Cohen Steven B, Fu Freddie H
Center for Sports Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Arthroscopy. 2007 Mar;23(3):325.e1-5. doi: 10.1016/j.arthro.2006.07.030. Epub 2007 Jan 18.
Standard endoscopic reconstruction of the anterior cruciate ligament (ACL) is performed with the use of 2 arthroscopic portals. The surgical error most commonly associated with ACL reconstruction is improper positioning of the tunnel. Errors in femoral tunnel position may be related to poor visualization of the lateral wall. When anatomic double-bundle ACL reconstruction is performed, proper visualization of the lateral wall is essential to ensure correct placement of both tunnels. We propose the use of a central portal, in addition to more standard anterolateral and anteromedial portals, to enhance visualization of the lateral wall. In addition, the arthroscope can be moved interchangeably throughout the portals during the procedure for improved viewing during specific steps. An accessory anteromedial portal placed inferiorly and medially allows placement of the femoral tunnels while providing a high central anteromedial portal for best visualization of the lateral wall. As a result, no notchplasty is required, and a more anatomic reconstruction can be performed.
前交叉韧带（ACL）的标准内镜重建是通过使用两个关节镜入口来进行的。与ACL重建最常相关的手术失误是隧道定位不当。股骨隧道位置的失误可能与外侧壁可视化不佳有关。当进行解剖双束ACL重建时，外侧壁的正确可视化对于确保两个隧道的正确放置至关重要。我们建议除了更标准的前外侧和前内侧入口外，使用一个中央入口，以增强外侧壁的可视化。此外，在手术过程中，关节镜可以在各个入口之间互换移动，以便在特定步骤中改善视野。一个位于下方和内侧的辅助前内侧入口允许放置股骨隧道，同时提供一个高中央前内侧入口以实现外侧壁的最佳可视化。因此，无需进行髁间窝成形术，并且可以进行更符合解剖结构的重建。
