Femoral tunnel apertures on the lateral cortex in anterior cruciate ligament reconstruction : An analysis of cortical button fixation
Femoral tunnel apertures on the lateral cortex in anterior cruciate ligament reconstruction : An analysis of cortical button fixation
复制标题
前交叉韧带重建中外侧皮质上的股骨隧道孔：皮质纽扣固定的分析
DOI：
10.1016/j.arthro.2014.03.004
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发表时间：
2014
期刊：
影响因子：
4.7
通讯作者：
Iwamoto Y
中科院分区：
文献类型：
--
作者：
Okazaki K;Matsubara H;Osaki K;Tashiro Y;Mizu-Uchi H;Hamai S;Doi T;Iwamoto Y
目的外侧皮质上椭圆形股骨隧道的开口大于皮质钛板的一半时，固定失败的风险增加。本研究探讨了股骨隧道的入口点和直径的位置上的隧道孔的长轴长度在前交叉韧带（ACL）reconstruction使用outside-in technology.MethodsSimulation股骨隧道钻孔的影响进行计算机断层扫描（CT）为基础的三维（3D）骨模型从40名参与者。隧道连接ACL足印中心和股骨外侧表面上的各个点。隧道直径设定为4.2 mm、5.2 mm或6 mm，具体取决于市售的由外向内手术系统（Arthrex，Naples，FL和Smith & Nephew，Andover，MA）。结果在距股骨外上髁2cm处，以45°的前近端方向引入隧道，椭圆孔长轴延长130.7% ± 9.0%（P<0.001）的隧道直径，并在65%的参与者中，其中钻了一个5.2毫米直径的隧道超过6.5毫米。当进针点距离外上髁3 cm时，60%的受试者有椭圆形开口，长轴大于6.5 mm，结论如果钻孔的进针点距离外上髁2 cm或更远，且隧道直径大于5 mm，则皮质骨钛板固定失败的风险增加。相关性本研究表明，在使用由外向内技术进行ACL重建时，股骨外侧表面上的椭圆形隧道孔会导致皮质骨钛板固定失败的潜在风险。
PurposeIf the aperture of the oval-shaped femoral tunnel on the lateral cortex becomes bigger than half the size of the cortical button, the risk of fixation failure increases. This study investigated the effect of the location of the entry point and diameter of the femoral tunnel on the length of the major axis of the tunnel aperture in anterior cruciate ligament (ACL) reconstruction using an outside-in technique.MethodsSimulation of femoral tunnel drilling was performed on computed tomography (CT)-based 3-dimensional (3D) bone models obtained from 40 participants. The tunnel connected the center of the ACL footprint and various points on the lateral femoral surface. The diameter of the tunnel was set at 4.2 mm, 5.2 mm, or 6 mm, depending on the commercially available outside-in surgical systems (Arthrex, Naples, FL and Smith & Nephew, Andover, MA). The length of the major axis of the oval-shaped aperture on the lateral femoral surface was measured.ResultsWhen the tunnel was introduced at 2 cm from the lateral epicondyle in a 45° anteroproximal direction, the major axis was lengthened to 130.7% ± 9.0% (P< .001) of the tunnel diameter, and it was more than 6.5 mm in 65% of participants in whom a 5.2-mm-diameter tunnel was drilled. When the entry point was 3 cm from the lateral epicondyle, 60% of participants had an oval-shaped aperture with a major axis of more than 6.5 mm, even though the diameter of the tunnel was only 4.2 mm.ConclusionsThe risk of fixation failure of a cortical button increases if the entry point for drilling is 2 cm or further from the lateral epicondyle and the tunnel diameter is more than 5 mm.Clinical RelevanceThis study indicates the potential risk of cortical button fixation failure caused by an oval tunnel aperture on the lateral femoral surface in ACL reconstruction using the outside-in technique.