Wang Hui, Wang Jinshui, Han Xuesong, Wang Wanming
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2014 May;28(5):571-5.
To investigate the best knee flexion angle by analyzing the length and orientation of the femoral tunnel through anteromedial portal (AM) at different flexion angles during anterior cruciate ligament (ACL) reconstruction.
Twelve fresh cadaveric knees were selected to locate the center of ACL femoral footprint through AM using the improved hook slot vernier caliper, and to locate the posterior bone cortex using a diameter 3 mm ball at flexion of 90, 100, 110, 120, and 130 degrees. The femoral tunnel length, standard coronal and sagittal plane angles, and the position relation between exit point and the lateral epicondyle were measured; the tunnel orientation on the anteroposterior and lateral X-ray films was also measured.
With increasing flexion of the knee, the femoral tunnel length showed a first increasing and then stable tendency; significant difference was found between at flexion of 90 degrees and at flexions of 100, 110, 120, and 130 degrees, and between flexions of 100 degrees and 120 degrees (P < 0.05). The femoral tunnel showed a trend of decreasing with coronal angle, whereas gradually increasing with sagittal angle. The knee flexion angle had significant difference either among flexions of 90, 110, and 130 degrees or between flexions of 100 degrees and 120 degrees (P < 0.05). The exit point of the femoral tunnel located at the lateral epicondyle of the femur proximal to posterior region at flexion of 90 degrees in all knees, and at flexion of 100 degrees in 7 knees, but it located at the lateral epicondyle of the femur proximal to anterior region at flexion of 110, 120, and 130 degrees in all knees. As the knee flexion angle increasing, the angle between femoral tunnel with the tangent of internal-external femoral condyle on anteroposterior X-ray films showed a trend of decreasing gradually, but a trend of increasing gradually on lateral X-ray films. On the anteroposterior X-ray films, significant differences were found in the angle either among flexions of 90, 110, and 130 degrees or between flexions of 100 degrees and 120 degrees (P < 0.05). On the lateral X-ray films, there were significant differences in the angle among flexions of 90, 100, 110, 120, and 130 degrees (P < 0.05).
During ACL reconstruction by AM, 110 degrees is the best flexion angle, which can get the ideal femoral tunnel.
通过分析前交叉韧带（ACL）重建术中不同屈膝角度下经前内侧入路（AM）的股骨隧道长度和方向，探讨最佳屈膝角度。
选取12具新鲜尸体膝关节，使用改良钩槽游标卡尺经AM定位ACL股骨足迹中心，并用直径3mm的球在屈膝90°、100°、110°、120°和130°时定位后骨皮质。测量股骨隧道长度、标准冠状面和矢状面角度以及出口点与外侧髁之间的位置关系；还测量前后位和侧位X线片上的隧道方向。
随着膝关节屈曲角度增加，股骨隧道长度呈先增加后稳定的趋势；90°屈膝时与100°、110°、120°和130°屈膝时以及100°与120°屈膝时之间存在显著差异（P<0.05）。股骨隧道冠状角呈减小趋势，矢状角呈逐渐增加趋势。90°、110°和130°屈膝时之间以及100°与120°屈膝时之间的屈膝角度存在显著差异（P<0.05）。所有膝关节在90°屈膝时股骨隧道出口点位于股骨外侧髁近端后方区域，7个膝关节在100°屈膝时位于该位置，但所有膝关节在110°、120°和130°屈膝时出口点位于股骨外侧髁近端前方区域。随着屈膝角度增加，前后位X线片上股骨隧道与股骨内外侧髁切线之间的角度呈逐渐减小趋势，而侧位X线片上呈逐渐增加趋势。在前后位X线片上，90°、110°和130°屈膝时之间以及100°与120°屈膝时之间的角度存在显著差异（P<0.05）。在侧位X线片上，90°、100°、110°、120°和130°屈膝时之间的角度存在显著差异（P<0.05）。
在经AM进行ACL重建时，110°是最佳屈膝角度，可获得理想的股骨隧道。
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