Orthopaedic Research Laboratories, 3820 South Water Street, Pittsburgh, PA 15203, USA.
Am J Sports Med. 2013 Aug;41(8):1794-800. doi: 10.1177/0363546513490657. Epub 2013 Jun 6.
A growing body of evidence supports the importance of anatomic tunnel positioning in the success of anterior cruciate ligament (ACL) reconstruction, which stimulates the need for technologies to aid surgeons in achieving accurate anatomic tunnel placement. Intraoperative fluoroscopy is potentially one such technology, while its efficacy and usability have yet to be established.
To investigate the performance of an intraoperative fluoroscopic overlay in guiding tunnel placement during ACL reconstruction.
Controlled laboratory study.
Twenty cadaveric knees underwent computed tomography (CT) scans and arthroscopic digitization of ACL insertion sites. The outlines of the digitized insertion sites were mapped to the corresponding CT-acquired bone models through a co-registration procedure. Twenty orthopaedic surgeons performed simulated ACL reconstructions, each on a randomly assigned cadaveric knee, first without and then with the aid of a fluoroscopic overlay system. The overlay system displayed on a lateral fluoroscopic image targets points representing the locations of the ACL insertion sites estimated from the literature data. Surgeons were allowed to adjust their tunnel positions under the guidance of the fluoroscopic image. Their initial, intermediate, and final positions were documented and compared with the target points as well as the native insertion sites.
Surgeons demonstrated significant (P < .01) improvements in femoral and tibial tunnel placements relative to the target points from an average distance of 3.9 mm to 1.6 mm on the femur and 2.1 mm to 0.9 mm on the tibia. The improvements toward the knee-specific actual insertion sites were significant on the tibial side but not on the femoral side.
Surgeons can be successfully guided with fluoroscopy to create more consistent femoral and tibial tunnels during ACL reconstruction. More research is warranted to develop better population representations of the locations of natural insertion sites.
Intraoperative fluoroscopy can be an effective, easy, and safe method for improving tunnel positioning during ACL reconstruction.
越来越多的证据支持解剖学隧道定位在前交叉韧带（ACL）重建成功中的重要性，这刺激了需要技术来帮助外科医生实现准确的解剖学隧道放置。术中透视术可能是这样一种技术，但其疗效和可用性尚未确定。
研究术中透视叠加在指导 ACL 重建中隧道放置中的性能。
对照实验室研究。
二十个尸体膝关节进行了计算机断层扫描（CT）扫描和 ACL 插入部位的关节镜数字化。通过配准过程将数字化插入部位的轮廓映射到相应的 CT 获得的骨骼模型上。二十名骨科医生对随机分配的尸体膝关节进行了模拟 ACL 重建，每个膝关节都进行了一次，首先是在没有透视叠加系统的情况下，然后是在透视叠加系统的帮助下进行。该叠加系统在侧透视图像上显示了代表从文献数据估计的 ACL 插入部位位置的目标点。外科医生可以在透视图像的指导下调整他们的隧道位置。记录他们的初始、中间和最终位置，并将其与目标点以及原始插入点进行比较。
与目标点相比，外科医生在股骨和胫骨隧道位置上都有显著的（P <.01）改善，股骨从平均 3.9 毫米到 1.6 毫米，胫骨从 2.1 毫米到 0.9 毫米。在胫骨侧，向膝关节特异性实际插入部位的改进是显著的，但在股骨侧则不然。
外科医生可以通过透视术成功地引导，在 ACL 重建过程中创建更一致的股骨和胫骨隧道。需要进行更多的研究来开发更好的自然插入部位位置的人群代表。
术中透视术是一种有效的、简单的、安全的方法，可以改善 ACL 重建中的隧道定位。
