Proximally positioned femoral grafts decrease passive anterior tibial subluxation in anterior cruciate ligament reconstruction using a posterior trans-septal portal.

IF 2 3区医学 Q2 ORTHOPEDICS

International Orthopaedics Pub Date : 2024-10-01 Epub Date: 2024-08-27 DOI:10.1007/s00264-024-06271-9

Hong Yeol Yang, Ji Won Kim, Jong Keun Seon

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Abstract

Purpose: To compare the anterior and posterior trans-septal (TS) portal approaches in anterior cruciate ligament reconstruction (ACLR) by evaluating femoral tunnel positioning and passive anterior tibial subluxation (PATS).

Methods: A total of 205 patients who underwent primary ACLR using the outside-in technique between March 2018 and December 2021 were retrospectively enrolled. Patients were classified into two groups based on the viewing techniques: the anterior group was treated using anteromedial or anterolateral portals (n = 155), and the TS group was treated using posterior TS portal (n = 55). The relative locations of the femoral tunnel were evaluated using the deep-shallow planes (X-axis) and superior-inferior planes (Y-axis) with the quadrant method in the lateral femoral condyle on a 3-dimensional computed tomography image. Anterior tibial subluxation for the lateral and medial compartments relative to the femoral condyles was evaluated as measured on magnetic resonance imaging. Knee laxity was assessed using the pivot-shift test and stress radiography.

Results: In the posterior TS group, the femoral tunnel was usually located deeper on the X-axis and more superior on the Y-axis, which corresponds to a more proximal position, than in the anterior group (deeper on the X-axis and superior on the Y-axis). Moreover, the femoral tunnel locations in this group were more compactly distributed than those in the anterior group. The TS group showed significantly better reduction of postoperative PATS in the lateral compartments than the anterior group (anterior group vs. TS group: lateral compartment, 3.2 ± 3.1 vs. 4.5 ± 3.2 mm; p = .016). Significantly better results were found in the TS group for knee stability as assessed by the pivot-shift grade (p = .044); however, there were no significant differences between the two groups with respect to patient-reported outcome measures (p > .05) and other complications (p = .090).

Conclusion: Our results suggest that positioning the femoral tunnel using the posterior TS portal approach may lead to better outcomes in terms of PATS and rotational stability compared to the anterior portal approach in ACLR.

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在使用经后隔门户的前十字韧带重建术中，股骨近端位置的移植物可减少被动的胫骨前脱位。

目的：通过评估股骨隧道定位和被动胫骨前脱位（PATS），比较前交叉韧带重建术（ACLR）中的前和后经隔（TS）入路：回顾性入选了2018年3月至2021年12月期间使用外入路技术进行初级ACLR的205例患者。根据观察技术将患者分为两组：前方组使用前内侧或前外侧入路进行治疗（n = 155），TS 组使用后方 TS 入路进行治疗（n = 55）。在三维计算机断层扫描图像上，使用象限法在股骨外侧髁上评估股骨隧道的深浅平面（X 轴）和上下平面（Y 轴）的相对位置。根据磁共振成像测量结果，评估相对于股骨髁的外侧和内侧胫骨前脱位情况。使用枢轴移位试验和应力X光检查评估膝关节松弛情况：在TS后侧组中，股骨隧道通常位于X轴的更深处和Y轴的更上部，与前侧组（X轴的更深处和Y轴的更上部）相比，股骨隧道的位置更近。此外，与前路组相比，该组的股骨隧道位置分布更紧凑。与前路组相比，TS 组术后外侧间隙 PATS 的缩小效果明显更好（前路组 vs. TS 组：外侧间隙，3.2 ± 3.1 mm vs. 4.5 ± 3.2 mm；P = .016）。根据枢轴移位等级评估，TS 组的膝关节稳定性明显更好（p = .044）；但是，在患者报告的结果指标（p > .05）和其他并发症（p = .090）方面，两组之间没有显著差异：结论：我们的研究结果表明，在前交叉韧带置换术中，使用 TS 后方入口方法定位股骨隧道可能会在 PATS 和旋转稳定性方面比使用前方入口方法获得更好的结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Orthopaedics 医学-整形外科

CiteScore

5.50

自引率

7.40%

发文量

360

审稿时长

1 months

期刊介绍： International Orthopaedics, the Official Journal of the Société Internationale de Chirurgie Orthopédique et de Traumatologie (SICOT) , publishes original papers from all over the world. The articles deal with clinical orthopaedic surgery or basic research directly connected with orthopaedic surgery. International Orthopaedics will also link all the members of SICOT by means of an insert that will be concerned with SICOT matters. Finally, it is expected that news and information regarding all aspects of orthopaedic surgery, including meetings, panels, instructional courses, etc. will be brought to the attention of the readers. Manuscripts submitted for publication must contain a statement to the effect that all human studies have been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki. It should also be stated clearly in the text that all persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study should be omitted. Reports of animal experiments must state that the "Principles of laboratory animal care" (NIH publication No. 85-23, revised 1985) were followed, as well as specific national laws (e.g. the current version of the German Law on the Protection of Animals) where applicable. The editors reserve the right to reject manuscripts that do not comply with the above-mentioned requirements. The author will be held responsible for false statements or for failure to fulfil the above-mentioned requirements.