Castoldi Filippo, Bonasia Davide Edoardo, Marmotti Antongiulio, Dettoni Federico, Rossi Roberto
Department of Orthopaedics and Traumatology, "Umberto I" Hospital, University of Turin, C.so Duca degli Abruzzi 15, 10128, Turin, Italy.
Knee Surg Sports Traumatol Arthrosc. 2008 Mar;16(3):275-8. doi: 10.1007/s00167-007-0459-9. Epub 2007 Dec 22.
The aim of this anatomic descriptive cadaver study is to evaluate the entrance points of cross-pins and the possible chondral damages, using a two cross-pin femoral fixation device via anteromedial portal, during anterior cruciate ligament (ACL) reconstruction. Twenty fresh-frozen cadaver knees (12 cadavers) were tested. We employed the Rigidfix Cross Pin device (Mitek, Norwood, MA), designed to use two biodegradable pins (PLA, length 42 mm, diameter 2.7 mm). Instead of PLA pins, we used color coded metallic pins. Femoral tunnel drilling and cross-pin guide insertions were performed through the anteromedial portal. We gave three positions to the cross-pin guide: 0 degrees , 45 degrees and 90 degrees slope, referring to the horizontal plane. Per each position, we inserted two metallic pins. We recorded and subdivided the pin holes, in three different groups: Group A (0 degrees ); B (45 degrees ); C (90 degrees of slope). Then a wide dissection has been implemented. Group A: 6 knees (30%) had two pins inside the cartilage of the lateral femoral condyle; 10 knees (50%) had one pin inside the cartilage; and 4 knees (20%) had both pins out of the cartilage. Group B: 7 knees (35%) had two pins inside the cartilage; 12 knees (60%) had one pin inside the cartilage; and one knee (5%) had both pins out of the cartilage. Group C: 7 knees (35%) had two pins inside the cartilage; and 13 knees (65%) had one pin inside the cartilage. The risk of chondral injury, using this technique, is high: from 80% (group A) to 100% (Group C) to have at least one pin inside the cartilage. The use of Rigidfix via AM portal is not recommended for routine ACL reconstruction.
本解剖描述性尸体研究的目的是，在进行前交叉韧带（ACL）重建时，通过前内侧入路使用双交叉针股骨固定装置，评估交叉针的入点及可能的软骨损伤情况。对20个新鲜冷冻尸体膝关节（来自12具尸体）进行了测试。我们使用了Rigidfix交叉针装置（Mitek公司，美国马萨诸塞州诺伍德），该装置设计使用两根可生物降解的针（聚乳酸，长度42毫米，直径2.7毫米）。我们用颜色编码的金属针代替了聚乳酸针。通过前内侧入路进行股骨隧道钻孔和交叉针导向器插入。我们将交叉针导向器设置为三个角度：相对于水平面0度、45度和90度倾斜。在每个角度，我们插入两根金属针。我们记录并将针孔分为三个不同组：A组（0度）；B组（45度）；C组（90度倾斜）。然后进行了广泛的解剖。A组：6个膝关节（30%）的两根针位于外侧股骨髁软骨内；10个膝关节（50%）的一根针位于软骨内；而4个膝关节（20%）的两根针均不在软骨内。B组：7个膝关节（35%）的两根针位于软骨内；12个膝关节（60%）的一根针位于软骨内；1个膝关节（5%）的两根针均不在软骨内。C组：7个膝关节（35%）的两根针位于软骨内；13个膝关节（65%）的一根针位于软骨内。使用该技术时软骨损伤的风险很高：至少有一根针位于软骨内的情况在A组为80%，在C组为100%。不建议在前交叉韧带常规重建中通过前内侧入路使用Rigidfix装置。
