Muneta Takeshi, Koga Hideyuki, Nakamura Tomomasa, Horie Masafumi, Watanabe Toshifumi, Yagishita Kazuyoshi, Sekiya Ichiro
Department of Orthopaedic Surgery, Medical Hospital, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
Department of Joint Surgery and Sports Medicine, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
Knee Surg Sports Traumatol Arthrosc. 2015 Dec;23(12):3743-9. doi: 10.1007/s00167-014-3300-2. Epub 2014 Sep 11.
To introduce a new behind-remnant approach for double-bundle (DB) anterior cruciate ligament (ACL) reconstruction and to compare the femoral tunnel positions of anteromedial (AM) and posterolateral (PL) bundles between the new and standard procedures by a three-dimensional computed tomography (3D-CT).
During DB ACL reconstruction, two approaches for femoral tunnel creation were consecutively practiced from 2010 to 2012. The patients were evaluated retrospectively as a cohort study. A total of 200 primary ACL reconstructions have been performed using a transtibial approach. One approach was a standard approach from the front in which the ACL remnant was peeled off from the attachment, and two guide wires were inserted based on anatomic bony landmarks (standard group). The other approach was a new behind-remnant approach in which the ACL remnant was kept untouched and two guide wires were inserted at the posterior margin of the direct ACL insertion (behind-remnant group). The position of the AM and PL femoral tunnels was expressed on a 3D-CT reconstructive image using the quadrant method with a statistical analysis.
The depth of the AM center was 24 ± 6 % (mean and standard deviation) in the standard group and 22 ± 5 % in the behind-remnant group. The height of the AM tunnel center was 22 ± 8 % in the standard group and 31 ± 8 % in the behind-remnant group. The depth of the PL tunnel center was 32 ± 6 % in the standard group and 35 ± 5 % in the behind-remnant group. The height of the PL tunnel center was 47 ± 9 % in the standard group and 55 ± 7 % in the behind-remnant group. The AM and PL femoral tunnels in both groups were created within the normal anatomic footprint of the previous studies. The behind-remnant approach created a significantly lower femoral tunnel for both AM (p = 0.000) and PL tunnels (p = 0.000). The depth of both AM and PL tunnels was not significantly different between the two groups (n.s.).
The new behind-remnant procedure is technically simple and reproducible as a remnant-preserving ACL reconstruction.
Cohort study, Level III.
介绍一种用于双束（DB）前交叉韧带（ACL）重建的新的残端后方入路，并通过三维计算机断层扫描（3D-CT）比较新手术与标准手术中前内侧（AM）束和后外侧（PL）束的股骨隧道位置。
在2010年至2012年期间，在DB ACL重建过程中，连续采用两种创建股骨隧道的方法。对患者进行回顾性队列研究评估。总共200例初次ACL重建采用经胫骨入路进行。一种方法是从前侧进行的标准入路，即从附着处剥离ACL残端，并根据解剖学骨性标志插入两根导丝（标准组）。另一种方法是新的残端后方入路，即不触动ACL残端，在ACL直接附着处的后缘插入两根导丝（残端后方组）。使用象限法在3D-CT重建图像上表示AM和PL股骨隧道的位置，并进行统计分析。
标准组中AM中心的深度为24±6%（均值和标准差），残端后方组为22±5%。标准组中AM隧道中心的高度为22±8%，残端后方组为31±8%。标准组中PL隧道中心的深度为32±6%，残端后方组为35±5%。标准组中PL隧道中心的高度为47±9%，残端后方组为55±7%。两组的AM和PL股骨隧道均在前人研究的正常解剖足迹范围内创建。残端后方入路为AM（p = 0.000）和PL隧道（p = 0.000）创建的股骨隧道明显更低。两组之间AM和PL隧道的深度无显著差异（无统计学意义）。
作为一种保留残端的ACL重建方法，新的残端后方手术技术简单且可重复。
队列研究，III级。
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