Gavriilidis Iosif, Motsis Efstathios K, Pakos Emilios E, Georgoulis Anastasios D, Mitsionis Gregory, Xenakis Theodore A
Department of Orthopaedic Surgery, University Hospital of Ioannina, University of Ioannina, School of Medicine, Ioannina, Greece.
Knee. 2008 Oct;15(5):364-7. doi: 10.1016/j.knee.2008.05.004. Epub 2008 Jun 25.
The aim of this cadaveric study was to compare the transtibial versus the anteromedial portal with respect to the anatomic femoral positioning of the ACL attachment. Ten fresh frozen cadaveric knees were included in our study. A standard arthroscopy was performed and the normal ACL was partially cut through with arthroscopic scissors leaving a small footprint of 2 mm at the anatomical insertion area on the lateral femoral condyle. The femoral tunnel was drilled through the tibial tunnel and subsequently through the anteromedial portal. Using a probe with standard magnification, we measured the distances of the two femoral tunnels from the margin of ACL footprint arthroscopically. The femurs were then dissected and we measured the distances of the two tunnels from the posterior part of the lateral femoral condyle. The median arthroscopically measured distance of the centers of transtibial femoral tunnel and of the femoral tunnel through the anteromedial portal from the margin of the femoral ACL footprint were 6.20 mm and 2.80 mm respectively. The difference was statistically significant. After femoral dissection the median distance of the centers of the transtibial femoral tunnel and the femoral tunnel performed through the anteromedial portal from the border of the articular surface at the lateral femoral condyle was 6.10 mm and 5.25 mm respectively (p<0.001). Both measurements showed that ACL reconstruction technique through the anteromedial portal is more accurate compared to the transtibial technique.
本尸体研究的目的是比较经胫骨入路与前内侧入路在解剖学上股骨前交叉韧带（ACL）附着点定位方面的差异。我们的研究纳入了10个新鲜冷冻的尸体膝关节。进行标准关节镜检查，并用关节镜剪刀部分切断正常的ACL，在股骨外侧髁的解剖学插入区域留下2mm的小残端。经胫骨隧道钻孔，随后从前内侧入路钻孔形成股骨隧道。使用具有标准放大倍数的探针，通过关节镜测量两个股骨隧道距ACL残端边缘的距离。然后解剖股骨，测量两个隧道距股骨外侧髁后部的距离。经胫骨股骨隧道中心和通过前内侧入路的股骨隧道中心在关节镜下测量的距股骨ACL残端边缘的中位数距离分别为6.20mm和2.80mm。差异具有统计学意义。股骨解剖后，经胫骨股骨隧道中心和通过前内侧入路的股骨隧道中心距股骨外侧髁关节面边缘的中位数距离分别为6.10mm和5.25mm（p<0.001）。两项测量均表明，与经胫骨技术相比，通过前内侧入路进行ACL重建技术更准确。
