| Objective Trans-anteromedial portal(AAMP)and transtibial(TT)techniques are the most widely used methods for drilling femoral tunnel in anterior cruciate ligament(ACL)reconstruction.The purpose of this study was to compare radiographic and clinical results of single bundle ACL reconstruction using these 2techniques.To observe the effect of Chinese medicine fumigation on postoperation rehabilitation.Methods From June 2011 to December 2014,single bundle ACL reconstruction was performed using the trans-accessory anteromedial portal(AAMP)technique and transtibial(TT)technique in 85 patients from Dafeng tongren hospital.According to the inclusion and exculusion criteria.40 cases of ACL rupture were enrolled in this retrospective.The experimental group(AAMP)consisted 20 patients who had undergone anatomic single-bundel ACL reconstruction using accessory anteromedial portal drilling the femoral tunnel between September 2013 and December 2014.There were15 males and 5 females with a mean age of 34.6 years(range,20 to 58 years).The affected knee was the right knee in 9 patients and left knee in 11 patients.9 patients had an injury of medial collateral ligament and 6 patients had an injury of meniscus.2patients had Segond fracture.Average time between injury and surgery was 12.4 days(range,9 to 20 days).The control group(TT)consisted 20 patients who had undergone single-bundel ACL reconstruction using tanstibial technique drilling the femoral tunnel between June 2011 and Septembber 2013.There were 16 males and 4 females with a mean age of 35.7 years(range,20 to 59 years).The affected knee was the right knee in 8 patients and left knee in 12 patients.8 patients had an injury of medial collateral ligament and 5 patients had an injury of meniscus.2 patients had Segond fracture.Average time between injury and surgery was 13.5days(range,9 to 22 days).These patients knee joint function were checked in preoperative and postoperative 6 months,the clinical resulte were assessed using Lysholm knee joint score and IKDC subjective scores.Anteroposterior stability was assessed using the Lachman test,Rotation stability was assessed using the pivot-shift test.Femoral tunnel obliquity was measured on the anteroposterior and lateral radiographs.Two groups of patients in the perioperative period with traditional Chinese medicine,guiding the function rehabilitation.Application of Chinese herbal fumigation and washing in the rehabilitation process.Some patients did not use Chinese medicine fumigation.The effect of the two methods of rehabilitation on the results is compared.Results All the patients in the two groups evaluation was performed with a follow-up over 6 months.The Lachman test,pivot-shift test, Lysholm score and IKDC score improved between the preoperation and the last follow-up examinations were observed in two groups.The preoperative Lachman test results were negative in 0 patients(0%)in the control group and 0 patients(0%)in the experimental group.At the last follow-up,remarkable improvements wrere observed in both groups,the results were negative in 8 patients(40%)in the control group and in 9 patients(45%)in the experimental group.However,statistically significant diffierences between the groups were not found(P>0.05).Results of the pivot-shift test improved between the preoperative and the last follow-up examinations in both groups,in the control group,the preoperative result were negative in 4 patients(20%)and in 8patients(40%)at the last follow-up.In the experimental group,the preoperative result were negative in 4 patients(20%)and in14patients(70%)at the last follow-up.A statistically significant intergroup difference was observed in the postoperative pivot-shift test results(P<0.05).The mean Lysholm score in the control group was 53.2 preoperratively and 86.7 at the last follow-up,the mean value in the experimental group was 54.3preoperatively and 88.6 at the last follow-up.There was no significant difference between the two groups(P>0.05).The IKDC score showed no statistocant difference between the two groups(P>0.05).In the control group,there were 58.2 preoperratively and74.1 at the last follow-up.In the experiment group,there were 59.4preoperratively and 76.9 at the last follow-up.The femoral and tibial tunnel length were measured in the operation,the mean value was not significantly different between the groups(P>0.05).The femoral length was 38.3±6.0mm in the control group and 35.8±3.6mm in the experimental group.The tibial length was 28.4±4.2mm in the control group and 30.3± 3.1mm in the experimental group.The postoperative femoral obliquity was measured on the kneetunnel views obtained at the last follow-up.The coronal obliquity of the grafted ACL was 56.4±9.6° in the control group and 39.4±7.2°in the experimental group,showing a significant difference between the two proups(P<0.05),the obliquity in the experimental group was more horizontal.The obliquity of the femoral tunnel on the sagittal plane was 49.4±6.3° in the control group and 50.9± 7.3 ° in the experimental group,showing no significant difference between the two proups(P>0.05).patients with knee joint recovery to 120°,Chinese medicine fumigation group was 41.5days,without Chinese medicine fumigation group was 47.2 days.The Lysholm score in the Chinese medicine fumigation group was 87.2 and87.9 in the without Chinese medicine fumigation group;The IKDC score in the Chinese medicine fumigation group was 76.2 and 75.6in the without Chinese medicine fumigation group.The Lysholm score and IKDC score showed no significant difference between the Chinese medicine fumigation group and without Chinese medicine fumigation group.Conclusion Arthroscopic single-bundle ACL reconstruction using the AAMP or TT drill the femoral tunnel,the two techniques could help to restore knee stability.Femoral tunnel obliquity in AAMP group was more horizontal than TT group on the coronal plane.The rotational stability assessed by the pivot-shift test in AAMP group was better than TT group.However,there was no significant difference among the two techniques in anteroposterior stability,femoral tunnel length,Lysholm score and IKDC score.Traditional Chinese medicine fumigation can promote the rehabilitation process and improve patient's comfort and tolerance.No significant effect on Lysholm and IKDC score. |
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