Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
Am J Sports Med. 2009 Dec;37(12):2368-76. doi: 10.1177/0363546509341577. Epub 2009 Aug 17.
Anterior cruciate ligament reconstruction with a double-bundle technique requires exact tunnel positioning. Reference values for the anatomic insertions are necessary for radiographic intra- and postoperative control and fluoroscopy-based navigation.
The femoral and tibial insertions of the anteromedial bundle (AMB) and posterolateral bundle (PLB) of the anterior cruciate ligament can be described using standardized computed tomography scans.
Descriptive laboratory study.
The insertion sites of the AMB and PLB were macroscopically identified and tagged by copper wire in 12 specimens. Computed tomography scans with predefined reconstructions were performed. Femorally, the geometric center of the insertions were determined in the sagittal view and described in a deep-high 10 x 10 grid. Tibially, the insertions were described as the ratio between the geometric center of the insertion sites with respect to the mediolateral and sagittal diameter of the tibia in frontal and sagittal reconstruction, respectively. The tibial insertions were described using a 10 x 10 grid in axial orientation.
The geometric midpoints of the insertion areas at the femur of the AMB and PLB were located on the reticule at x = 21% + or - 3% and y = 22% + or - 2% for the AMB and x = 27% + or - 3% and y = 45% + or - 3% for the PLB. In the sagittal plane, the center of the tibial insertion was located at 41% + or - 3% and 52% + or - 3% of the tibial diameter from the anterior border for the AMB and PLB, respectively. The geometric centers of the tibial insertions in axial view were x = 52% + or - 2% and y = 37% + or - 3% for the AMB and x = 50% + or - 2% and y = 48% + or - 3% for the PLB.
The insertion site characteristics of the AMB and PLB can be evaluated by predefined reconstructions of computed tomography scans. Clinical relevance These results can serve as orientation landmarks for intra- and postoperative radiographic control and fluoroscopic-based navigation.
前交叉韧带重建采用双束技术，需要精确的隧道定位。解剖学附着点的参考值对于放射学的术中及术后控制和基于透视的导航是必要的。
前交叉韧带的前内束（AMB）和后外束（PLB）的股骨和胫骨附着点可以使用标准化的 CT 扫描来描述。
描述性实验室研究。
在 12 个标本中，通过铜丝对 AMB 和 PLB 的附着点进行宏观识别和标记。使用预设重建进行 CT 扫描。股骨上，在矢状视图中确定附着点的几何中心，并在深高 10x10 网格中进行描述。胫骨上，在前后位和矢状位重建中，将附着点的几何中心描述为相对于胫骨的内外径和矢状径的比例。胫骨附着点在轴向方向上使用 10x10 网格进行描述。
AMB 和 PLB 的股骨附着区的几何中点位于网格的 x = 21%+/-3%和 y = 22%+/-2%处对于 AMB 和 x = 27%+/-3%和 y = 45%+/-3%对于 PLB。在矢状面，AMB 和 PLB 的胫骨附着点的中心分别位于胫骨前缘的 41%+/-3%和 52%+/-3%和 52%+/-3%和 48%+/-3%处。在轴向视图中，AMB 和 PLB 的胫骨附着点的几何中心分别为 x = 52%+/-2%和 y = 37%+/-3%和 x = 50%+/-2%和 y = 48%+/-3%。
通过 CT 扫描的预设重建可以评估 AMB 和 PLB 的附着点特征。临床意义这些结果可以作为术中及术后放射学控制和基于透视的导航的定位标志。
