Tensho Keiji, Shimodaira Hiroki, Aoki Tetsuhiro, Narita Nobuyo, Kato Hiroyuki, Kakegawa Akira, Fukushima Nanae, Moriizumi Tetsuji, Fujii Masahiro, Fujinaga Yasunari, Saito Naoto
Department of Orthopedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan.
Department of Anatomy, Shinshu University School of Medicine, Matsumoto, Japan.
Am J Sports Med. 2014 Jun;42(6):1433-40. doi: 10.1177/0363546514528789. Epub 2014 Apr 18.
Although the importance of tibial tunnel position for achieving stability after anterior cruciate ligament (ACL) reconstruction was recently recognized, there are fewer detailed reports of the anatomy of the tibial topographic footprint compared with the femoral side.
The ACL tibial footprint has a relationship to bony prominences and surrounding bony landmarks.
Descriptive laboratory study.
This study consisted of 2 anatomic procedures for the identification of bony prominences that correspond to the ACL tibial footprint and 3 surrounding landmarks: the anterior ridge, lateral groove, and intertubercular fossa. In the first procedure, after computed tomography (CT) was performed on 12 paired, embalmed cadaveric knees, 12 knees were visually observed, while their contralateral knees were histologically observed. Comparisons were made between macroscopic and microscopic findings and 3-dimensional (3D) CT images of these bony landmarks. In the second procedure, the shape of the bony prominence and incidence of their bony landmarks were evaluated from the preoperative CT data of 60 knee joints.
In the first procedure, we were able to confirm a bony prominence and all 3 surrounding landmarks by CT in all cases. Visual evaluation confirmed a small bony eminence at the anterior boundary of the ACL. The lateral groove was not confirmed macroscopically. The ACL was not attached to the lateral intercondylar tubercle, ACL tibial ridge, and intertubercular space at the posterior boundary. Histological evaluation confirmed that the anterior ridge and lateral groove were positioned at the anterior and lateral boundaries, respectively. There was no ligament tissue on the intercondylar space corresponding to the intercondylar fossa. In the second investigation, the bony prominence showed 2 morphological patterns: an oval type (58.3%) and a triangular type (41.6%). The 3 bony landmarks, including the anterior ridge, lateral groove, and intertubercular fossa, existed in 96.6%, 100.0%, and 96.6% of the cases, respectively.
There is a bony prominence corresponding to the ACL footprint and bony landmarks on the anterior, posterior, and lateral boundaries.
The study results may help create an accurate and reproducible tunnel, which is essential for successful ACL reconstruction surgery.
尽管近期人们认识到胫骨隧道位置对于前交叉韧带（ACL）重建术后实现稳定性的重要性，但与股骨侧相比，关于胫骨表面解剖学足迹的详细报告较少。
ACL胫骨足迹与骨突及周围骨性标志有关。
描述性实验室研究。
本研究包括2种解剖学方法，用于识别与ACL胫骨足迹相对应的骨突以及3个周围标志：前嵴、外侧沟和髁间窝。在第一种方法中，对12对防腐处理的尸体膝关节进行计算机断层扫描（CT）后，对12个膝关节进行肉眼观察，同时对其对侧膝关节进行组织学观察。对这些骨性标志的宏观和微观观察结果与三维（3D）CT图像进行比较。在第二种方法中，从60个膝关节的术前CT数据评估骨突的形状及其骨性标志的发生率。
在第一种方法中，我们能够通过CT在所有病例中确认骨突和所有3个周围标志。肉眼评估在ACL的前边界确认有一个小骨隆起。外侧沟在宏观上未得到确认。ACL在后部边界未附着于外侧髁间结节、ACL胫骨嵴和髁间间隙。组织学评估确认前嵴和外侧沟分别位于前边界和外侧边界。与髁间窝相对应的髁间间隙上没有韧带组织。在第二项研究中，骨突呈现2种形态模式：椭圆形（58.3%）和三角形（41.6%）。包括前嵴、外侧沟和髁间窝在内的3个骨性标志分别存在于96.6%、100.0%和96.6%的病例中。
存在与ACL足迹相对应的骨突以及在前、后和外侧边界的骨性标志。
研究结果可能有助于创建一个准确且可重复的隧道，这对于成功的ACL重建手术至关重要。
