단일 다발 전방 십자인대 재건술
Single Bundle Anterior Cruciate Ligament Reconstruction
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초록
전방 십자인대 재건술은 전방 십자인대 파열 후 슬관절의 불안정성에 관련된 증상을 방지하고 추가적인 2차 손상을 예방하기 위한 수술로 초기에는 경골 터널을 이용한 단일 다발 재건술이 행하여졌으나 단일 다발 재건술은 슬관절의 전방 안정성의 회복에는 긍정적이나 회전 안정성의 회복에는 부정적이라고 보고되면서 이중 다발 전방 십자인대 재건술이 개발되었다. 그러나 이중 다발 재건술은 수술 술기가 어렵고 모든 환자에 적용하는 것은 무리가 있으며 그 결과 또한 단일 다발 재건에 비해 월등하다는 장기적인 추시 결과는 없다. 최근 전방십자인대의 해부학적 재건술이 보고되면서 단일 다발 재건술도 전방 및 회전 안정성의 회복에 긍정적이며 대퇴 터널의 생성 시 경골 터널보다는 전내측 삽입구를 이용한 대퇴 터널의 생성이 좀 더 정확한 해부학적 대퇴 터널 생성에 도움이 되는 것으로 보고되면서 이 방법을 이용한 전방 십자인대 재건술이 많이 이루어지고 있으며 그 결과도 좋은 것으로 보고되고 있다.
Abstract
Anterior cruciate ligament (ACL) reconstruction is generally accepted as the most reliable method of re-establishing knee kinematics so as to prevent various symptoms related to the instability and subsequent injuries to the knee. Double bundle ACL reconstruction has emerged as a potential solution for single bundle reconstruction, as the latter can restore anteroposterior stability, but it had limitations for improving the rotational stability. However, double bundle reconstruction is a more complex surgical procedure and it remain unclear whether double bundle reconstruction has better results than single bundle reconstruction on long term follow-up. Recent studies have demonstrated that a femoral tunnel could be created independently of the tibial tunnel and in a more anatomic position by using the anteromedial portal technique, so that that there is better restoration of the rotational stability as well as anterior stability than that with performing the transtibial technique.
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