30°与70°关节镜在关节镜下前交叉韧带重建术中对股骨及胫骨隧道定位的影响
简介
本研究回顾性分析了55例ACL重建患者（30°关节镜组28例，70°关节镜组27例），均由同一术者采用腘绳肌腱移植物、股骨悬吊固定及胫骨可吸收螺钉完成。术后CT评估股骨及胫骨骨道位置（分别采用Bernard-Hertel和Staubli-Rauschning法），≥6个月时以IKDC评分评估临床疗效。关键发现：70°关节镜组股骨骨道显著更偏后、偏远（深度29…
英文摘要
OBJECTIVE: The success of anterior cruciate ligament reconstruction depends on anatomical tunnel placement. The aim of this was to compare the effects of 30° and 70° arthroscopes on femoral and tibial tunnel positioning and their relationship with clinical outcomes. METHODS: This retrospective study analyzed 55 patients who underwent anterior cruciate ligament reconstruction between 2020 and 2024 (30° arthroscope, n=28; 70° arthroscope, n=27). All procedures were performed by the same surgeon using hamstring tendon grafts with suspensory femoral fixation and bioabsorbable tibial screws. Femoral and tibial tunnel positions were evaluated on postoperative computed tomography using the Bernard-Hertel and Staubli-Rauschning methods, respectively, with measurements performed by four orthopedic surgeons; clinical outcomes were assessed at ≥6 months using the International Knee Documentation Committee score. RESULTS: Femoral tunnels were significantly more posterior and distal in the 70° group (depth 29.4 vs. 38.7%; height 33.7 vs. 43.1%; both p<0.001). Tibial tunnel placement showed no significant difference (p=0.49). International Knee Documentation Committee scores were higher in the 70° group (89.2±5.4 vs. 84.6±6.8; p=0.02). Correlation and regression analyses confirmed femoral tunnel position as an independent predictor of functional outcome. Receiver operating characteristic curve analysis showed area under the curve values of 0.75 (95%CI 0.69-0.79) for depth and 0.71 (95%CI 0.67-0.78) for height. CONCLUSION: Use of a 70° arthroscope in anterior cruciate ligament reconstruction enables more anatomical femoral tunnel placement and improves functional outcomes, while tibial tunnel positioning is unaffected. Arthroscopic viewing angle should be regarded not only as a technical factor but also as a determinant of clinical success.