Apsingi Sunil, Bull Anthony M J, Deehan David J, Amis Andrew A
Department of Mechanical Engineering, Imperial College London, London, SW7 2AZ, UK.
Knee Surg Sports Traumatol Arthrosc. 2009 Jun;17(6):652-9. doi: 10.1007/s00167-009-0747-7. Epub 2009 Mar 14.
Accurate placement of the femoral tunnel position is an important aspect of cruciate ligament reconstruction surgery. However, a wide range of positions have been described in the literature for the femoral tunnels for posterior cruciate ligament (PCL) reconstruction, and there is no consensus regarding the optimal placement. It was hypothesised that some of the prior studies used femoral PCL graft tunnels that were outside of the anatomical attachments. A systematic review and descriptive anatomical study in vitro were undertaken. Fifty articles that described PCL reconstruction since 1917 were reviewed; the description of the femoral tunnel placement was reproducible from only 20 of these. A right, distal femur was disarticulated and the PCL attachment was dissected; the centres of the anterolateral and posteromedial bundles were marked and confirmed to be close to the mean published data. The tunnel positions described in the 20 papers were also marked. The descriptions of 15 of the 20 anterolateral and 4 of the 5 posteromedial bundle tunnel centres were close (within +/-2 mm deep and +/-01:00 o'clock) to the anatomical centres of the bundle attachments. Other tunnels were placed either deeper or shallower than the anatomical attachments. The mean positions were: 7 mm from the articular cartilage at 1 o'clock for the anterolateral bundle, and 8 mm from the cartilage at 3 o'clock for the posteromedial bundle, in a right knee. It was concluded that it was not possible to replicate the tunnel positions used in most of the literature because of inadequate descriptions. Most of the usable descriptions of the anterolateral bundle position were close to the anatomical centre, but some tunnels were placed non-anatomically. A reproducible system for description of the femoral tunnel positions should be used.
准确放置股骨隧道位置是交叉韧带重建手术的一个重要方面。然而，文献中描述了用于后交叉韧带（PCL）重建的股骨隧道的多种位置，对于最佳放置位置尚无共识。据推测，一些先前的研究使用的股骨PCL移植物隧道位于解剖附着点之外。为此进行了一项系统综述和体外描述性解剖学研究。回顾了自1917年以来描述PCL重建的50篇文章；其中只有20篇对股骨隧道放置的描述具有可重复性。将右侧股骨远端关节离断，解剖PCL附着点；标记前外侧束和后内侧束的中心，并确认其与已发表的平均数据接近。还标记了20篇论文中描述的隧道位置。20个前外侧束隧道中心中的15个以及5个后内侧束隧道中心中的4个的描述与束附着的解剖中心接近（深度在±2mm以内，时钟位置在±01:00）。其他隧道的放置位置比解剖附着点更深或更浅。在右膝关节中，平均位置为：前外侧束在1点位置距关节软骨7mm，后内侧束在3点位置距软骨8mm。得出的结论是，由于描述不充分，无法复制大多数文献中使用的隧道位置。前外侧束位置的大多数可用描述接近解剖中心，但一些隧道的放置位置不符合解剖学要求。应使用一种可重复的系统来描述股骨隧道位置。
