观察入路选择对前交叉韧带重建术后股骨隧道位置及膝前痛的影响
简介
回顾性比较了184例ACL重建患者，按股骨隧道制备时观察入路分为经髌腱中央入路（CTP）与前内侧入路（AM）两组，影像学隧道参数无差异。CTP组术后3个月VAS及Kujala评分均劣于AM组（P=0.001），6个月差异缩小，12、24个月无差异。提示AM入路可视化可在确保隧道位置理想的同时减轻早期膝前痛，便于术者灵活选择入路。
英文摘要
BACKGROUND: Accurate femoral tunnel placement is considered important for successful anterior cruciate ligament reconstruction (ACL-R). Visualization portal selection during femoral tunnel preparation may influence postoperative clinical and radiographic outcomes. METHODS: This retrospective comparative study included 184 patients (mean age: 28.1 ± 6.7 years) who underwent primary ACL-R with ≥24-month follow up. Patients were grouped according to the arthroscopic visualization portal used during femoral tunnel preparation: central transpatellar portal (CTP; n = 90) or anteromedial (AM) portal (n = 94). Femoral tunnel angle, femoral tunnel height ratio, femoral tunnel depth ratio , and tibial tunnel angle were evaluated on postoperative radiographs. Clinical outcomes were assessed using visual analog scale (VAS) and Kujala scores at 3, 6, 12, and 24 months postoperatively. RESULTS: Mean radiographic tunnel parameters did not differ significantly between groups. At 3 months, VAS scores were higher in the CTP group than in the AM group (5.29 ± 1.51 vs. 3.44 ± 1.45; P = 0.001), while Kujala scores were lower (70.64 ± 4.87 vs. 73.00 ± 4.25; P = 0.001). Smaller differences were observed at 6 months, whereas no significant differences were identified at 12 or 24 months. Early postoperative differences remained below previously reported thresholds for clinically meaningful change. CONCLUSION: Patients undergoing ACL reconstruction with CTP visualization demonstrated higher anterior knee pain-related scores during the early postoperative period compared with those treated using an anteromedial portal. However, these differences were not observed at 12- or 24-month follow up. Mean radiographic tunnel parameters were similar between groups. These findings suggest that AM portal visualization may provide a more favorable early postoperative course while achieving comparable radiographic and mid-term clinical outcomes.