Improved footprint location of the femoral tunnel via the tibia and post-operative assessment of the bone tunnel in anterior cruciate ligament reconstruction
ZHANG Pengli1，2，WANG Yaoting1，JIA Yiming3，LIU Shuitao4, and XING Gengyan1，2.
1.Department of Orthopedics, General Hospital of Chinese People’s Armed Police Forces， Beijing 100039, China；
2. Graduate School of Hebei Medical University，Shijiazhuang 050017，China；
3. Department of Orthopedics,Chifeng Hospital of Inner Mongolia,Chifeng 024001,China；
4.Affiliated Hospital of Chinese People’s Armed Police Forces Logistics College,Tianjin 300162,China
摘要 目的 探讨前交叉韧带重建术中经胫骨的股骨隧道足迹定位方法的改进及术后骨道位置评估。 方法 分析2007 -06至2010-01于武警总医院行自体半腱肌腱和股薄肌腱单束重建前交叉韧带手术患者196例，应用改进的方法进行关节镜下经胫骨的股骨隧道足迹定位，并应用国际膝关节文献委员会（international knee documentation commitee, IKDC）评分及术后MRI行骨道位置评估的资料。 结果 经随访10～36个月，患者的前抽屉试验及Lachman试验均为阴性，IKDC评分情况均较术前差异有统计学意义( P <0.05) ，采用矢状位上关节线与移植肌腱的夹角(the angle between the joint line and the graft on the sagittal view，JGS)和冠状位上关节线与移植肌腱的夹角(the angle between the joint line and the graft on the coronal image，JGC) ，对术后6个月及正常侧膝关节MRI行骨道位置评估，重建的前交叉韧带的位置与正常对照组的位置差异无统计学意义（ P >0.05）。 结论 单束重建前交叉韧带时，改进的经胫骨的股骨隧道的足迹定位方法是理想的股骨隧道定位方法，患者关节稳定性与功能均得到显著改善；采用JGS和JGC对骨道位置进行评估可较客观、准确地反映股骨隧道定位情况，骨隧道位置与临床效果相关。
Abstract：Objective To establish an improved method of footprint location of the femoral tunnel via the tibia and post-operative assessment of the bone tunnel in anterior cruciate ligament (ACL) reconstruction. Methods 196 patients were investigated who underwent the single-bundle ACL reconstruction with autogenous semitendinosus tendon and gracilis tendon using the improved method of footprint location of the femoral tunnel via the tibia under arthroscopy from June 2007 to January 2010. The position of the femoral tunnel was measured by MRI and the knee function was assessed by IKDC scores. Results After a follow-up of 10-36 months, anterior drawer tests and Lachman tests in the patients were all negative. The IKDC scores increased significantly( P <0.05). The location of the bone tunnel was evaluated by the angle between the joint line and the graft on the sagittal view(JGS) and the angle between the joint line and the graft on the coronal image(JGC )on MRI after 6 months and there was no difference in the position of the anterior cruciate ligament between the reconstruction group and control group( P >0.05) . Conclusions The improved method of footprint location of the femoral tunnel via the tibia in single-bundle ACL reconstruction is an ideal method . The stability and functions of knees of the patients can improved significantly. The measurement of knees using JGS and JGC can reflect the tunnel positions objectively and accurately,which are related to the clinical effect.
