Management of tibial cortical cuts by loop plates during reconstruction of the anterior cruciate ligament by all-inside technique
10.3760/cma.j.cn121113-20250306-00228
- VernacularTitle:全内技术重建前十字韧带术中襻钢板切割胫骨骨皮质的处理方案
- Author:
Liang XU
1
;
Yang TANG
1
;
Gang YU
1
;
Yingming WANG
1
;
Chao FANG
1
;
Di WU
1
;
Qichun ZHAO
1
Author Information
1. 中国科学技术大学附属第一医院（安徽省立医院）运动医学科，合肥 230001
- Publication Type:Journal Article
- Keywords:
Knee joint;
Anterior cruciate ligament reconstruction;
Arthroscopy;
Reoperation
- From:
Chinese Journal of Orthopaedics
2025;45(8):508-514
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the management options for loop plate cutting of the tibial cortex during reconstruction of the anterior cruciate ligament (ACL) by the all-inside technique.Methods:From January 2022 to December 2024, a total of 13 patients with ACL injury who underwent all-inside reconstruction with tibial lateral loop plate cutting of the cortex and immediate revision for ACL injuries at Department of Sports Medicine, the First Affiliated Hospital of University of Science and Technology of China were retrospectively analyzed (cut group). There were 5 males and 8 females with an average age of 28.7±9.1 years (range, 17-39 years). During the revision, a transverse tunnel was drilled at the distal end of the tibial tunnel, and the loop plate was fixed to the lateral tibial cortex through the transverse tunnel. Matched by gender, age, and side, the patients who underwent ACL reconstruction with all-inside loop steel without cutting the tibial cortex during the same period (the uncut group) were selected as the control group at a ratio of 1∶2, including 10 males and 16 females, aged 29.1±9.3 years (range, 17-39 years). The visual analogue scale (VAS), Tegner score, International Knee Documentation Committee (IKDC) and Lysholm score for knee pain before and after surgery were compared between the two groups, and bone tunnel enlargement was assessed using the Peyrache grading scale.Results:All patients were successfully operated and followed up for 13.1±2.5 months and 13.3±2.6 months, respectively. The Lysholm scores of the cutting group before surgery, 6 months after surgery, and 1 year after surgery were 35.44±15.69, 75.21±16.77, and 93.47±18.56 respectively, while those of the uncut group were 37.81±17.33, 71.45±15.82, and 91.05±19.54. The Lysholm scores of both groups 6 months and 1 year after surgery were higher than those before surgery, and the Lysholm scores 1 year after surgery were higher than those 6 months after surgery, with statistically significant differences ( P<0.05). There were no statistically significant differences in the Lysholm scores between the two groups before and after surgery ( P>0.05). The IKDC scores of the cutting group before surgery, 6 months after surgery, and 1 year after surgery were 39.12±14.28, 69.52±15.36, and 84.24±17.91 respectively, while those of the uncut group were 37.46±11.55, 72.81±17.73, and 87.62±18.52. The IKDC scores of both groups 6 months and 1 year after surgery were higher than those before surgery, and the IKDC scores 1 year after surgery were higher than those 6 months after surgery, with statistically significant differences ( P<0.05). There were no statistically significant differences in the IKDC scores between the two groups before and after surgery ( P>0.05). The Tegner scores of the cutting group before surgery, 6 months after surgery, and 1 year after surgery were 1.61±1.11, 3.59±1.66, and 5.59±1.79 respectively, while those of the non-cutting group were 1.57±1.05, 3.47±1.51, and 5.41±1.63. The Tegner scores of both groups 6 months and 1 year after surgery were higher than those before surgery, and the Tegner scores 1 year after surgery were higher than those 6 months after surgery, with statistically significant differences ( P<0.05). There were no statistically significant differences in the Tegner scores between the two groups before and after surgery ( P>0.05). According to Peyrache's grading criteria, 7 cases in the cutting group had femoral side bone tunnel enlargement and 8 cases had tibial side bone tunnel enlargement; 12 cases in the non-cutting group had femoral side bone tunnel enlargement and 15 cases had tibial side bone tunnel enlargement, with no statistically significant differences (χ 2=0.205, P=0.650; χ 2=0.053, P=0.818). At the last follow-up, there were 2 cases of Lachman grade I in the cutting group and 3 cases in the non-cutting group, 1 case of joint stiffness in the cutting group and 2 cases in the non-cutting group. None of the patients in the two groups had vascular nerve injury, deep vein thrombosis, or intra-articular infection. Conclusion:The method of drilling a transverse tunnel at the distal end of the outer opening of the tibial tunnel and fixing the loop plate to the lateral tibial cortex through the transverse tunnel, along with cutting the tibial cortex, can improve the knee joint function.
