胫骨隧道位置对自体腘绳肌腱解剖单束前交叉韧带重建术后功能及等速肌力测试结果的影响
简介
本研究回顾性分析34例接受腘绳肌腱自体移植物解剖单束ACL重建患者的术后MRI，分别采用胫骨止点解剖标志法和健侧ACL解剖标志法测量胫骨骨道位置，评估其对膝关节稳定性、等速肌力、单腿跳测试及KOOS、IKDC-2000评分的影响。结果显示：按解剖标志法，23例骨道位于常规位置，5例偏前，6例偏后；按健侧法，20例常规，4例偏前，6例偏后，4例偏内。仅后位骨道…
英文摘要
BACKGROUND: Tunnel malposition is a frequent complication of anterior cruciate ligament (ACL) reconstruction. We evaluated whether the tibial tunnel location of patients who underwent anatomical single-bundle ACL reconstruction with hamstring tendons affected knee stability, muscle strength, and clinical outcomes. METHODS: We retrospectively evaluated operated and normal knee MRI scans of 34 patients who underwent anatomical single-bundle ACL reconstruction technique with hamstring tendons. Tibial tunnel location was measured according to two techniques: anatomical landmarks of tibial footprint and contralateral normal knee ACL anatomical scans. The effect of tibial tunnel location on knee stability, isokinetic and single-leg hop test (SLHT) results, and Knee injury and Osteoarthritis Outcome Score (KOOS) and International Knee Documentation Committee (IKDC-2000) scores were evaluated. RESULTS: For tunnel position evaluated by anatomical landmark methods, patients were defined as regular footprint in 23 patients, anterior in 5, and posterior in 6. Similarly, tibial tunnel positions evaluated by contralateral footprint, twenty patients were grouped as regular, 4 as anterior, 6 as posterior, and 4 as medial tibial tunnel position. Groups were compared according to both techniques. KOOS pain scores were significantly different in posterior tunnel position patients compared to patients with regular position (p = 0.023). No significant difference was found between the pivot shift, Kneelax 3 anterior translation and SLHT, and leg symmetry index (LSI). Isokinetic test results and IKDC and other KOOS scores of all groups were similar. The kappa value between two measurement techniques was 0.681, and the agreement between techniques was 82% (p < 0.001). CONCLUSION: Tibial tunnel position may not be optimal because of technical reasons. Tunnel malposition does not significantly affect the stability and clinical outcomes of the patients in mid-term results. We can evaluate tibial tunnel only with the operated knee's routine control MRI scans. KEY WORDS: Anterior cruciate ligament reconstruction, single-bundle, tibial tunnel position, MRI.