Progress of different methods for femoral tunnel positioning in anterior cruciate ligament reconstruction_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

HUANG Biying ¹ , DENG Wenyu ¹ , LI Tao ² ,  LI Qi ²

1. West China School of Medicine, Sichuan University, Chengdu Sichuan, 610041, P.R.China;
2. Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China;

Corresponding author：

LI Qi, Email: liqimm@163.com

Keywords：

Anterior cruciate ligament reconstruction; femoral tunnel positioning; graft; effectiveness

DOI：

10.7507/1002-1892.202005003

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To systematically review the progress of different methods for femoral tunnel positioning in anterior cruciate ligament (ACL) reconstruction and provide a clinical reference for treatment of ACL rupture.Methods The literature about the femoral tunnel positioning in ACL reconstruction was widely reviewed. The advantages and disadvantages and the clinical results of each method were summarized.Results Currently in ACL reconstruction, methods for femoral tunnel positioning include transtibial technique (TT), anteromedial technique (AM), outside-in (OI), modified TT (mTT), and computer assisted surgery. There is no significant difference in the postoperative effectiveness between TT technique and AM technique. Compared with the TT technique, the OI technique has higher rotational stability of knee, but there is no significant difference in clinical results. The femoral tunnel located by mTT technique is closer to the anatomical placement than that of TT technique, but mTT technique is not effective for systematically anatomic femoral tunnel positioning, and further research is needed to prove its advantages.Conclusion Different femoral tunnel positioning methods have their own advantages and disadvantages, and there is no definite evidence that one is superior than the rest.

Citation： HUANG Biying, DENG Wenyu, LI Tao, LI Qi. Progress of different methods for femoral tunnel positioning in anterior cruciate ligament reconstruction. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(1): 118-123. doi: 10.7507/1002-1892.202005003 Copy

1.	Nakamura T, Koga H, Otabe K, et al. Comparison of three approaches for femoral tunnel during double-bundle anterior cruciate ligament reconstruction: A case controlled study. J Orthop Sci, 2019, 24(1): 147-152.
2.	Hefzy MS, Grood ES, Noyes FR. Factors affecting the region of most isometric femoral attachments. Part Ⅱ: The anterior cruciate ligament. Am J Sports Med, 1989, 17(2): 208-216.
3.	Giron F, Cuomo P, Aglietti P, et al. Femoral attachment of the anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc, 2006, 14(3): 250-256.
4.	Venosa M, Delcogliano M, Padua R, et al. Femoral tunnel positioning in anterior cruciate ligament reconstruction: Anteromedial portal versus transtibial technique-a randomized clinical trial. Joints, 2017, 5(1): 34-38.
5.	李飞龙, 罗小辑, 梁熙, 等. 前交叉韧带解剖研究进展及其对韧带重建技术的影响. 中国修复重建外科杂志, 2018, 32(3): 377-381.
6.	Gali JC, Camargo DB, Oliveira FAM, et al. Descriptive anatomy of the anterior cruciate ligament femoral insertion. Rev Bras Ortop, 2018, 53(4): 421-426.
7.	Siebold R, Schuhmacher P, Fernandez F, et al. Flat midsubstance of the anterior cruciate ligament with tibial “C”-shaped insertion site. Knee Surg Sports Traumatol Arthrosc, 2015, 23(11): 3136-3142.
8.	Siegel L, Vandenakker-Albanese C, Siegel D. Anterior cruciate ligament injuries: anatomy, physiology, biomechanics, and management. Clin J Sport Med, 2012, 22(4): 349-355.
9.	Sohn OJ, Lee DC, Park KH, et al. Comparison of the modified transtibial technique, anteromedial portal technique and outside-in technique in acl reconstruction. Knee Surg Relat Res, 2014, 26(4): 241-248.
10.	Kopf S, Forsythe B, Wong AK, et al. Nonanatomic tunnel position in traditional transtibial single-bundle anterior cruciate ligament reconstruction evaluated by three-dimensional computed tomography. J Bone Joint Surg (Am), 2010, 92(6): 1427-1431.
11.	Ahn JH, Jeong HJ, Ko CS, et al. Three-dimensional reconstruction computed tomography evaluation of tunnel location during single-bundle anterior cruciate ligament reconstruction: a comparison of transtibial and 2-incision tibial tunnel-independent techniques. Clin Orthop Surg, 2013, 5(1): 26-35.
12.	Nakamura K, Nakamura T, Horie M, et al. Anatomic femoral tunnel placement is difficult by the transtibial technique: comparison of three different femoral tunnel drilling techniques in double-bundle anterior cruciate ligament reconstructions. Knee Surg Sports Traumatol Arthrosc, 2020, 28(2): 584-593.
13.	Robin BN, Jani SS, Marvil SC, et al. Advantages and disadvantages of transtibial, anteromedial portal, and outside-in femoral tunnel drilling in single-bundle anterior cruciate ligament reconstruction: A systematic review. Arthroscopy, 2015, 31(7): 1412-1417.
14.	Kilinc BE, Kara A, Oc Y, et al. Transtibial vs anatomical single bundle technique for anterior cruciate ligament reconstruction: A retrospective cohort study. Int J Surg, 2016, 29: 62-69.
15.	Lee DH, Kim HJ, Ahn HS, et al. Comparison of femoral tunnel length and obliquity between transtibial, anteromedial portal, and outside-in surgical techniques in single-bundle anterior cruciate ligament reconstruction: A meta-analysis. Arthroscopy, 2016, 32(1): 142-150.
16.	董喆, 王磊, 马延辉, 等. 关节镜下经胫骨隧道入路与前内侧入路重建前交叉韧带效果的 Meta 分析. 中国组织工程研究, 2015, 19(51): 8352-8358.
17.	Lee DW, Kim JG, Lee JH, et al. Comparison of modified transtibial and outside-in techniques in anatomic single-bundle anterior cruciate ligament reconstruction. Arthroscopy, 2018, 34(10): 2857-2870.
18.	Park SH, Moon SW, Lee BH, et al. The sagittal plane angle and tunnel-related complications in double-bundle anterior cruciate ligament reconstruction using the transportal technique: an in vivo imaging study. Arthroscopy, 2015, 31(2): 283-292.
19.	Krupp R, Scovell F, Cook C, et al. Femoral cross-pin safety in anterior cruciate ligament reconstruction as a function of femoral tunnel position and insertion angle. Arthroscopy, 2011, 27(1): 83-88.
20.	McGlaston TJ, Entezari V, Nazarian A, et al. The safe zone for TransFix fixation in anterior cruciate ligament reconstruction using the anteromedial portal technique. Arthroscopy, 2011, 27(1): 77-82.
21.	Burnham JM, Malempati CS, Carpiaux A, et al. Anatomic femoral and tibial tunnel placement during anterior cruciate ligament reconstruction: anteromedial portal all-inside and outside-in techniques. Arthrosc Tech, 2017, 6(2): e275-e282.
22.	Farrow LD, Liu RW. Lateral anatomic structures at risk during transepiphyseal anterior cruciate ligament reconstruction. J Knee Surg, 2010, 23(4): 209-213.
23.	Panni AS, Milano G, Tartarone M, et al. Clinical and radiographic results of ACL reconstruction: a 5- to 7-year follow-up study of outside-in versus inside-out reconstruction techniques. Knee Surg Sports Traumatol Arthrosc, 2001, 9(2): 77-85.
24.	Lemos MJ, Albert J, Simon T, et al. Radiographic analysis of femoral interference screw placement during ACL reconstruction: endoscopic versus open technique. Arthroscopy, 1993, 9(2): 154-158.
25.	Kambara S, Nakayama H, Yamaguchi M, et al. Comparison of transportal and outside-in techniques for posterolateral femoral tunnel drilling in double-bundle ACL reconstruction -three-dimensional CT analysis of bone tunnel geometry. J Orthop Sci, 2017, 22(3): 481-487.
26.	Lee SR, Jang HW, Lee DW, et al. Evaluation of femoral tunnel positioning using 3-dimensional computed tomography and radiographs after single bundle anterior cruciate ligament reconstruction with modified transtibial technique. Clin Orthop Surg, 2013, 5(3): 188-194.
27.	Chhabra A, Diduch DR, Blessey PB, et al. Recreating an acceptable angle of the tibial tunnel in the coronal plane in anterior cruciate ligament reconstruction using external landmarks. Arthroscopy, 2004, 20(3): 328-330.
28.	Raffo CS, Pizzarello P, Richmond JC, et al. A reproducible landmark for the tibial tunnel origin in anterior cruciate ligament reconstruction: avoiding a vertical graft in the coronal plane. Arthroscopy, 2008, 24(7): 843-845.
29.	Lee DW, Kim JG. Anatomic single-bundle anterior cruciate ligament reconstruction using the modified transtibial technique. Arthrosc Tech, 2017, 6(1): e227-e232.
30.	Lee JK, Lee S, Kim KT, et al. Anatomic tunnel placement can be achieved with a modification to transtibial technique in single bundle anterior cruciate ligament reconstruction: A cadaver study. PLoS One, 2017, 12(7): e0180860.
31.	da Silva RR, Matos MA, Costa VCNB, et al. Tomographic study of femoral positioning in anterior cruciate ligament reconstruction using the transtibial technique. Knee Surg Relat Res, 2017, 29(3): 195-202.
32.	Kim Y, Lee BH, Mekuria K, et al. Registration accuracy enhancement of a surgical navigation system for anterior cruciate ligament reconstruction: A phantom and cadaveric study. Knee, 2017, 24(2): 329-339.
33.	Zaffagnini S, Urrizola F, Signorelli C, et al. Current use of navigation system in ACL surgery: a historical review. Knee Surg Sports Traumatol Arthrosc, 2016, 24(11): 3396-3409.
34.	Jamsher M, Ballarati C, Viganò M, et al. Graft inclination angles in anterior cruciate ligament reconstruction vary depending on femoral tunnel reaming method: Comparison among transtibial, anteromedial portal, and outside-in retrograde drilling techniques. Arthroscopy, 2020, 36(4): 1095-1102.
35.	Tejpal T, Gupta A, Shanmugaraj A, et al. Anteromedial portal double-bundle anterior cruciate ligament reconstruction yields similar outcomes to non-amp femoral drilling double-bundle techniques: A systematic review of comparative studies. Orthop J Sports Med, 2019, 7(12): 2325967119888140.
36.	Lee JK, Lee S, Seong SC, et al. Anatomic single-bundle ACL reconstruction is possible with use of the modified transtibial technique: a comparison with the anteromedial transportal technique. J Bone Joint Surg (Am), 2014, 96(8): 664-672.
37.	Larson AI, Bullock DP, Pevny T. Comparison of 4 femoral tunnel drilling techniques in anterior cruciate ligament reconstruction. Arthroscopy, 2012, 28(7): 972-979.
38.	Shin YS, Ro KH, Jeon JH, et al. Graft-bending angle and femoral tunnel length after single-bundle anterior cruciate ligament reconstruction: comparison of the transtibial, anteromedial portal and outside-in techniques. Bone Joint J, 2014, 96-B(6): 743-751.
39.	Youm YS, Cho SD, Lee SH, et al. Modified transtibial versus anteromedial portal technique in anatomic single-bundle anterior cruciate ligament reconstruction: comparison of femoral tunnel position and clinical results. Am J Sports Med, 2014, 42(12): 2941-2947.
40.	Chen H, Tie K, Qi Y, et al. Anteromedial versus transtibial technique in single-bundle autologous hamstring ACL reconstruction: a meta-analysis of prospective randomized controlled trials. J Orthop Surg Res, 2017, 12(1): 167.
41.	Ro KH, Kim HJ, Lee DH. The transportal technique shows better clinical results than the transtibial techniques for single-bundle anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc, 2018, 26(8): 2371-2380.
42.	MacDonald P, Kim C, McRae S, et al. No clinical differences between anteromedial portal and transtibial technique for femoral tunnel positioning in anterior cruciate ligament reconstruction: a prospective randomized, controlled trial. Knee Surg Sports Traumatol Arthrosc, 2018, 26(5): 1335-1342.
43.	张磊, 姜博, 孙晋, 等. 关节镜下经胫骨隧道技术和经内侧入路技术重建前交叉韧带的比较研究. 中国修复重建外科杂志, 2019, 33(9): 1077-1082.
44.	李顺昌, 伏兰, 郭小川, 等. 运动疗法对前交叉韧带重建术后膝关节功能恢复的 Meta 分析. 中国循证医学杂志, 2019, 19(9): 1086-1092.
45.	Ji G, Han A, Hao X, et al. Better rotational control but similar outcomes with the outside-in versus the transtibial drilling technique for anterior cruciate ligament reconstruction: a systematic review of comparative trials. Arch Orthop Trauma Surg, 2018, 138(11): 1575-1581.
46.	Ahn JH, Lee YS, Jeong HJ, et al. Comparison of transtibial and retrograde outside-in techniques of anterior cruciate ligament reconstruction in terms of graft nature and clinical outcomes: a case control study using 3T MRI. Arch Orthop Trauma Surg, 2017, 137(3): 357-365.
47.	毛云鹤, 唐婕晞, 李箭, 等. 膝关节多发韧带损伤不同手术时机与疗效相关性的 Meta 分析. 中国循证医学杂志, 2019, 19(4): 418-423.

1. Nakamura T, Koga H, Otabe K, et al. Comparison of three approaches for femoral tunnel during double-bundle anterior cruciate ligament reconstruction: A case controlled study. J Orthop Sci, 2019, 24(1): 147-152.
2. Hefzy MS, Grood ES, Noyes FR. Factors affecting the region of most isometric femoral attachments. Part Ⅱ: The anterior cruciate ligament. Am J Sports Med, 1989, 17(2): 208-216.
3. Giron F, Cuomo P, Aglietti P, et al. Femoral attachment of the anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc, 2006, 14(3): 250-256.
4. Venosa M, Delcogliano M, Padua R, et al. Femoral tunnel positioning in anterior cruciate ligament reconstruction: Anteromedial portal versus transtibial technique-a randomized clinical trial. Joints, 2017, 5(1): 34-38.
5. 李飞龙, 罗小辑, 梁熙, 等. 前交叉韧带解剖研究进展及其对韧带重建技术的影响. 中国修复重建外科杂志, 2018, 32(3): 377-381.
6. Gali JC, Camargo DB, Oliveira FAM, et al. Descriptive anatomy of the anterior cruciate ligament femoral insertion. Rev Bras Ortop, 2018, 53(4): 421-426.
7. Siebold R, Schuhmacher P, Fernandez F, et al. Flat midsubstance of the anterior cruciate ligament with tibial “C”-shaped insertion site. Knee Surg Sports Traumatol Arthrosc, 2015, 23(11): 3136-3142.
8. Siegel L, Vandenakker-Albanese C, Siegel D. Anterior cruciate ligament injuries: anatomy, physiology, biomechanics, and management. Clin J Sport Med, 2012, 22(4): 349-355.
9. Sohn OJ, Lee DC, Park KH, et al. Comparison of the modified transtibial technique, anteromedial portal technique and outside-in technique in acl reconstruction. Knee Surg Relat Res, 2014, 26(4): 241-248.
10. Kopf S, Forsythe B, Wong AK, et al. Nonanatomic tunnel position in traditional transtibial single-bundle anterior cruciate ligament reconstruction evaluated by three-dimensional computed tomography. J Bone Joint Surg (Am), 2010, 92(6): 1427-1431.
11. Ahn JH, Jeong HJ, Ko CS, et al. Three-dimensional reconstruction computed tomography evaluation of tunnel location during single-bundle anterior cruciate ligament reconstruction: a comparison of transtibial and 2-incision tibial tunnel-independent techniques. Clin Orthop Surg, 2013, 5(1): 26-35.
12. Nakamura K, Nakamura T, Horie M, et al. Anatomic femoral tunnel placement is difficult by the transtibial technique: comparison of three different femoral tunnel drilling techniques in double-bundle anterior cruciate ligament reconstructions. Knee Surg Sports Traumatol Arthrosc, 2020, 28(2): 584-593.
13. Robin BN, Jani SS, Marvil SC, et al. Advantages and disadvantages of transtibial, anteromedial portal, and outside-in femoral tunnel drilling in single-bundle anterior cruciate ligament reconstruction: A systematic review. Arthroscopy, 2015, 31(7): 1412-1417.
14. Kilinc BE, Kara A, Oc Y, et al. Transtibial vs anatomical single bundle technique for anterior cruciate ligament reconstruction: A retrospective cohort study. Int J Surg, 2016, 29: 62-69.
15. Lee DH, Kim HJ, Ahn HS, et al. Comparison of femoral tunnel length and obliquity between transtibial, anteromedial portal, and outside-in surgical techniques in single-bundle anterior cruciate ligament reconstruction: A meta-analysis. Arthroscopy, 2016, 32(1): 142-150.
16. 董喆, 王磊, 马延辉, 等. 关节镜下经胫骨隧道入路与前内侧入路重建前交叉韧带效果的 Meta 分析. 中国组织工程研究, 2015, 19(51): 8352-8358.
17. Lee DW, Kim JG, Lee JH, et al. Comparison of modified transtibial and outside-in techniques in anatomic single-bundle anterior cruciate ligament reconstruction. Arthroscopy, 2018, 34(10): 2857-2870.
18. Park SH, Moon SW, Lee BH, et al. The sagittal plane angle and tunnel-related complications in double-bundle anterior cruciate ligament reconstruction using the transportal technique: an in vivo imaging study. Arthroscopy, 2015, 31(2): 283-292.
19. Krupp R, Scovell F, Cook C, et al. Femoral cross-pin safety in anterior cruciate ligament reconstruction as a function of femoral tunnel position and insertion angle. Arthroscopy, 2011, 27(1): 83-88.
20. McGlaston TJ, Entezari V, Nazarian A, et al. The safe zone for TransFix fixation in anterior cruciate ligament reconstruction using the anteromedial portal technique. Arthroscopy, 2011, 27(1): 77-82.
21. Burnham JM, Malempati CS, Carpiaux A, et al. Anatomic femoral and tibial tunnel placement during anterior cruciate ligament reconstruction: anteromedial portal all-inside and outside-in techniques. Arthrosc Tech, 2017, 6(2): e275-e282.
22. Farrow LD, Liu RW. Lateral anatomic structures at risk during transepiphyseal anterior cruciate ligament reconstruction. J Knee Surg, 2010, 23(4): 209-213.
23. Panni AS, Milano G, Tartarone M, et al. Clinical and radiographic results of ACL reconstruction: a 5- to 7-year follow-up study of outside-in versus inside-out reconstruction techniques. Knee Surg Sports Traumatol Arthrosc, 2001, 9(2): 77-85.
24. Lemos MJ, Albert J, Simon T, et al. Radiographic analysis of femoral interference screw placement during ACL reconstruction: endoscopic versus open technique. Arthroscopy, 1993, 9(2): 154-158.
25. Kambara S, Nakayama H, Yamaguchi M, et al. Comparison of transportal and outside-in techniques for posterolateral femoral tunnel drilling in double-bundle ACL reconstruction -three-dimensional CT analysis of bone tunnel geometry. J Orthop Sci, 2017, 22(3): 481-487.
26. Lee SR, Jang HW, Lee DW, et al. Evaluation of femoral tunnel positioning using 3-dimensional computed tomography and radiographs after single bundle anterior cruciate ligament reconstruction with modified transtibial technique. Clin Orthop Surg, 2013, 5(3): 188-194.
27. Chhabra A, Diduch DR, Blessey PB, et al. Recreating an acceptable angle of the tibial tunnel in the coronal plane in anterior cruciate ligament reconstruction using external landmarks. Arthroscopy, 2004, 20(3): 328-330.
28. Raffo CS, Pizzarello P, Richmond JC, et al. A reproducible landmark for the tibial tunnel origin in anterior cruciate ligament reconstruction: avoiding a vertical graft in the coronal plane. Arthroscopy, 2008, 24(7): 843-845.
29. Lee DW, Kim JG. Anatomic single-bundle anterior cruciate ligament reconstruction using the modified transtibial technique. Arthrosc Tech, 2017, 6(1): e227-e232.
30. Lee JK, Lee S, Kim KT, et al. Anatomic tunnel placement can be achieved with a modification to transtibial technique in single bundle anterior cruciate ligament reconstruction: A cadaver study. PLoS One, 2017, 12(7): e0180860.
31. da Silva RR, Matos MA, Costa VCNB, et al. Tomographic study of femoral positioning in anterior cruciate ligament reconstruction using the transtibial technique. Knee Surg Relat Res, 2017, 29(3): 195-202.
32. Kim Y, Lee BH, Mekuria K, et al. Registration accuracy enhancement of a surgical navigation system for anterior cruciate ligament reconstruction: A phantom and cadaveric study. Knee, 2017, 24(2): 329-339.
33. Zaffagnini S, Urrizola F, Signorelli C, et al. Current use of navigation system in ACL surgery: a historical review. Knee Surg Sports Traumatol Arthrosc, 2016, 24(11): 3396-3409.
34. Jamsher M, Ballarati C, Viganò M, et al. Graft inclination angles in anterior cruciate ligament reconstruction vary depending on femoral tunnel reaming method: Comparison among transtibial, anteromedial portal, and outside-in retrograde drilling techniques. Arthroscopy, 2020, 36(4): 1095-1102.
35. Tejpal T, Gupta A, Shanmugaraj A, et al. Anteromedial portal double-bundle anterior cruciate ligament reconstruction yields similar outcomes to non-amp femoral drilling double-bundle techniques: A systematic review of comparative studies. Orthop J Sports Med, 2019, 7(12): 2325967119888140.
36. Lee JK, Lee S, Seong SC, et al. Anatomic single-bundle ACL reconstruction is possible with use of the modified transtibial technique: a comparison with the anteromedial transportal technique. J Bone Joint Surg (Am), 2014, 96(8): 664-672.
37. Larson AI, Bullock DP, Pevny T. Comparison of 4 femoral tunnel drilling techniques in anterior cruciate ligament reconstruction. Arthroscopy, 2012, 28(7): 972-979.
38. Shin YS, Ro KH, Jeon JH, et al. Graft-bending angle and femoral tunnel length after single-bundle anterior cruciate ligament reconstruction: comparison of the transtibial, anteromedial portal and outside-in techniques. Bone Joint J, 2014, 96-B(6): 743-751.
39. Youm YS, Cho SD, Lee SH, et al. Modified transtibial versus anteromedial portal technique in anatomic single-bundle anterior cruciate ligament reconstruction: comparison of femoral tunnel position and clinical results. Am J Sports Med, 2014, 42(12): 2941-2947.
40. Chen H, Tie K, Qi Y, et al. Anteromedial versus transtibial technique in single-bundle autologous hamstring ACL reconstruction: a meta-analysis of prospective randomized controlled trials. J Orthop Surg Res, 2017, 12(1): 167.
41. Ro KH, Kim HJ, Lee DH. The transportal technique shows better clinical results than the transtibial techniques for single-bundle anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc, 2018, 26(8): 2371-2380.
42. MacDonald P, Kim C, McRae S, et al. No clinical differences between anteromedial portal and transtibial technique for femoral tunnel positioning in anterior cruciate ligament reconstruction: a prospective randomized, controlled trial. Knee Surg Sports Traumatol Arthrosc, 2018, 26(5): 1335-1342.
43. 张磊, 姜博, 孙晋, 等. 关节镜下经胫骨隧道技术和经内侧入路技术重建前交叉韧带的比较研究. 中国修复重建外科杂志, 2019, 33(9): 1077-1082.
44. 李顺昌, 伏兰, 郭小川, 等. 运动疗法对前交叉韧带重建术后膝关节功能恢复的 Meta 分析. 中国循证医学杂志, 2019, 19(9): 1086-1092.
45. Ji G, Han A, Hao X, et al. Better rotational control but similar outcomes with the outside-in versus the transtibial drilling technique for anterior cruciate ligament reconstruction: a systematic review of comparative trials. Arch Orthop Trauma Surg, 2018, 138(11): 1575-1581.
46. Ahn JH, Lee YS, Jeong HJ, et al. Comparison of transtibial and retrograde outside-in techniques of anterior cruciate ligament reconstruction in terms of graft nature and clinical outcomes: a case control study using 3T MRI. Arch Orthop Trauma Surg, 2017, 137(3): 357-365.
47. 毛云鹤, 唐婕晞, 李箭, 等. 膝关节多发韧带损伤不同手术时机与疗效相关性的 Meta 分析. 中国循证医学杂志, 2019, 19(4): 418-423.

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