Anatomical limitations of transtibial drilling in anterior cruciate ligament reconstruction
Anatomical limitations of transtibial drilling in anterior cruciate ligament reconstruction
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DOI：
10.1177/0363546507304137
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发表时间：
2007-10-01
影响因子：
4.8
通讯作者：
Steiner, Mark E.
中科院分区：
文献类型：
--
作者：
Heming, James F.;Rand, Jason;Steiner, Mark E.
背景资料：前交叉韧带重建中经胫骨钻孔的推荐技术基于防止移植物撞击和保留胫骨隧道长度的策略。这种钻孔技术的局限性可能会限制将隧道集中在前交叉韧带足迹中的能力。假设：可以确定将胫骨和股骨隧道集中在各自足迹中的经胫骨钻孔起点，但这将导致胫骨隧道较短。研究设计：描述性实验室研究。方法：在12个新鲜冷冻尸体膝关节上，对前交叉韧带的股骨和胫骨附着进行了表征。在屈曲700和900时固定膝关节。通过股骨中央和近端前交叉韧带附着部位，通过胫骨中央前交叉韧带附着部位，顺行钻取导针，在胫骨前部退出。在使用股骨和胫骨中心连接部位的901次屈曲中，胫骨前上的销的出口点距离胫骨关节线14.1mm，并且距离浅内侧副韧带前方20.9mm。在胫骨的针的长度为30.6 mm。延长膝关节70度或直接通过股骨近端前交叉韧带附件针移动的起始点小于4 mm，从这一点。结论：经胫骨技术可以产生隧道为中心的前交叉韧带足迹，但需要一个接近胫骨关节线的起始点。这将导致胫骨隧道相对较短。临床相关性：如果需要在前交叉韧带附着点中心建立隧道，则需要使用短的胫骨隧道。短胫骨隧道可能影响移植物固定和移植物结合，或者可能导致隧道长度-移植物长度不匹配。可以采用替代钻井策略。
Background: Recommended techniques for transtibial drilling in anterior cruciate ligament reconstruction are based on strategies to prevent graft impingement and preserve tibial tunnel length. The limitations of this drilling technique may restrict the ability to centralize tunnels in the anterior cruciate ligament footprints.Hypothesis: A transtibial drilling starting point to centralize the tibial and femoral tunnels in their respective footprints can be identified, but it will result in a short tibial tunnel.Study Design: Descriptive laboratory study.Methods: The femoral and tibial attachments of the anterior cruciate ligament were characterized in 12 fresh-frozen cadaveric knees. Knees were secured in 700 and 900 of flexion. A guide pin was drilled antegrade through the central femoral and proximal anterior cruciate ligament attachment sites through the central tibia] anterior cruciate ligament attachment site to exit on the anterior tibia.Results: In 901 of flexion using the central femoral and tibial attachment sites, the exit point of the pin on the anterior tibia was 14.1 mm from the tibial joint line and 20.9 mm anterior to the superficial medial collateral ligament. The length of the pin in the tibia was 30.6 mm. Extending the knee to 70 degrees or directing the pin through the proximal femoral anterior cruciate ligament attachment moved the starting point less than 4 mm from this point.Conclusion: The transtibial technique can produce tunnels centered in the anterior cruciate ligament footprints, but a starting point close to the tibial joint line is required. This will result in a relatively short tibial tunnel. Clinical Relevance: If tunnels centered in the anterior cruciate ligament attachment sites are desired with the transtibial drilling technique, then a short tibial tunnel is necessary. A short tibial tunnel may compromise graft fixation and graft incorporation, or it may result in a tunnel length-graft length mismatch. An alternative drilling strategy might be employed.