Abstract
We performed a comparative study of two series of 25 patellar tendon arthroscopic reconstructions of isolated chronic anterior cruciate ligament injuries, alternating between a double-incision (using a rear-entry guide) or single-incision technique (using a transtibial approach). The patients were reviewed to assess the clinical, KT-2000 and radiological differences at an average follow-up of 14 months (range 8–18 months). For the clinical evaluation the International Knee Documentation Committee Form was used. The following radiographic parameters were measured: (1) the direction of the femoral and tibial tunnels in the antero-posterior (AP) and lateral (LL) views; (2) the location of the anterior border of the intra-articular exit hole of the femoral tunnel in the LL radiologic view; (3) femoral interference screw divergence with the bone block. An extension loss ≤5° was detected in 40% of the double-incision and 36% of the single-incision patients (NS). A flexion loss≤10° was present in 8% of the double-incision and 16% of single-incision group (NS). There were no differences in terms of pivot shift test between the two groups (pivot glide in 12% of both groups). The average side-to-side KT-2000 differences at the manual maximum test were 1.98 mm in the double-incision and 2.64 mm in the single-incision group. With the double-incision technique the fermoral and tibial tunnels were divergent in the AP plane and crossed the joint at an angle of 37° and 72°, respectively. With the single-incision technique the bone tunnels were almost parallel and crossed the joint at an average angle of 68°. The location of the intra-articular exit of the femoral tunnel was posterior in both techniques (63% and 66%, respectively). Screw divergence (≥20°) on the femoral side was absent in the double-incision and present in 12% in the single-incision group (NS). In conclusion, even without straight line tunnels, satisfactory results in terms of stability may be obtained. Despite our similar results, we feel that the single-incision technique is perhaps preferable because there is less postoperative pain and swelling, and it is preferred by the patients. The single-incision technique has a long learning curve.
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Aglietti, P., Zaccherotti, G., Menchetti, P.P.M. et al. A comparison of clinical and radiological parameters with two arthroscopic techniques for anterior cruciate ligament reconstruction. Knee Surg, Sports traumatol, Arthroscopy 3, 2–8 (1995). https://doi.org/10.1007/BF01553517
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DOI: https://doi.org/10.1007/BF01553517