Tansatit Tanvaa, Saowaprut Suriyapong, Kanchanatawan Wicharn, Chomkerd Thanisara
Department of Anatomy, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
J Med Assoc Thai. 2005 Sep;88 Suppl 4:S95-102.
Improper femoral and/or tibial tunnel placements are major causes of failure in anterior cruciate ligament (ACL) reconstruction. The 52 embalmed cadaveric knees were measured the dimensions of the surgical related structures using vernier caliper and goniometer. The intercondylar notch width was 17.4 +/- 2.3 mm and slope of the roof was 31.3 +/- 3.4 degrees. The average length of ACL was 21.6 +/- 2.5 mm. The relation of tibial attachment was 47.98% of the width of the lateral tibial plateau and 49.8% anteriorly, when it was measured through ACL attachment. Angle of ACL in sagittal plane was decreased during knee flexion. On the contrary, angle of ACL in coronal plane was increased during knee flexion. According to this study), The expected femoral tunnel at 10.00 am to 10.30 am could be performed by arthroscopic transtibial technique using the 48% of tibial width anteriorly for intraartricular tibial-tunnel drill-guide placement and aiming for sagittal and coronal plane of 52.0+/-4.6 / 20.9+/-3.9, 46.2+/-5.1 / 26.8+/-4.6 degrees, and 41.6+/-5.1 / 32.0+/-4.3 degrees while knee flexion degree were as 60, 90, and 120 degrees, respectively.
股骨和/或胫骨隧道放置不当是前交叉韧带（ACL）重建失败的主要原因。对52具防腐处理的尸体膝关节，使用游标卡尺和量角器测量手术相关结构的尺寸。髁间切迹宽度为17.4±2.3毫米，髁间切迹顶部斜率为31.3±3.4度。ACL的平均长度为21.6±2.5毫米。通过ACL附着点测量时，胫骨附着点的关系为外侧胫骨平台宽度的47.98%，且在前方49.8%处。膝关节屈曲时，ACL矢状面角度减小。相反，膝关节屈曲时，ACL冠状面角度增大。根据本研究，上午10:00至10:30预期的股骨隧道可通过关节镜下经胫骨技术进行，使用胫骨宽度前方48%的位置放置关节内胫骨隧道钻导向器，并分别在膝关节屈曲角度为60度、90度和120度时，瞄准矢状面和冠状面角度为52.0±4.6 / 20.9±3.9度、46.2±5.1 / 26.8±4.6度和41.6±5.1 / 32.0±4.3度。
