Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA.
Arthroscopy. 2011 Feb;27(2):200-6. doi: 10.1016/j.arthro.2010.07.010.
The purpose of this study was to determine whether drilling the femoral tunnel when performing anterior cruciate ligament (ACL) reconstruction through the accessory medial portal, as opposed to drilling the tunnel transtibially, will lead to more frequent location of the anteromedial femoral tunnel within the anatomic anteromedial bundle insertion site.
Primary anatomic double-bundle reconstruction was performed on 113 patients. Intraoperatively, we placed a guide pin through the anteromedial and posterolateral tibial tunnels and accessory medial portal, attempting to reach the center of the native femoral anteromedial bundle insertion. For each approach, the position of the guide pin was classified as (1) within the center of, (2) off-center within, or (3) outside of the femoral anteromedial insertion.
There were significant differences in the ability of each approach to reach the center of the femoral anteromedial bundle insertion. Through the tibial anteromedial tunnel, the femoral anteromedial insertion center was reached in 4.4% of cases, whereas it was off-center within and outside of the femoral anteromedial insertion in 23.0% and 72.6%, respectively. Through the tibial posterolateral tunnel, the femoral anteromedial insertion center was reached in 60.2% of cases, whereas it was off-center within and outside of the femoral anteromedial insertion in 23.9% and 15.9% of cases, respectively. When approached from the accessory medial portal, the center of the femoral anteromedial insertion was reached in 100% of the cases. Ultimately, the femoral anteromedial tunnel was drilled through the tibial anteromedial tunnel in 0.9%, through the posterolateral tunnel in 62.8%, and through the accessory medial portal in 36.3% of cases.
Drilling the femoral tunnel for the anteromedial graft through the accessory medial portal, as opposed to drilling the tunnel transtibially, leads to more frequent location of the anteromedial femoral tunnel within the anterior cruciate ligament anteromedial bundle anatomic footprint.
本研究旨在确定在进行前交叉韧带（ACL）重建时，通过辅助内侧入路钻孔还是经胫骨钻孔来进行股骨隧道的钻取，是否会导致前内侧股骨隧道更频繁地位于前交叉韧带前内侧束解剖附着点内。
对 113 例患者进行了初次解剖双束重建。术中，我们将导针穿过前内侧和后外侧胫骨隧道及辅助内侧入路，试图到达内源性前交叉韧带前内侧束附着处的中心。对于每种方法，导针的位置分为（1）位于中心内、（2）偏心位于内、（3）位于中心外。
每种方法到达前交叉韧带前内侧束附着中心的能力存在显著差异。通过胫骨前内侧隧道，前交叉韧带前内侧束附着中心的到达率为 4.4%，而偏心位于前交叉韧带前内侧束附着内和附着外的比例分别为 23.0%和 72.6%。通过胫骨后外侧隧道，前交叉韧带前内侧束附着中心的到达率为 60.2%，而偏心位于前交叉韧带前内侧束附着内和附着外的比例分别为 23.9%和 15.9%。从辅助内侧入路进入时，前交叉韧带前内侧束附着中心的到达率为 100%。最终，前内侧股骨隧道通过胫骨前内侧隧道钻取的比例为 0.9%，通过后外侧隧道钻取的比例为 62.8%，通过辅助内侧入路钻取的比例为 36.3%。
与经胫骨钻孔相比，通过辅助内侧入路钻取前内侧移植物的股骨隧道，可使前内侧股骨隧道更频繁地位于前交叉韧带前内侧束解剖附着处。
