University of Iowa, Department of Orthopaedics and Rehabilitation, Iowa City, IA 52242, USA.
Am J Sports Med. 2013 Jun;41(6):1265-73. doi: 10.1177/0363546513483271. Epub 2013 Apr 25.
Multicenter and multisurgeon cohort studies on anterior cruciate ligament (ACL) reconstruction are becoming more common. Minimal information exists on intersurgeon and intrasurgeon variability in ACL tunnel placement. Purpose/
The purpose of this study was to analyze intersurgeon and intrasurgeon variability in ACL tunnel placement in a series of The Multicenter Orthopaedic Outcomes Network (MOON) ACL reconstruction patients and in a clinical cohort of ACL reconstruction patients. The hypothesis was that there would be minimal variability between surgeons in ACL tunnel placement.
Cross-sectional study; Level of evidence, 3.
Seventy-eight patients who underwent ACL reconstruction by 8 surgeons had postoperative imaging with computed tomography, and ACL tunnel location and angulation were analyzed using 3-dimensional surface processing and measurement. Intersurgeon and intrasurgeon variability in ACL tunnel placement was analyzed.
For intersurgeon variability, the range in mean ACL femoral tunnel depth between surgeons was 22%. For femoral tunnel height, there was a 19% range. Tibial tunnel location from anterior to posterior on the plateau had a 16% range in mean results. There was only a small range of 4% for mean tibial tunnel location from the medial to lateral dimension. For intrasurgeon variability, femoral tunnel depth demonstrated the largest ranges, and tibial tunnel location from medial to lateral on the plateau demonstrated the least variability. Overall, surgeons were relatively consistent within their own cases. Using applied measurement criteria, 85% of femoral tunnels and 90% of tibial tunnels fell within applied literature-based guidelines. Ninety-one percent of the axes of the femoral tunnels fell within the boundaries of the femoral footprint.
The data demonstrate that surgeons performing ACL reconstructions are relatively consistent between each other. There is, however, variability of average tunnel placement up to 22% of mean condylar depth, likely reflecting the difference in individual surgeons' preferred tunnel locations. Individual surgeons are relatively consistent in their cases of ACL tunnels.
多中心、多外科医生队列研究在前交叉韧带（ACL）重建中越来越常见。关于 ACL 隧道位置的外科医生间和外科医生内变异性的信息很少。
目的/假设：本研究的目的是分析多中心骨科结局网络（MOON）ACL 重建患者系列和 ACL 重建患者临床队列中 ACL 隧道位置的外科医生间和外科医生内变异性。假设是外科医生在 ACL 隧道位置方面的变异性最小。
横断面研究；证据水平，3 级。
8 名外科医生对 78 例接受 ACL 重建的患者进行术后影像学检查，使用三维表面处理和测量分析 ACL 隧道位置和角度。分析 ACL 隧道位置的外科医生间和外科医生内变异性。
对于外科医生间的变异性，外科医生间 ACL 股骨隧道深度的平均值差异为 22%。对于股骨隧道高度，差异范围为 19%。胫骨平台上前到后的胫骨隧道位置的平均值差异为 16%。胫骨隧道从内侧到外侧的平均值差异仅为 4%。对于外科医生内的变异性，股骨隧道深度的范围最大，胫骨平台上从内侧到外侧的胫骨隧道位置的变异性最小。总体而言，外科医生在自己的病例中相对一致。使用应用测量标准，85%的股骨隧道和 90%的胫骨隧道符合应用文献为基础的指南。91%的股骨隧道轴位于股骨足迹的边界内。
数据表明，进行 ACL 重建的外科医生彼此之间相对一致。然而，隧道位置的平均变异性为平均髁间深度的 22%，这可能反映了个别外科医生首选隧道位置的差异。个别外科医生在其 ACL 隧道病例中相对一致。
