| Objective :Anterior cruciate ligament(lacquer joint)is an important structure and power of lacquer joint to maintain stability and normal work.Once ACL is damaged,it has a great impact on lacquer joint.If not treated in time,it will cause serious impact on the motor function of patients,and even cause joint degeneration and osteoarthropathy of patients.Currently,the clinical treatment of paint-joint injury mainly adopts single-beam ACL reconstruction under arthroscopy,which can restore the result and function of the ligament to the maximum extent,meet the movement requirements of the knee joint,and its operation is simpler and less damaging,the choice of the central location of the femoral tunnels is closely related to the therapeutic effect.Currently,two femoral tunnels are mainly used in clinic based on different concepts,one is isometric reconstruction of femoral tunnel,the other is anatomical reconstruction of femoral tunnel.In order to select a more accurate and individualized treatment plan,this study was mainly to compare the stability and clinical efficacy of single strand anterior cruciate ligament reconstruction based on isometric reconstruction and anatomic reconstruction.Methods:Eighty patients with cruciate ligament injury admitted to the Second Affiliated Hospital of Nanchang University and the Department of Orthopedics of the First People’s Hospital of Jiujiang City from January 2020 to December 2021 were retrospectively selected as the research objects and divided into two groups with 40 patients in each group according to different central positioning of femoral tunnel.In the first group,the iso-length femoral tunnel was reconstructed,that is,the internal opening of the femoral tunnel was positioned at the distance 7 mm before the apex of the lateral wall of the intercondylar fossa,and the guide needle was driven outside the skin of the femoral lateral condyle.The other group used anatomical reconstruction of the femoral tunnel,that is,the internal opening of the femoral tunnel was located in the tread center of the femoral stop of the ACL.Subjective knee function score(Lysholm score,IKDC score),stability evaluation(axial shift test,Lachman test)and patellofemoral joint degeneration were observed in 2 groups before and 1 year after surgery,and the incidence of complications were analyzed and compared between 2groups.Results:1.In this study,80 patients were enrolled and divided into 2 groups.All patients were followed up with knee MRI examination and functional score about 1 year after surgery,and the results were analyzed.The two groups were comparable in age,sex,course of disease,body mass index and other general conditions(P>0.05)..2.In the isometric reconstruction group,30 patients could basically recover to the level of exercise before injury,and the excellent and good rate reached 75.0%.7patients were able to do daily activities and mild sports,accounting for 17.5%.In the anatomical reconstruction group,31 patients recovered to the level of exercise before injury,accounting for 77.5% of excellent and good rate.7 patients could meet the requirements of daily activities and mild physical activities,accounting for 17.5%.There were 3 patients in the isometric reconstruction group and 2 patients in the anatomical reconstruction group who occasionally felt joint pain or swelling,but had no influence on daily life.The knee function scores of isometric reconstruction group and anatomic reconstruction group were compared,and there was no significant difference between the two groups before surgery(P>0.05).One year after surgery,The mean of IKDC score and Lysholm score in isometric reconstruction group were87.49±9.14 and 86.54±8.15 respectively.The mean IKDC score and Lysholm score of the anatomical reconstruction group were 91.36±9.82 and 90.46±8.73 respectively.The postoperative IKDC score and Lysholm score of the two groups were significantly higher than those before surgery,and the anatomical reconstruction group was significantly better than the isometric reconstruction group,the differences were statistically significant(P<0.05).3.There was no significant difference between the two groups in preoperative Lachman test and axial shift test(P>0.05);One year after surgery,the knee stability evaluation(Lachman test and axial shift test)of the two groups were followed up and found that 14 cases in the isometric reconstruction femoral tunnel group were positive for Lachman test and 14 cases were positive for axial shift test.Lachman test and axial shift test were positive in 9 cases and 10 cases in the anatomic reconstructed femoral tunnel group.The Lachman test and axial shift test data in the anatomic reconstructed femoral tunnel group were better than those in the isometric reconstructed femoral tunnel group,and the difference was statistically significant(P<0.05).4.The Recht grading scores of patellofemoral articular cartilage in isometric reconstruction group and anatomical reconstruction group were compared,and there was no significant difference between the two groups before surgery(P>0.05).MRI follow-up of the two groups 1 year after surgery showed that the Recht grade of patellofemoral articular cartilage in the isometric reconstruction group was significantly lower than that before surgery,and the difference was statistically significant(P<0.05);There was no significant difference in the Recht grade of patellofemoral articular cartilage in the anatomical reconstruction group compared with that before surgery(P>0.05).A comparative analysis between the two groups showed that the Recht grade of patellofemoral articular cartilage in the anatomical reconstruction group was better than that in the isometric reconstruction group 1 year after surgery,and the difference was statistically significant(Z=2.375,P<0.05).5.No infection or vascular and nerve injury occurred in the isometric reconstruction group and anatomic reconstruction group,and the postoperative incision healing was good.In the isometric reconstruction femoral tunnel group,2patients occasionally felt joint swelling and 1 patient felt pain.In the anatomical reconstruction of femoral tunnel group,1 patient occasionally felt joint swelling and 1patient felt pain.There was no statistical significance in the total complication rate between the two groups(P>0.05).Conclusion:There are some differences between the two methods of single beam ACL reconstruction,and the recent clinical results are satisfactory.However,compared with the equivalent length femoral tunnel,the single beam reconstruction of anatomical reconstruction femoral tunnel has certain advantages in promoting the functional recovery and stability of knee joint after surgery and reducing the degeneration of patellofemoral joint cartilage.Better functional recovery and stability of knee joint can be obtained,and the degree of degeneration of patellofemoral joint cartilage after surgery is smaller. |
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