ObjectiveTo compare the effectiveness of the arthroscopic anterior cruciate ligament (ACL) reconstruction with the transtibial technique and through anteromedial approach. MethodsBetween April 2008 and May 2012, 86 patients (86 knees) with ACL rupture underwent single bundle reconstruction with autogeneic hamstring tendons with the transtibial technique in 44 cases (group A) and through anteromedial approach in 42 cases (group B). There was no significant difference in age, gender, injury causes, injury to admission time, preoperative International Knee Documentation Committee (IKDC) score, and Lysholm score between 2 groups (P>0.05). The femoral and tibia tunnels were measured by X-ray films and CT. The knee stability and function were evaluated by Lachman test, pivot shift test, IKDC score, and Lysholm score. ResultsThe patients were followed up 1-2 years (mean, 1.5 years) in group A and 1 year-1 year and 6 months (mean, 1.2 years) in group B. No limitation of knee motion was observed. The Lysholm score and IKDC score were significantly increased at 1 year after operation when compared with preoperative scores in 2 groups (P<0.05), but no significant difference was found between 2 groups (P>0.05). At 1 year after operation, the stability of the knee in group B was significantly better than that in group A, and the results of Lachman test and pivot shift test showed significant differences between 2 groups (P<0.05). The femoral tunnel in group A was significantly longer in length and bigger in coronal angles and sagittal location than that in group B (P<0.05). ConclusionACL reconstruction through anteromedial approach is a surgical technique to be closer to anatomy reconstruction, which can obtain better rotation function and stability of the knee than the transtibial technique.
ObjectiveTo compare the incidence of chondral injury using Rigidfix femoral fixation device via the anteromedial approach and the tibial tunnel approach during anterior cruciate ligament (ACL) reconstruction. MethodsEighteen adult cadaver knees were divided randomly into 2 groups, 9 knees in each group. Femoral tunnel drilling and cross-pin guide insertions were performed using the Rigidfix femoral fixation device through the anteromedial approach (group A) and the tibial tunnel approach (group B). ACL reconstruction simulation was performed at 0, 10, 20, 30, 45, 60, 70, 80, and 90°in the horizontal position. The correlation between incidence of chondral injury and slope angles was analyzed, and then the incidence was compared between the 2 groups. ResultsThe correlation analysis indicated that the chondral injury incidence increased with the increasing of the slope angle (r=0.611, P=0.000; r=0.852, P=0.000). The incidence of chondral injury was 69.1% (56/81) and 48.1% (39/81) in groups A and B respectively, showing significant difference (χ2=7.356, P=0.007). The sublevel analysis showed that the chondral injury incidence of group A (36.1%, 13/36) was significantly higher than that of group B (0) at 0-30°(χ2=15.864, P=0.000), but no significant difference was found between group A (95.6%, 43/45) and group B (86.7%, 39/45) at 45-90°(P=0.267). ConclusionIt has more risk of chondral injury to use Rigidfix femoral fixation device via the anteromedial approach than the tibial tunnel approach to reconstruct ACL.