Wechter John F, Bohm Kyle C, Macalena Jeffrey A, Sikka Robby Singh, Tompkins Marc
Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Ave. S, Suite R200, Minneapolis, MN, 55454, USA,
Knee Surg Sports Traumatol Arthrosc. 2015 Jul;23(7):1895-9. doi: 10.1007/s00167-014-3087-1. Epub 2014 Jun 4.
Using data from our MRI study, we found that a tunnel oriented 50° externally rotated and 60° cephalad would better connect the fibular collateral ligament (FCL) insertion to the popliteofibular ligament (PFL) insertion as compared to a traditional anterior-to-posterior (A-P) fibular tunnel. The purpose of this study was to test that finding in a cadaver model.
In eight cadaver knee pairs (16 knees), a guide pin was driven from the fibular FCL insertion point in a 50° externally rotated and 60° cephalad trajectory in 8 knees, and in a traditional A-P trajectory in the contralateral 8 knees. Proximity of the pin to the native PFL insertion, the peroneal and tibial nerves was measured, followed by drilling over the guide pin and measuring the remaining fibular bone stock.
In comparison with the A-P fibular tunnel technique, the 50°/60° technique resulted in a fibular exit point significantly closer to the native PFL insertion (p < 0.01). Both techniques were safe with regard to the tibial and peroneal nerves. There were no instances of fibular wall blowout in either technique; however, there was less superior bone remaining in the 50°/60° technique (p < 0.04).
In a cadaveric model, the 50°/60° technique for PLC reconstruction resulted in a more anatomic-based tunnel than an A-P fibular tunnel.
利用我们MRI研究的数据，我们发现，与传统的从前到后的（A-P）腓骨隧道相比，一个向外旋转50°且头侧成角60°的隧道能更好地连接腓侧副韧带（FCL）止点与腘腓韧带（PFL）止点。本研究的目的是在尸体模型中验证这一发现。
在八对尸体膝关节（16个膝关节）中，在8个膝关节中，从腓侧FCL止点沿向外旋转50°且头侧成角60°的轨迹打入导针，在对侧的8个膝关节中沿传统的A-P轨迹打入导针。测量导针与天然PFL止点、腓总神经和胫神经的接近程度，然后沿导针钻孔并测量剩余的腓骨骨量。
与A-P腓骨隧道技术相比，50°/60°技术导致腓骨出口点显著更靠近天然PFL止点（p<0.01）。两种技术在胫神经和腓总神经方面都是安全的。两种技术均未出现腓骨壁破裂的情况；然而，50°/60°技术中剩余的上侧骨量较少（p<0.04）。
在尸体模型中，用于后外侧复合体（PLC）重建的50°/60°技术比A-P腓骨隧道形成的隧道更符合解剖结构。
