Anatomical Single-bundle ACL Reconstruction: Comparison Of Femoral Oval Tunnel Technique And Round Tunnel Technique

Objective: The study was carried out to evaluate the effectiveness of oval femoral tunnel(OFT)technique versus round femoral tunnel(RFT)technique in anatomical anterior cruciate ligament(ACL)reconstruction by comparing the clinical outcomes between these two groups.Methods: Between March 2016 and February 2018,125 patients who underwent single-bundle ACL reconstruction with hamstring tendon autografts and met the inclusion and exclusion criteria were included in this retrospective study.Of the included patients,43 patients underwent ACL reconstruction were used oval tunnel technique(Group A)and 82 patients were used round tunnel technique(Group B).There was no significant difference between the two groups in terms of age,gender,BMI,the interval from injury to surgery,the injury side,and preoperative knee function score such as Lysholm score,IKDC score and Tegner score(P<0.05).Knee function scores were compared between the two groups at3-,6-,12-and 24-months follow-up points,and KT-1000 was used to evaluate knee stability.The position and shape of the tunnels wereevaluated by the 3D-CT 1 day after surgery and MRI was performed at 6-,12-,and 24-months follow-up to calculate the signal/noise quotient(SNQ)of ACL grafts.Second-look arthroscopy was conducted to compare the graft status and synovial coverage at 24-months post-operative.Results : All the patients were followed up with an average of 23months(range,12-26 months).Two patients in Group A and 5 patients in Group B presented with redness and swelling of the surgical site,one patient in Group B sustained a tibial peri-tunnel fracture and one patient in Group A had postoperative stiffness.The Lysholm score,IKDC score and Tegner score were significantly higher in Group A than in Group B at the post-operative follow-up period except for the 3-months post-operative Tenger score.The postoperative outcome of KT1000 measurement was better in Group A than in Group B(p? <? 0.05).The entrances of the femoral tunnel and tibial tunnel in both groups were within the ACL anatomical footprint,as confirmed by 3D-CT.There were no re-rupture cases at the last follow-up,as confirmed by the MRI scans.There was no significant difference with regard to the middle or the distal SNQ between the two groups at 6-months follow-up(P>0.05),whereas the proximal SNQ of oval group was lower than control group(P<0.05).The grafts SNQ in Group A were significantly lower than that in Group B at 12-and24-months follow-up(P<0.05).Twenty-one patients in Group A and 38 patients in Group B underwent secondary arthroscopy and the resultshowed no significant difference in graft status or synovial coverage between the two groups(P>0.05).Conclusion: The clinical outcomes and graft maturity of femoral oval tunnel group were statistically superior to those of the round tunnel group.Patients underwent femoral oval tunnel ACL reconstruction have a better knee function after surgery.