Schroeder F J
Arthroscopy. 1999 Jan-Feb;15(1):41-8. doi: 10.1053/ar.1999.v15.015004.
One of the complications of endoscopic anterior cruciate ligament (ACL) reconstruction is femoral interference screw divergence, usually occurring when the femoral screw insertion is different than the portal used for reaming the femoral tunnel. A new technique using a StraightShot graft passer (DePuy Orthopaedic Technology, Tracy, CA) allows the safe passage of a 7 mm M. Kurosaka Advantage cannulated femoral interference screw (DePuy) through the tibial tunnel with the patella tendon graft fully in position. This study compares femoral interference screw divergence in bone-patellar tendon-bone ACL reconstruction using two different screw insertion portals: the accessory anteromedial patella portal and the tibial tunnel portal (StraightShot technique). A radiographic analysis of 81 consecutive endoscopic ACL reconstructions was performed. The total divergence of each femoral screw was measured on both anteroposterior and lateral radiographs and then combined. Group I had the 7-mm femoral screw inserted through the accessory anteromedial patella portal; group II had the femoral screw inserted directly through the tibial tunnel. Group I showed more than 10 degrees of divergence in 50% of the cases, compared with only 4% percent in group II. The average divergence dropped from 11.3 degrees in group I to 1.2 degrees in group II. Femoral interference screw divergence can be virtually eliminated by inserting the femoral screw directly through the tibial tunnel using the StraightShot technique.
关节镜下前交叉韧带（ACL）重建的并发症之一是股骨挤压螺钉发散，通常发生在股骨螺钉插入位置与用于扩髓股骨隧道的入口不同时。一种使用直插式移植物导入器（DePuy骨科技术公司，加利福尼亚州特雷西）的新技术，可使一枚7毫米的黑坂优势型空心股骨挤压螺钉（DePuy）在髌腱移植物完全就位的情况下安全通过胫骨隧道。本研究比较了在骨-髌腱-骨ACL重建中，使用两种不同螺钉插入入口（辅助髌前内侧入口和胫骨隧道入口（直插式技术））时股骨挤压螺钉的发散情况。对连续81例关节镜下ACL重建进行了影像学分析。在前后位和侧位X线片上测量每枚股骨螺钉的总发散度，然后将其合并。第一组通过辅助髌前内侧入口插入7毫米股骨螺钉；第二组将股骨螺钉直接通过胫骨隧道插入。第一组50%的病例发散度超过10度，而第二组仅为4%。平均发散度从第一组的11.3度降至第二组的1.2度。使用直插式技术直接通过胫骨隧道插入股骨螺钉，几乎可以消除股骨挤压螺钉的发散。
