The relationship between femoral tunnels created by the transtibial, anteromedial portal, and outside-in techniques and the anterior cruciate ligament footprint.
The relationship between femoral tunnels created by the transtibial, anteromedial portal, and outside-in techniques and the anterior cruciate ligament footprint.
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DOI：
10.1177/0363546511434276
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发表时间：
2012-04
期刊：
影响因子：
--
通讯作者：
Li G
中科院分区：
文献类型：
--
作者：
Gadikota HR;Sim JA;Hosseini A;Gill TJ;Li G
为重建撕裂的前交叉韧带（ACL）而创建的隧道是关节稳定性和临床结果的关键决定因素。关于经胫骨（TT）、前内侧（AM）门静脉和由外向内（OI）手术技术在建立解剖隧道方面的能力，客观证据有限。(1)与TT技术相比，胫骨隧道独立技术可以在解剖前交叉韧带足迹中心更准确地创建隧道；(2)OI和TT技术在外侧皮质上的股骨隧道出口位置将比AM门静脉技术的股骨隧道出口位置远离外侧上髁。对照实验室研究。8例平均年龄为56岁的尸体膝关节标本用于本研究。使用数字化系统记录沿ACL插入区域的轮廓点和由TT、AM门静脉和OI技术创建的隧道孔径。从数字化点测量以下参数：(1)隧道覆盖ACL、前内侧束和后外侧束的数量；(2) ACL中心与隧道的关系；(3)股骨隧道出口中心到外上髁的距离。所有记录的参数在三维实体建模软件中进行分析。所有3种手术技术实现的ACL足迹覆盖百分比彼此之间没有显着差异。然而，与TT隧道相比，AM通道和OI技术创建的隧道中观察到更大的股骨后外侧束覆盖。在前内侧束覆盖方面，3种技术之间没有显著差异。平均27.1%±17.4%的TT隧道位于ACL足迹之外。与AM门静脉技术的13.6%±15.7% （P = 0.01）和成骨不全技术的10.8%±10.8% （P = 0.01）相比，这一比例显著增加。TT、AM门静脉和OI技术建立的股骨隧道中心分别位于距ACL足迹中心3.0±1.5 mm、2.1±0.9 mm和1.5±1.2 mm的距离。AM门静脉技术在股外侧皮质上的股骨隧道出口位置比OI和TT技术的股骨隧道出口位置更接近外侧上髁。本研究结果表明，AM门静脉和OI技术比TT技术实现了更大的后外侧束覆盖。AM门户和OI技术创建的隧道的中心比TT技术隧道的中心更接近本机ACL占用空间中心。相对于外侧上髁，AM门静脉技术的股骨后隧道出口发生率高于OI和TT技术。对于使用软组织移植物重建前交叉韧带，胫骨隧道独立技术比TT技术可以产生更多的解剖隧道。
Tunnels created for reconstruction of a torn anterior cruciate ligament (ACL) are critical determinants of joint stability and clinical outcomes. There is limited objective evidence on the ability of transtibial (TT), anteromedial (AM) portal, and outside-in (OI) operative techniques in creating anatomic tunnels. (1) Tibial tunnel–independent techniques can create tunnels more accurately at the anatomic ACL footprint center than the TT technique, and (2) femoral tunnel exit location of the OI and TT techniques on the lateral cortex will be significantly further away from the lateral epicondyle than the femoral tunnel exit location of the AM portal technique. Controlled laboratory study. Eight cadaveric knee specimens with a mean age of 56 years were used in this study. A digitizing system was used to record points along the outlines of the ACL insertion area and apertures of tunnels created by the TT, AM portal, and OI techniques. The following parameters were measured from the digitized points: (1) amount of ACL, anteromedial bundle, and posterolateral bundle coverage by the tunnels; (2) relationship between the centers of the ACL and the tunnels; and (3) distance between the center of the femoral tunnel exit and the lateral epicondyle. All the recorded parameters were analyzed in 3-dimensional solid modeling software. The percentage of ACL footprint coverage achieved by all 3 surgical techniques was not significantly different from one another. However, larger femoral posterolateral bundle coverage was observed in tunnels created by the AM portal and OI techniques than in the TT tunnel. In terms of anteromedial bundle coverage, no significant differences were observed between the 3 techniques. On average, 27.1% ± 17.4% of the TT tunnel was outside the ACL footprint. This was significantly larger compared with 13.6%± 15.7% with the AM portal technique (P = .01) and 10.8%± 10.8% in the OI technique (P = .01). Centers of femoral tunnels created by the TT, AM portal, and OI techniques were located at a distance of 3.0 ± 1.5 mm, 2.1 ± 0.9 mm, and 1.5 ± 1.2 mm, respectively, from the ACL footprint center. The femoral tunnel exit location of the AM portal technique on the lateral femoral cortex was closer to the lateral epicondyle than the femoral tunnel exit location of the OI and TT techniques. Findings of this study indicate that a larger posterolateral bundle coverage is achieved by the AM portal and OI techniques than by the TT technique. Centers of the tunnels created by the AM portal and OI techniques were closer to the native ACL footprint center than the center of the TT technique tunnel. The incidence of a posterior femoral tunnel exit relative to the lateral epicondyle is higher in the AM portal technique than in the OI and TT techniques. For ACL reconstruction using soft tissue grafts, tibial tunnel–independent techniques can produce more anatomic tunnels than the TT technique.
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