Kaseta Maria K, DeFrate Louis E, Charnock Brian L, Sullivan Robert T, Garrett William E
Division of Orthopaedics, Sports Medicine Center, Duke University Medical Center, Durham, NC 27710, USA.
Clin Orthop Relat Res. 2008 Jun;466(6):1467-74. doi: 10.1007/s11999-008-0238-z. Epub 2008 Apr 11.
Grafts placed too anteriorly on the femur are reportedly a common cause of failure in anterior cruciate ligament reconstruction. Some studies suggest more anatomic femoral tunnel placement improves kinematics. The ability of the transtibial technique and a tibial tunnel-independent technique (placed transfemorally outside-in) to place the guide pin near the center of the femoral attachment of the anterior cruciate ligament was compared in 12 cadavers. After arthroscopic placement of the guide pins, the femur was dissected and the three-dimensional geometry of the femur, anterior cruciate ligament footprint, and positions of each guide pin were measured. The transtibial guide-pin placement was 7.9 +/- 2.2 mm from the center of the footprint (near its anterior border), whereas the independent technique positioned the guide pin 1.9 +/- 1.0 mm from the center. The center of the footprint was within 2 mm of an anteroposterior line through the most posterior border of the femoral cartilage in the notch and a proximodistal line through the proximal margin of the cartilage at the capsular reflection. More accurate placement of the femoral tunnel might reduce the incidence of graft failure and might reduce long-term degeneration observed after reconstruction although both would require clinical confirmation.
据报道，在股骨上放置得过于靠前的移植物是前交叉韧带重建失败的常见原因。一些研究表明，更符合解剖学的股骨隧道放置可改善运动学。在12具尸体上比较了经胫骨技术和独立于胫骨隧道的技术（经股骨由外向内放置）将导针放置在前交叉韧带股骨附着点中心附近的能力。在关节镜下放置导针后，解剖股骨并测量股骨的三维几何形状、前交叉韧带足迹以及每个导针的位置。经胫骨导针放置位置距足迹中心7.9±2.2毫米（靠近其前边界），而独立技术将导针放置在距中心1.9±1.0毫米处。足迹中心位于通过髁间窝股骨软骨最后边界的前后线以及通过关节囊反折处软骨近端边缘的近远侧线2毫米范围内。更精确地放置股骨隧道可能会降低移植物失败的发生率，并可能减少重建后观察到的长期退变，尽管这两者都需要临床证实。
