Objective To compare the effectiveness of I.D.E.A.L technique and transtibial (TT) technique in anterior cruciate ligament (ACL) reconstruction. Methods A clinical data of 60 patients with ACL injury, who were admitted and met the selection criteria between January 2020 and September 2022, was retrospectively analyzed. All patients underwent arthroscopic ACL reconstruction with autologous tendon. During operation, the femoral tunnel was prepared by using I.D.E.A.L technique in 30 cases (I.D.E.A.L group) and using TT technique in 30 cases (TT group). There was no significant difference in baseline data such as age, gender, body mass index, cause of injury, injured side, interval from injury to operation, constituent ratio of combined cartilage and meniscus injury, and preoperative Lysholm score, International Knee Documentation Committee (IKDC) score, visual analogue scale (VAS) score, anterior tibial translation difference, and Blumensaat angle between the two groups (P>0.05). The length of hospital stay and the occurrence of early and late complications were recorded. During follow-up, the Lysholm score, IKDC score, and VAS score were used to evaluate knee joint function and pain degree, and the anterior tibial translation difference was measured. MRI reexamination was performed to observe the healing of the graft, and the signal to noise quotient (SNQ) values of the femoral end, middle section, and tibial end of the graft, as well as the Blumensaat angle of the knee joint were measured. The differences in tibial anterior translation difference and Blumensaat angle before and after operation (change values) were calculated and compared between the two groups. Results The incisions in both groups healed by first intention after operation, and there was no significant difference in the length of hospital stay between the two groups (P>0.05). All patients were followed up 12-18 months, with an average of 14.9 months. The Lysholm score and IKDC score of the knee joint in both groups after operation increased when compared with those before operation, and the VAS score decreased. Compared to preoperative scores, except for the VAS score of the TT group at 1 week after operation (P>0.05), there were significant differences in all scores at different time points postoperatively in the two groups (P<0.05). The above scores in both groups showed a further improvement trend with the prolongation of time after operation. There were significant differences in Lysholm score and VAS score among 1 week, 1 month, 3 months, 6 months, and 12 months after operation in the two groups (P<0.05). The IKDC score of both groups at 1 month after operation was significantly different from that at 1 week after operation (P<0.05). At 1 week after operation, the Lysholm score and IKDC score in the I.D.E.A.L group were significantly higher than those in the TT group (P<0.05), and the VAS score was significantly lower (P<0.05); there was no significant difference between the two groups at 1, 3, 6, and 12 months after operation (P>0.05). At 12 months after operation, the anterior tibial translation differences in both groups were significantly lower than those before operation (P<0.05); and the change value in the I.D.E.A.L group was significantly higher than that in the TT group (P<0.05). The incidences of early and late complications in the I.D.E.A.L group were significantly lower than those in the TT group (P<0.05). At 12 months after operation, MRI examination showed that the grafts of the knee joint in both groups survived well, and the Blumensaat angles of both groups were significantly smaller than those before operation (P<0.05). The change value of the Blumensaat angle in the I.D.E.A.L group was significantly higher than that in the TT group (P<0.05). The SNQ values of the femoral end, middle section, and tibial end of the graft in the I.D.E.A.L group were significantly higher than those in the TT group (P<0.05). Conclusion The early effectiveness of ACL reconstruction by using the I.D.E.A.L technique is better, the knee joint is more stable, and the incidence of postoperative complication is lower. However, the maturity of the graft after reconstruction using the TT technique is higher.
Objective To investigate the effectiveness of modified single patellar tunnel medial patella femoral ligament (MPFL) reconstruction in the treatment of recurrent patellar dislocation. MethodsBetween January 2023 and June 2023, a total of 61 patients with recurrent patellar dislocation who underwent MPFL reconstruction with autologous semitendinosus were enrolled and divided into 2 groups using random number table method. In the patellar anchor group, 31 patients were treated with MPFL reconstruction with double medial patellar anchors, and 30 patients in the patellar tunnel group were treated with MPFL reconstruction with single patellar tunnel. The femoral ends of both groups were fixed with absorbable compression screws. There was no significant difference in baseline data such as gender, age, side, tibial tubercle-trochlear groove (TT-TG), Q angle, Caton-Deschamps index, number of dislocation, and preoperative Kujala score, preoperative patellar inclination angle (P>0.05). Patellar tunnel, patellar anchor position, patellar reduction, and the patellar inclination angle were measured by CT scan after operation. Kujala score was used to evaluate the function of knee joint before operation, at 2 weeks and 1, 3, 6, 12 months after operation. Incision aesthetic satisfaction score was performed at 3 months after operation. The signal-to-noise quotient (SNQ) of the transplanted tendon was measured by knee MRI at 12 months after operation to compare the maturity of the graft between the two groups. Results There was no significant difference in operation time and intraoperative blood loss between the two groups (P>0.05). Knee CT reexamination showed that the patellar tunnel and the patellar anchor position were consistent with the intraoperative fluoroscopy. There was no significant difference in the difference of the patellar inclination angle between the two groups before and after operation (P>0.05). All patients were followed up for an average of 12.8 months (range, 12-14months). There was 1 case of patellar anchor suture rejection in patellar anchor group, and the wound healed after debridement and dressing change. During the follow-up, there was no complication such as recurrence of patellar dislocation, infection and postoperative stiffness. The Kujala scores of the two groups significantly improved at each time point after 1 month of operation when compared with those before operation (P<0.05), and the Kujala scores of the two groups returned to normal levels at 3 months after operation. The Kujala score in the patellar tunnel group was significantly higher than that in the patellar anchor group in the very early stage (2 weeks) (P<0.05), and there was no significant difference between the two groups at other time points (P>0.05). Patients in the patellar tunnel group were significantly better than those in the patellar anchor group in the score of incision aesthetic satisfaction at 3 months after operation and the SNQ at 12 months after operation (P<0.05). Conclusion Modified single patellar tunnel MPFL reconstruction was used to treat patients with recurrent patellar dislocation without pathological TT-TG. The slide-fixation structure formed by single patellar tunnel positioning provides a variable degree of freedom for the reconstructed MPFL, which shows good effectiveness in the very early stage of the rehabilitation process.