Pan Am Clinic, Winnipeg, Canada.
Knee Surg Sports Traumatol Arthrosc. 2011 Aug;19(8):1258-64. doi: 10.1007/s00167-011-1397-0. Epub 2011 Feb 3.
To compare the reliability of tibial tunnel position and angle produced with a standard ACL guide (two-dimensional guide) or Howell 65° Guide (three-dimensional guide) in the coronal and sagittal planes. In the sagittal plane, the dependent variables were the angle of the tibial tunnel relative to the tibial plateau and the position of the tibial tunnel with respect to the most posterior aspect of the tibia. In the coronal plane, the dependent variables were the angle of the tunnel with respect to the medial joint line of the tibia and the medial and lateral placement of the tibial tunnel relative to the most medial aspect of the tibia.
The position and angle of the tibial tunnel in the coronal and sagittal planes were determined from anteroposterior and lateral radiographs, respectively, taken 2-6 months postoperatively. The two-dimensional and three-dimensional guide groups included 28 and 24 sets of radiographs, respectively. Tibial tunnel position was identified, and tunnel angle measurements were completed. Multiple investigators measured the position and angle of the tunnel 3 times, at least 7 days apart.
The angle of the tibial tunnel in the coronal plane using a two-dimensional guide (61.3 ± 4.8°) was more horizontal (P < 0.05) than tunnels drilled with a three-dimensional guide (64.7 ± 6.2°). The position of the tibial tunnel in the sagittal plane was more anterior (P < 0.05) in the two-dimensional (41.6 ± 2.5%) guide group compared to the three-dimensional guide group (43.3 ± 2.9%).
The Howell Tibial Guide allows for reliable placement of the tibial tunnel in the coronal plane at an angle of 65°. Tibial tunnels were within the anatomical footprint of the ACL with either technique. Future studies should investigate the effects of tibial tunnel angle on knee function and patient quality of life.
Case-control retrospective comparative study, Level III.
比较标准 ACL 导板（二维导板）或 Howell 65°导板（三维导板）在冠状面和矢状面产生的胫骨隧道位置和角度的可靠性。在矢状面，依赖变量是胫骨隧道相对于胫骨平台的角度和胫骨隧道相对于胫骨后表面的位置。在冠状面，依赖变量是隧道相对于胫骨内侧关节线的角度以及胫骨隧道相对于胫骨最内侧的内侧和外侧位置。
分别从术后 2-6 个月的前后位和侧位 X 线片确定冠状面和矢状面胫骨隧道的位置和角度。二维导板组和三维导板组分别包括 28 组和 24 组 X 线片。确定胫骨隧道位置，并完成隧道角度测量。多名研究者至少相隔 7 天对隧道的位置和角度进行了 3 次测量。
使用二维导板的胫骨隧道在冠状面的角度（61.3 ± 4.8°）更水平（P < 0.05），而使用三维导板的胫骨隧道角度（64.7 ± 6.2°）更大。在矢状面，二维导板组（41.6 ± 2.5%）的胫骨隧道位置更靠前（P < 0.05），而三维导板组（43.3 ± 2.9%）则更靠后。
Howell 胫骨导板可在冠状面以 65°的角度可靠地放置胫骨隧道。两种技术均使胫骨隧道位于 ACL 的解剖学范围内。未来的研究应探讨胫骨隧道角度对膝关节功能和患者生活质量的影响。
病例对照回顾性比较研究，III 级。
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