The Royal Orthopaedic Hospital, Northfield, Birmingham, UK.
Knee Surg Sports Traumatol Arthrosc. 2010 Sep;18(9):1195-200. doi: 10.1007/s00167-010-1062-z. Epub 2010 Feb 6.
The study aim was to determine whether an experienced ACL surgeon could convert from a single-bundle to a double-bundle technique with relative accuracy. We also wanted to determine whether there was a significant learning curve. Ten double-bundle ACL reconstruction procedures were carried out on suitable individuals. Following the procedure, all patients underwent a CT scan of the relevant knee. Femoral and tibial tunnel locations were then measured and compared to reference anatomical locations previously described in the literature. The results were not known to the surgeon until all 10 cases were completed. The total percentage difference between the sum of all four study tunnel locations from their reference anatomical positions was calculated for each patient to assess overall accuracy in tunnel placement. Surgical time and all complications were recorded. There were no complications. The surgical time for patient 1 was 125 min and 65 min for patient 10. There was a tendency to place the anteromedial tunnel on the femur more distal than its anatomical location. The femoral posterolateral tunnel position was placed distal to its anatomical location in all cases. As a consequence, it was also slightly anterior compared to its anatomical location. Accurate tibial tunnel placement was achieved for both the AM and the PL tunnels. An improvement in tunnel placement was observed over the 10 cases. This present study shows that it is possible for an experienced ACL surgeon to convert from a transtibial single-bundle technique to a medial portal double-bundle reconstruction with relative accuracy.
本研究旨在确定经验丰富的前交叉韧带（ACL）外科医生是否可以相对准确地从单束技术转换为双束技术。我们还想确定是否存在明显的学习曲线。在合适的个体中进行了 10 例双束 ACL 重建手术。手术后，所有患者均接受了相关膝关节的 CT 扫描。然后测量股骨和胫骨隧道的位置，并与文献中先前描述的参考解剖位置进行比较。在完成所有 10 例病例之前，外科医生不知道结果。为了评估隧道放置的总体准确性，计算了每位患者所有四个研究隧道位置与其参考解剖位置之间的总和的总百分比差异。记录了手术时间和所有并发症。无并发症。患者 1 的手术时间为 125 分钟，患者 10 的手术时间为 65 分钟。股骨前内侧隧道的位置倾向于比其解剖位置更靠远端。所有病例中股骨后外侧隧道的位置均位于其解剖位置的远端。因此，与解剖位置相比，它也略微靠前。AM 和 PL 隧道的胫骨隧道位置均准确。在 10 例病例中观察到隧道位置的改善。本研究表明，经验丰富的 ACL 外科医生可以相对准确地从经胫骨单束技术转换为内侧入路双束重建。
