Femoral tunnel placement in single-bundle anterior cruciate ligament reconstruction
Femoral tunnel placement in single-bundle anterior cruciate ligament reconstruction
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DOI：
10.1177/0363546507311093
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发表时间：
2008-01-01
影响因子：
4.8
通讯作者：
Bach, Bernard R., Jr.
中科院分区：
文献类型：
--
作者：
Rue, John-Paul H.;Ghodadra, Neil;Bach, Bernard R., Jr.
背景资料：关于重建前交叉韧带后外侧束和前内侧束的必要性存在争议。假设：一个横向定向的经胫骨钻孔的股骨隧道取代了前交叉韧带前内侧束和后外侧束的部分股骨足迹。研究设计：描述性实验室研究：方法：前交叉韧带的前内侧束和后外侧束的足迹保存在7对（5女，2男）新鲜冷冻的人尸体股骨（共14个股骨）。根据解剖学定位每个股骨，并将其固定在定制尺寸适当的侧匹配胫骨复制模型中，以模拟每个样本中10 mm股骨隧道的经胫骨逆行钻孔。使用Microscribe MX数字化仪记录隧道相对于前交叉韧带两束足迹的关系。股骨隧道相对于垂直12点钟位置的角度被记录为所有14个标本，只有10个标本被用于足迹measurements.Results：平均而言，10毫米股骨隧道重叠50%的前内侧束（范围，2%-83%）和51%的后外侧束（范围，16%-97%）。前内侧束的足迹占隧道面积的32%（范围，3%-49%）;后外侧束的足迹占隧道面积的26%（范围，7%-41%）。10 mm隧道的其余区域未与前交叉韧带足印区重叠。直接在样本上测量的股骨隧道的平均绝对角度为480（范围，420-530）与垂直方向的距离，对应于右膝上大约10：30的时钟面位置。结论：使用侧向经胫骨钻孔股骨隧道进行前交叉韧带重建，融合了自体前交叉韧带前内侧和后外侧束起源的部分。临床相关性：在10：30位置（左膝为1：30）放置一个外侧定向的经胫骨钻孔股骨隧道，重建前交叉韧带前内侧和后外侧束的部分。
Background: There is controversy regarding the necessity of reconstructing both the posterolateral and anteromedial bundles of the anterior cruciate ligament.Hypothesis: A laterally oriented transtibial drilled femoral tunnel replaces portions of the femoral footprints of the anteromedial and posterolateral bundles of the anterior cruciate ligament. Study Design: Descriptive laboratory study.Methods: Footprints of the anteromedial and posterolateral bundles of the anterior cruciate ligament were preserved on 7 matched pairs (5 female, 2 male) of fresh-frozen human cadaveric femurs (14 femurs total). Each femur was anatomically oriented and secured in a custom size-appropriate, side-matched replica tibia model to simulate transtibial retrograde drilling of a 10-mm femoral tunnel in each specimen. The relationship of the tunnel relative to footprints of both bundles of the anterior cruciate ligament was recorded using a Microscribe MX digitizer. The angle of the femoral tunnel relative to the vertical 12-o'clock position was recorded for all 14 specimens; only 10 specimens were used for footprint measurements.Results: On average, the 10-mm femoral tunnel overlapped 50% of the anteromedial bundle (range, 2%-83%) and 51 % of the posterolateral bundle (range, 16%-97%). The footprint of the anteromedial bundle occupied 32% (range, 3%-49%) of the area of the tunnel; the footprint of the posterolateral bundle contributed 26% (range, 7%-41 %). The remainder of the area of the 10mm tunnel did not overlap with the anterior cruciate ligament footprint. The mean absolute angle of the femoral tunnel as measured directly on the specimen was 480 (range, 420-530) from vertical, corresponding to approximately a 10:30 clock face position on a right knee.Conclusion: Anterior cruciate ligament reconstruction using a laterally oriented transtibial drilled femoral tunnel incorporates portions of the anteromedial and posterolateral bundle origins of the native anterior cruciate ligament.Clinical Relevance: A laterally oriented transtibial drilled femoral tunnel placed at the 10:30 position (1:30 for left knees) reconstructs portions of the anteromedial and posterolateral bundles of the anterior cruciate ligament.