Behrend H, Stutz G, Kessler M A, Rukavina A, Giesinger K, Kuster M S
Department of Orthopaedic Surgery, Kantonsspital St. Gallen, Rohrschacherstrasse 92, 9007 St. Gallen, Switzerland.
Knee Surg Sports Traumatol Arthrosc. 2006 Nov;14(11):1159-65. doi: 10.1007/s00167-006-0186-7. Epub 2006 Sep 2.
Correct placement of the femoral and tibial bone tunnels is decisive for a successful anterior cruciate ligament (ACL) reconstruction. Our method of tunnel placement was evaluated as part of quality control at a teaching hospital. The emphasis was placed mainly on investigating the influence of surgical experience on tunnel placement, and the effect of tunnel position on the clinical outcome. Seventeen surgeons with different levels of experience (between 0 and >150 ACL reconstructions) performed endoscopic ACL repair in uniform technique from August 2000 to August 2003 on 50 patients (18 women, 32 men, age range 18-43 years). The patients were available to clinical and radiological follow-up after an average of 19 months. The clinical outcome was classified according to the International Knee Documentation Committee (IKDC) standard evaluation form. The femoral tunnel was evaluated according to the quadrant method of Bernard and Hertel; the position of the tibial bone tunnel was assessed according to the criteria of Stäubli and Rauschnig. The IKDC score revealed 47 (94%) patients with a normal (A) or nearly normal (B) knee joint at follow-up. According to the quadrant method, the femoral canal was situated on average at 29% in the saggital plane. The tibial tunnel was situated on average at 43% of the a.p. diameter of the tibial condyle. Statistical analysis of our data showed no significant correlation between tunnel placement and surgical expertise. However, a highly significant correlation was found (alpha<0.01) between the femoral position of the tunnel in the sagittal plane and the IKDC score. The more anterior the femoral canal, the poorer the IKDC score. The method of tunnel placement in ACL reconstruction being investigated here only showed slight dependence on surgical experience, whereby good short-term clinical outcomes were achieved. Therefore, the method is suitable for application at a teaching hospital. A far too anterior femoral tunnel placement will probably lead to a decline in the clinical result.
股骨和胫骨骨隧道的正确定位对于前交叉韧带（ACL）重建手术的成功至关重要。作为一家教学医院质量控制的一部分，我们对隧道定位方法进行了评估。重点主要放在研究手术经验对隧道定位的影响以及隧道位置对临床结果的影响上。2000年8月至2003年8月，17名经验水平不同（0至超过150例ACL重建手术）的外科医生采用统一技术对50例患者（18名女性，32名男性，年龄范围18 - 43岁）进行了关节镜下ACL修复手术。患者平均在19个月后接受临床和放射学随访。临床结果根据国际膝关节文献委员会（IKDC）标准评估表进行分类。股骨隧道根据Bernard和Hertel的象限法进行评估；胫骨骨隧道的位置根据Stäubli和Rauschnig的标准进行评估。IKDC评分显示，随访时有47例（94%）患者膝关节为正常（A）或接近正常（B）。根据象限法，股管在矢状面平均位于29%处。胫骨隧道平均位于胫骨髁前后径的43%处。对我们的数据进行统计分析表明，隧道定位与手术专业知识之间无显著相关性。然而，发现矢状面隧道的股骨位置与IKDC评分之间存在高度显著相关性（α<0.01）。股管越靠前，IKDC评分越差。此处所研究的ACL重建中隧道定位方法仅显示出对手术经验的轻微依赖性，从而取得了良好的短期临床结果。因此，该方法适用于教学医院。股骨隧道放置过于靠前可能会导致临床结果下降。
