0.05).One year after operation,the Lysholm score of the outside-in group was(95.56 ± 1.29)points,and that of the anterior-medial group was(95.16 ± 1.40)points,with no significant difference(P > 0.05).The difference in the Lysholm score between the two groups before and after operation was statistically significant(P < 0.05).The Lysholm score of grade 0 bone tunnel enlargement was(95.65± 1.25)points,grade 1 was(94.91 ± 1.04)points,and grade 2 was(92.50 ± 0.71)points.The Lysholm score of bone tunnel enlargement was significantly different in three different grades(P < 0.05).After further pairwise comparison of bone tunnel enlargement in 3 different grades,it was found that grade 2 was significantly lower than grade 1 and 0(P < 0.05),But there was no significant difference between grade 1 and grade 0(P > 0.05).Conclusion: Two kinds of femoral tunnel drilling methods can cause bone tunnel enlargement,the occurrence of bone tunnel enlargement is closely related to the femoral tunnel drilling method,from the outside to the inside method will cause more obvious femoral tunnel enlargement,two kinds of femoral tunnel drilling method in postoperative1 year curative effect is similar and can achieve satisfactory clinical effect,when the bone tunnel appears 1 grade expansion of knee joint subjective function is not obvious,but the bone tunnel appears 2 grade expansion can obviously affect the subjective function of knee joint.