前交叉韧带重建中双股骨-双胫骨隧道构型相比解剖单束和双股骨-单胫骨隧道构型可改善长期重返运动：一项12年回顾性队列研究
简介
该研究回顾性分析了83例ACL重建患者（腘绳肌腱自体移植物），平均随访12.6年，比较解剖单束（ASB）、双股骨-单胫骨骨道（DFST）和双股骨-双胫骨骨道（DFDT）三种隧道配置的长期临床效果。关键发现：DFDT组在Tegner（6.95 vs 5.88和5.2）、Lysholm（85.42 vs 74.03和75.47）及IKDC（84.95 vs 73…
英文摘要
INTRODUCTION/OBJECTIVES: Double-bundle (DB) anterior cruciate ligament (ACL) reconstruction has demonstrated biomechanical advantages over anatomic single-bundle (ASB) techniques; however, long-term clinical superiority remains controversial, and the potential influence of tibial tunnel configuration has not been well established. This study aims to compare long-term clinical outcomes of ASB ACL reconstruction with two DB configurations -double femoral-single tibial tunnel (DFST) and double femoral-double tibial tunnel (DFDT)-and to evaluate return to preinjury activity. METHODS: Patients undergoing primary ACL reconstruction with hamstring autograft by a single surgeon between 2007 and 2011 were retrospectively reviewed using prospectively collected data. Surgical technique selection was based on surgeon preference and chronological evolution of practice. Clinical outcomes at a mean follow-up of 12.6 years included the International Knee Documentation Committee (IKDC), Lysholm, and Tegner scores. Return to preinjury activity was defined as postoperative Tegner ≥ preinjury Tegner. Groups were compared using univariate analyses, and effect sizes were calculated for key comparisons. RESULTS: Eighty-three patients were available for final follow-up (30 ASB, 34 DFST, and 19 DFDT). When DB techniques were analyzed as a single group, only Tegner score was modestly higher compared with ASB (6.26 vs 5.20; p=0.049). Subgroup analysis demonstrated that DFDT was superior to DFST and ASB in Tegner (6.95 vs 5.88 and 5.2 respectively; p=0.0.34), Lysholm (85.42 vs 74.03 and 75.47 respectively; p=0.012) and IKDC (84.95 vs 73.65 and 75.7 respectively; p=0.018) scores. CONCLUSION: At more than 12 years of follow-up DFDT was associated with modestly improved patient-reported outcomes compared with ASB and DFST techniques. These findings suggest that tunnel configuration may influence long-term functional activity restoration after ACL reconstruction. LEVEL OF EVIDENCE: III (Retrospective Comparative study without negative criteria).