| ObjectiveUsing three-dimensional CT reconstruction technique before arthroscopic anterior cruciate ligament reconstruction (ACL) surgery premenstrual medial approach AM (anteromedial) and through the TT (transtibial) establish femoral tunnel length, angle and position to compare. To investigate the relationship between the position of the femoral tunnel and clinical efficacy, a retrospective clinical arthroscopic ACL reconstruction, improving the accuracy of intraoperative localization and reconstruction of the stability of the knee joint, and provide a theoretical basis for the selection of better surgical ACL reconstruction.MethodsA retrospective analysis from March 2012 to May 2014,4th Orthopedics of No 1. affiliate hospital of GuangZhou University of Chinese Medicine arthroscopic ipsilateral gracilis tendon autograft, before semitendinosus line cross ligament reconstruction in 62 patients, in which 60 patients completed more than one year follow-up. According to the way in the establishment of the femoral tunnel used, patients were divided into anterior medial approach group (AM) [31 cases,17 males and 14 females; aged 19 to 45 years, mean (32.55±7.06) years of age; half 15 cases of plate injury, follow-up time (13.87±1.34) months] and through the tibial tunnel approach group (TT) [29 cases,15 males and 14 females; aged 19 to 45 years, mean (33.48±6.73) years of age; meniscal 13 cases, follow-up time (14.24±1.21) months]. All patients completed the surgery performed by the same surgeon, MD, postoperative rehabilitation exercises unified method. All patients were treated within a week after CT 3D reconstruction. Bernard adopt "four grid method" measure, measure femoral tunnel in the three-dimensional CT image in the coronal plane and the angle between the inside and outside wiring condyle, femoral tunnel accurately measured and calculated the distance to the center of the mouth after the lateral femoral condyle and margin accounts percentage around the outside diameter of the femoral condyle, measure and calculate the center of the femoral tunnel mouth intercondylar fossa and the distance from the top of the height of the percentage accounted intercondylar fossa. Kneelax3 line detection and pivot shift test evaluation before and rotational stability of the knee at the last follow-up. Comparative analysis using the Lysholm knee score and IKDC knee score level evaluation of knee movement, and for statistics.ResultsFemoral tunnel length, angle measurements of the femoral condyle wiring inside and outside the tunnel:the AM group are (38.90±2.53) mm, (38.39±3.19) °;the TT group are:(51.21±4.06) mm, (52.24±4.06)°, Femoral tunnel length and angle of the medial femoral approach group and condylar tunnel connections are less than through the tibial tunnel group, the difference was statistically significant (P<0.05). Femoral tunnel mouth to the lateral femoral condyle after center distance around the outside edge of the percentage of the diameter of the femoral condyle, the percentage of the height of the femoral intercondylar fossa center tunnel mouth intercondylar fossa to occupy the top of the distance: the AM group are (30.61±1.57)%, (28.17±2.65)%; the TT group are: (39.89±2.04)%, (19.96±2.27)%, Femoral tunnel position of the femoral tunnel through the medial approach established in the outer wall of the intercondylar fossa position than through the tibial tunnel after the establishment of biased, partial, the difference was statistically significant (P<0.05). At last follow-up, Lysholm score, IKDC score:the AM group are(92.77±3.58); (93.77±3.40); the TT group are: (91.66±2.77); (93.17±2.21), the two groups showed no significant difference (P>0.05);Kneelax3 detection:the AM group is (4.31±0.50) mm; the TT group is (4.46±0.51) mm, the two groups was not statistically significant (P>0.05). Pivot shift test:the AM group 28 cases were negative,3 were weakly positive; after 20 cases of TT group is negative, weakly positive 9 cases, the difference was statistically significant (P<0.05).ConclusionCompared with TT technique, AM portal technique creates more oblique and shorter femoral tunnel. After partial, partial femoral tunnel position of the femoral tunnel through the anteromedial approach established in the outer wall of the intercondylar fossa position than established by the tibial tunnel, after possible to obtain good stability of the knee joint, especially knee joint rotation in restoring stability, by AM portal technique is superior to the TT technique. Capable of reproducing three-dimensional CT arthroscopic ACL reconstruction of bone tunnel, the tunnel can be multi-faceted and objective observation of bone quantitative measurements can be retrospective clinical arthroscopic ACL reconstruction, improving the accuracy of intraoperative positioning success rate ligament reconstruction imaging methods and stability of the knee after reconstruction, three-dimensional CT can be used as effective evaluation of ACL reconstructive surgery. |
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