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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >Hybrid Transtibial Femoral Preparation for Transphyseal Anterior Cruciate Ligament Reconstruction: A Radiographic Comparison to Transtibial and Anteromedial Portal Techniques
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Hybrid Transtibial Femoral Preparation for Transphyseal Anterior Cruciate Ligament Reconstruction: A Radiographic Comparison to Transtibial and Anteromedial Portal Techniques

机译：用于转椎骨前十字韧带重建的杂种抗体股骨制剂：与串易和前置门户技术的射线照相比较

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Background: Transphyseal anterior cruciate ligament (ACL) reconstruction remains the most commonly used technique for pubescent patients. The principles of creating vertical and central femoral tunnels are well accepted to minimize physeal area of injury and are typically accomplished with a transtibial (TT) technique. This, however, may come at the expense of a non-anatomic tunnel. The hybrid transtibial (HTT) technique offers the potential of combining an anatomic femoral position with tunnel geometry similar to the TT technique but has never been assessed in a clinical cohort. Hypothesis/Purpose: We hypothesized that tunnels created by a HTT technique would be similar in orientation and physeal location to TT tunnels, but significantly more vertical and central than tunnels created with an anteromedial portal (AM). Methods: We retrospectively screened all ACL reconstructions performed in children aged 10 to 16 years, at our institution between 2013 to 2019, with the requirements of having a transphyseal reconstruction and an available post-operative radiographs. Radiographs were then assessed for the coronal femoral tunnel angle (FTA), as well as the location of the tunnel-physis penetration on the AP (LTAP) and lateral (LTL) views. Physeal lesion surface area was calculated. Data were compared between the three groups using ANOVA. Results: Forty-seven patients met eligibility criteria with 9 TT, 18 AM, and 20 HTT patients. Mean patient age was 14.3 +/- 1.2 years. The FTA was significantly more vertical in the TT (60.7 ~(o) +/-7.2) and HTT (54.4 ~(o) +/- 5.7) groups as compared to the AM group (48.8 ~(o) +/- 5.9); p = 0.0037 and p = 0.02 respectively. There was no significant difference between the TT and HTT groups ( p = 0.066). The LTAP was not significantly different between groups (p = 0.097). The LTL demonstrated that the HTT tunnels penetrated the physis at a more central location in the sagittal plane (28.9% +/- 4.8%) than the AM tunnels (20.0% +/- 5.1%, p = 0.00002), but was statistically indistinguishable from the TT (24.4%+/- 4.0%, p= 0.066) tunnels. Conclusion: The hybrid transtibial technique presents an option for transphyseal ACL reconstruction, with femoral tunnel obliquity and estimated physeal disruption similar to the TT technique, significantly less than the AM technique. The HTT also results in the most central physeal perforation of all techniques, predominantly in the sagittal plane. With the known ability of the HTT technique to recreate an anatomic femoral footprint, this may represent the “best of both worlds” for transphyseal ACL reconstruction.
机译：背景：异骨前十字韧带（ACL）重建仍然是青春期患者最常用的技术。创建垂直和中央股骨隧道的原理很好地接受，以最大限度地减少体质损伤区域，并且通常用串易（TT）技术完成。然而，这可能会以非解剖隧道为代价。混合式串易（HTT）技术提供了与TT技术类似的隧道几何形状组合解剖学股骨位置，但从未在临床队列中进行评估。假设/目的：我们假设由HTT技术创建的隧道在TT隧道中的方向和身体位置类似，但比用主题门户网站（AM）创建的隧道明显更多。方法：我们回顾性地筛选了在2013年至2019年的10至16岁儿童中进行的所有ACL重建，在2013年至2019年之间，具有多发性重建和可用的术后X线片。然后评估射线照片的冠状股隧道角（FTA），以及在AP（LTAP）和横向（LT1）视图上的隧道生理渗透的位置。计算性能病变表面积。使用ANOVA比较三个组之间的数据。结果：四十七名患者达到了9 TT，18A和20名HTT患者的资格标准。平均患者年龄为14.3 +/- 1.2岁。与AM组相比，TT（60.7〜（O）+/- 7.2）和HTT（54.4〜（o）+/- 5.7）组（48.8〜（o）+/- 5.9 ）; p = 0.0037和p = 0.02。 TT和HTT组之间没有显着差异（P = 0.066）。在组之间没有显着差异（p = 0.097）。 LTL证明HTT隧道在矢状平面的更中心位置（28.9％+/- 4.8％）比AM隧道（20.0％+/- 5.1％，P = 0.00002），但在统计上无法区分来自TT（24.4％+ / - 4.0％，P = 0.066）隧道。结论：杂交抗静电技术呈现出硬膜炎ACL重建的选择，股骨隧道倾斜和估计的性能中断与TT技术相似，显着小于AM技术。 HTT还导致所有技术的最中心性穿孔，主要在矢状平面中。随着HTT技术的已知能力重新创建解剖股骨量表，这可能代表失检ACL重建的“两全其美”。

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