Moon Dong Kyu, Yoon Chul Ho, Park Jin Seung, Kang Bun Jung, Cho Seong Hee, Jo Ho Seung, Hwang Sun Chul
Department of Orthopaedic Surgery, Military Hospital, Hongcheon, Korea.
Department of Rehabilitation Medicine and Institute of Health Sciences, School of Medicine, Gyeongsang National University, Gyeongsang National University Hospital, Jinju, Korea.
Yonsei Med J. 2014 Nov;55(6):1584-91. doi: 10.3349/ymj.2014.55.6.1584.
The object of this study was to evaluate entrance angle effects on femoral tunnel length and cartilage damage during anteromedial portal drilling using three-dimensional computer simulation.
Data was obtained from an anatomic study performed using 16 cadaveric knees. The anterior cruciate ligament femoral insertion was dissected and the knees were scanned by computer tomography. Tunnels with different of three-dimensional entrance angles were identified using a computer simulation. The effects of different entrance angles on the femoral tunnel length and medial femoral cartilage damage were evaluated. Specifically, tunnel length and distance from the medial femoral condyle to a virtual cylinder of the femoral tunnel were measured.
In tunnels drilled at a coronal angle of 45°, an axial angle of 45°, and a sagittal angle of 45°, the mean femoral tunnel length was 39.5±3.7 mm and the distance between the virtual cylinder of the femoral tunnel and the medial femoral condyle was 9.4±2.6 mm. The tunnel length at a coronal angle of 30°, an axial angle of 60°, and a sagittal angle of 45°, was 34.0±2.9 mm and the distance between the virtual cylinder of the tunnel and the medial femoral condyle was 0.7±1.3 mm, which was significantly shorter than the standard angle (p<0.001).
Extremely low and high entrance angles in both of axial plane and coronal plane produced inappropriate tunnel angles, lengths and higher incidence of cartilage damage. We recommend that angles in proximity to standard angles be chosen during femoral tunnel drilling through the anteromedial portal.
本研究的目的是使用三维计算机模拟评估前内侧入路钻孔过程中入口角度对股骨隧道长度和软骨损伤的影响。
数据来自对16具尸体膝关节进行的解剖学研究。解剖前交叉韧带的股骨附着点，并用计算机断层扫描对膝关节进行扫描。使用计算机模拟确定具有不同三维入口角度的隧道。评估不同入口角度对股骨隧道长度和股骨内侧软骨损伤的影响。具体而言，测量隧道长度以及从股骨内侧髁到股骨隧道虚拟圆柱体的距离。
在冠状角为45°、轴角为45°和矢状角为45°钻出的隧道中，平均股骨隧道长度为39.5±3.7mm，股骨隧道虚拟圆柱体与股骨内侧髁之间的距离为9.4±2.6mm。在冠状角为30°、轴角为60°和矢状角为45°时，隧道长度为34.0±2.9mm，隧道虚拟圆柱体与股骨内侧髁之间的距离为0.7±1.3mm，明显短于标准角度（p<0.001）。
轴向平面和冠状平面中极低和极高的入口角度会产生不合适的隧道角度、长度以及更高的软骨损伤发生率。我们建议在通过前内侧入路进行股骨隧道钻孔时选择接近标准角度的角度。
