Protection of the Medial Femoral Condyle Articular Cartilage During Drilling of the Femoral Tunnel Through the Accessory Medial Portal in Anatomic Anterior Cruciate Ligament Reconstruction
Protection of the Medial Femoral Condyle Articular Cartilage During Drilling of the Femoral Tunnel Through the Accessory Medial Portal in Anatomic Anterior Cruciate Ligament Reconstruction
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DOI：
10.1016/j.eats.2012.05.008
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发表时间：
2012-09-01
影响因子：
1.2
通讯作者：
Abdelkafy, Ashraf
中科院分区：
文献类型：
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作者：
Abdelkafy, Ashraf
在原股前交叉韧带（ACL）足迹中准确定位股骨隧道需要通过副内侧门静脉（AMP）钻孔。AMP位于远内侧和低水平。尽管通过AMP钻孔有很多好处，但钻头头沿着引导针滑动到前交叉韧带的股止点时，可能会损伤股骨内侧髁的关节软骨。由于现在越来越多的外科医生进行解剖前交叉韧带重建，并且从胫骨钻孔转向运输钻孔，这种损伤的风险可能会增加，特别是在他们学习曲线的开始阶段。为了避免这种伤害，使用了生物干扰螺钉护套。将其通过AMP插入导针上方，直至接近股骨外侧髁的内侧壁。所述钻头插入在所述导销上并穿过所述生物干扰螺钉护套。使用生物干扰螺钉鞘不仅可以保护股骨内侧髁的关节软骨，还可以保护内侧半月板、后十字韧带和AMP的皮肤免受损伤，因为在运输钻孔过程中钻头头与这些结构非常接近。
Accurate positioning of the femoral tunnel in the native femoral anterior cruciate ligament (ACL) footprint requires drilling through an accessory medial portal (AMP). The AMP is located far medial and at a low level. Despite the benefits of drilling through the AMP, it is possible that the drill bit head will injure the articular cartilage of the medial femoral condyle as it slides along the guide pin to the femoral insertion of the ACL. Because more surgeons are now performing anatomic ACL reconstructions and shifting from transtibial drilling toward transportal drilling, the risk of this injury might be increasing, especially during the beginning of their learning curve. To avoid such injury, a bio-interference screw sheath is used. It is inserted through the AMP over the guide pin until it reaches near the medial wall of the lateral femoral condyle. The drill bit is inserted over the guide pin and through the bio-interference screw sheath. Using the bio-interference screw sheath not only protects the articular cartilage of the medial femoral condyle but also protects the medial meniscus, posterior cruciate ligament, and skin of the AMP from injury because of the close proximity of the drill bit head to these structures during transportal drilling.