Orthopaedic Sports Medicine Section, New England Baptist Hospital, Boston, Massachusetts, U.S.A.
Arthroscopy. 2012 Jun;28(6):835-43. doi: 10.1016/j.arthro.2011.11.029. Epub 2012 Jan 30.
This study evaluated the ability of flexible instruments compared with rigid instruments to place anatomic femoral tunnels in anterior cruciate ligament reconstructions by use of both transtibial drilling and anteromedial drilling without hyperflexion.
Rigid and flexible pins were placed in 12 matched pairs of cadaveric knees with transtibial drilling (6 pairs) and anteromedial drilling (6 pairs) at 110° of flexion. Intraosseous pin lengths, femoral exit locations, and tunnel alignment were measured.
Transtibial drilling with rigid pins placed relatively vertical femoral tunnels 5.8 ± 1.0 mm superior to the central anterior cruciate ligament insertion. Transtibial drilling with flexible pins placed tunnels in the center of the femoral attachment, but the tunnels were relatively close to the posterior femoral cortex, with a mean distance of 8.0 ± 5.9 mm (P < .05), compared with transtibial drilling with rigid pins. Anteromedial drilling resulted in central anatomic pin placements with rigid and flexible instruments. Tunnel lengths with flexible pins were longer (42.0 ± 7.2 mm) compared with tunnel lengths with rigid pins (32.5 ± 7.1 mm) (P < .01). Flexible pins exited farther from the posterior cortex compared with rigid pins (P < .01). In 3 of 6 knees with rigid pins, the exit point was at the posterior border of the femoral cortex. All flexible pins exited a safe distance from the posterior femoral cortex.
Transtibial drilling with rigid instruments did not produce anatomic femoral tunnels. Transtibial drilling with flexible pins produced anatomic tunnels, but the tunnels were close to the posterior femoral cortex. Anteromedial drilling without hyperflexion produced anatomic tunnels by use of rigid and flexible instruments, but with flexible instruments, the tunnels were longer and were farther from the posterior femoral cortex. Anteromedial drilling with flexible pins produced tunnels with good length and the best position.
Flexible instruments compared with rigid instruments can facilitate the creation of anatomic femoral tunnels by use of anteromedial drilling without hyperflexion.
本研究通过使用经胫骨和前内侧入路（均不进行过伸），比较了刚性和柔性器械在不进行过伸的情况下在前交叉韧带重建中置入解剖股骨隧道的能力。
在 12 对匹配的尸体膝关节中，使用经胫骨和前内侧钻孔（每组 6 对），在 110°的屈曲位分别放置刚性和柔性导针。测量骨内导针的长度、股骨出口位置和隧道的对准情况。
经胫骨钻孔使用刚性导针可将相对垂直的股骨隧道放置在距前交叉韧带止点中心上方 5.8 ± 1.0mm 处。经胫骨钻孔使用柔性导针可将隧道放置在股骨附着的中心位置，但隧道与股骨后皮质较近，平均距离为 8.0 ± 5.9mm（P＜0.05），与经胫骨钻孔使用刚性导针相比。使用刚性和柔性器械进行前内侧钻孔可获得中心解剖导针位置。与刚性导针相比，柔性导针的隧道长度更长（42.0 ± 7.2mm）（P＜0.01）。与刚性导针相比，柔性导针从后皮质的出口点更远（P＜0.01）。在 6 个使用刚性导针的膝关节中，有 3 个的出口点位于股骨皮质的后缘。所有的柔性导针都从股骨后皮质安全距离处穿出。
经胫骨钻孔使用刚性器械不能产生解剖股骨隧道。经胫骨钻孔使用柔性导针可产生解剖隧道，但隧道靠近股骨后皮质。不进行过伸的前内侧钻孔使用刚性和柔性器械均可产生解剖隧道，但使用柔性器械时，隧道更长且更远离股骨后皮质。使用柔性导针的前内侧钻孔可产生具有良好长度和最佳位置的隧道。
与刚性器械相比，柔性器械可通过不进行过伸的前内侧钻孔来帮助创建解剖股骨隧道。
