Comparison of Femoral Tunnel and Clinical Outcome Using Two Anterior Cruciate Ligament Reconstruction Techniques

Not Applicable

Completed

Brief Summary: 1. Purpose :To compare of femoral tunnel placement, tunnel geometry and clinical outcome using two anterior cruciate ligament reconstruction techniques ; transportal technique with flexible reamer and single bundle outside in technique with remnant preservation.

2. Subjects: anterior cruciate ligament (ACL) injury 66 patients

* Double bundle transportal technique with flexible reamer: 33

* Single bundle outside in technique with remnant preservation: 33

Detailed Description: Anterior cruciate ligament (ACL) injury patients : Total 66

1. Double bundle transportal technique with flexible reamer: 33

* Advantage: more normal ACL reconstruction than single bundle technique

* Disadvantage: to make the two bone tunnel must remove all the residual tissue.

2. Single bundle outside in technique with remnant preservation: 33

* Advantage: good for being synovium and revascularization. Remained proprioception function helps to functional recovery.

* Disadvantage: difficult to ensure of visibility and tunnel drilling in the correct position because of remnant tissue.

Recruitment & Eligibility

Inclusion Criteria

Lachman test grade II,III and Pivot shift test grade II,III in physical examination
ACL rupture in MRI
Age 20~60
within 6 months after trauma

Exclusion Criteria

Arm && Interventions

Group	Intervention	Description
Transportal	type of anterior cruciate ligament reconstruction	this is a type of anterior cruciate ligament reconstruction. this arm for patients who underwent operation with transportal technique
Outside in	type of anterior cruciate ligament reconstruction	this is a type of anterior cruciate ligament reconstruction. this arm for patients who underwent operation with patients who underwent operation with outside in technique

Primary Outcome Measures

Name	Time	Method
Vascularity of Graft Tendon	1yr after surgery	For evaluation of graft vascularity, quantitative parameter of area under the curve (AUC) was measured from DCE-MRI by using an image-processing software (IntelliSpace Portal, version 5.0; Philips Healthcare). A musculoskeletal radiologist manually drew the ROIs for intra-articular portion of the ACL graft including synovial membrane at the proximal, middle and distal zones. The software automatically generated time to signal intensity curves and then calculated the quantitative parameter, area under the time to signal intensity curve values, which were acquired by integrating the area under the time to signal intensity curve. To normalize the AUC (nAUC), we divided the AUC of medial gastrocnemius muscle into that of the ACL graft.

Secondary Outcome Measures

Name	Time	Method
Arthroscopy Grading	1yr after surgery	Graft continuity was graded as no tears, superficial tear (fibrillation or tear of superficial fibers), or substantial tear (rupture of 1 or more strands). Graft tension was graded as taut, mild lax, and lax by probing at knee flexion and extension. Synovial coverage of the grafts was graded as excellent (synovial coverage \> 80% around graft), fair (coverage \> 50%), or poor (coverage \< 50%) On the second-look arthroscopic examination, graft continuity, graft tension, graft synovialization, and the presence of cyclops lesions were assessed by a senior surgeon.
Graft Maturity (SNQ)	1 yr after surgery
Clinical Knee Scoring	2 yr after surgery	Lysholm score (ragne 0-100), HSS (hospital for special surgery) score (0-100) , IKDC (international knee doucomentation commitee) subjective score (0-100), Tegner activity scale (0-10). All of scores demonstrated that higher score means a better outcomes.
Instability	2 yr after surgery	The side-to-side difference was measured using a KT-200- arthrometer (MEDmetric) at 30 lb in 30° of knee flexion.