| Objective: To evaluate if the anteromedial portal(AMP)is better than transtibial(TT)approach in terms of clinical function,knee joint stability,femoral tunnel length and location.Methods: From October 2016 to October 2017,we prospectively collected 120 cases undergoing anterior cruciate ligament reconstruction.Inclusion criteria: normal contralateral knee joint,no history of knee joint traumano.Exclusion criteria: less than one year post-operative follow-up,accompanying collateral ligament injury,combining anterior and posterior cruciate ligaments injury,serious osteoarthritis,serious postoperative complications and revision surgery,no postoperative three-dimensional reconstruction CT imaging data.Randomisation was performed according to a random number table,with even numbers in the AMP group and odd numbers in the TT group.Initially there were 63 patients in AMP group and 57 patients in TT group.Because 4cases were followed up for less than 1 year,2 cases had postoperative complications,and1 case did not get postoperative CT three-dimensional reconstruction imaging data,a total of 7 cases were excluded in the anteromedial portal group.Because 6 cases were followed for less than 1 year,1 case had postoperative complications and 2 cases did not get postoperative CT three-dimensional reconstruction images,a total of 9 cases were excluded from the transtibial approach group.Finally,56 cases were in the AMP group including 46 males and 10 females,mean age(29.6 ± 11.7)years;48 cases were in the TT group including 40 males and 8 females,mean age(31.8 ± 11.0)years.All the patients were assessed by Lysholm score,International Knee Documentation Committee(IKDC)score,Tegner score pre-operatively and at last follow-up.All the patients underwent Lachman test,Pivot-shift test and KT-1000 evaluation at the last follow-up.The length of femoral tunnel was measured intraoperatively;one week after the operation,3D-CT anatomical reconstruction was performed to assess the location of the femoral tunnel.As for Lysholm score,IKDC score,Tegner score,KT-1000 and the length and location of tunnel,unpaired t test was used.And Mann-Whitney rank test is for the Lachman test and Pivot-shift test comparisons.Results: The mean follow-up time of the AMP group was(15.7 ± 6.8)months,andthe average follow-up time of the TT group was(14.9 ± 6.0)months.There was no statistically significant difference in Lysholm score(pre-operation t=0.347,P>0.05;last follow-up t=1.557,P >0.05),IKDC score(pre-operation t=-0.383,P >0.05;last follow-up t =1.102,P >0.05)or Tegner score(pre-operation t =0.283,P >0.05;last follow-up t =1.763,P >0.05)between the two groups before the operation or at the last follow-up.In Lachman test(Z=-0.482,P >0.05),Pivot-shift test(Z =-1.455,P >0.05)and KT-1000(t =-0.750,P >0.05),there was no statistically significant difference between the two groups at the last follow-up.The mean femoral tunnel length in the AMP group was significantly shorter than that in the TT group(t=-5.554,P <0.01).Tunnel location was significantly lower(t =8.865,P<0.01)and deeper(t =-4.508,P<0.01)with the AMP technique than with the TT method.Conclusions: Clinical function and knee joint stability are similar in AMP group and TT group;however,AMP group has a shorter femoral tunnel than TT group which the surgeon should be alert;but the location of femoral tunnel of AMP group is deeper,lower,and closer to the femoral footprint. |
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