Zuiderbaan Hendrik A, Khamaisy Saker, Nawabi Danyal H, Thein Ran, Nguyen Joseph T, Lipman Joseph D, Pearle Andrew D
Sports Medicine and Shoulder Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY, United States.
Department of Biomechanics and Implant Design, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY, United States.
Knee. 2014 Dec;21(6):1160-5. doi: 10.1016/j.knee.2014.08.011. Epub 2014 Sep 30.
In an effort to minimize graft impingement among various ACL deficient states, we sought to quantitatively determine requirements for bone resection during notchplasty with respect to both volumetric amount and location.
A validated method was used to evaluate Magnetic Resonance Imaging scans. We measured the ATT of the medial and lateral compartments in the following four states: intact ACL (27 patients), acute ACL disruption; <2 months post-injury (76 patients), chronic ACL disruption; 12 months post-injury (42 patients) and failed ACL reconstruction (75 patients). Subsequently, 11 cadaveric knees underwent Computed Tomography (CT) scanning. Specialized software allowed virtual anterior translation of the tibia according to the average ATT measured on MRI. Impingement volume was analyzed by performing virtual ACLRs onto the various associated CT scans. Location was analyzed by overlaying an on-screen protractor. The center of the notch was defined as 0°.
Average impingement volume changed significantly in the various groups compared to the intact ACL group (acute 577 ± 200 mm(3), chronic 615 ± 199 mm(3), failed ACLR 678 ± 210 mm(3), p=0.0001). The location of the required notchplasty of the distal femoral wall border did not change significantly. The proximal femoral border moved significantly towards the center of the notch (acute 8.6° ± 4.8°, chronic 7.8° ± 4.2° (p=0.013), failed ACLR 5.1° ± 5.9° (p=0.002)).
Our data suggests that attention should be paid peri-operatively to the required volume and location of notchplasty among the various ACL deficient states to minimize graft impingement.
为尽量减少不同前交叉韧带（ACL）损伤状态下移植物撞击，我们试图定量确定在髁间窝成形术中骨切除在体积量和位置方面的要求。
采用一种经过验证的方法评估磁共振成像扫描。我们在以下四种状态下测量了内侧和外侧间室的前交叉韧带切迹（ATT）：ACL完整（27例患者）、急性ACL断裂（伤后<2个月，76例患者）、慢性ACL断裂（伤后12个月，42例患者）和ACL重建失败（75例患者）。随后，对11个尸体膝关节进行计算机断层扫描（CT）。专用软件可根据在MRI上测量的平均ATT对胫骨进行虚拟前向平移。通过在各种相关CT扫描上进行虚拟ACL重建来分析撞击体积。通过在屏幕上叠加量角器来分析位置。将髁间窝中心定义为0°。
与ACL完整组相比，不同组的平均撞击体积有显著变化（急性组577±200 mm³，慢性组615±199 mm³，ACL重建失败组678±210 mm³，p = 0.0001）。股骨远端壁边界所需髁间窝成形术的位置没有显著变化。股骨近端边界显著向髁间窝中心移动（急性组8.6°±4.8°，慢性组7.8°±4.2°（p = 0.013），ACL重建失败组5.1°±5.9°（p = 0.002））。
我们的数据表明，在不同ACL损伤状态下，术中应注意髁间窝成形术所需的体积和位置，以尽量减少移植物撞击。
