Lu Wei, Zhu Weimin, Peng Liangquan, Fen Wenzhe, Li Hao, Ou Yangkan, Liu Haifeng, Wang Daping, Zeng Yanjun
Department of Sports Medical, The First Affiliated Hospital of Shenzhen University (Shenzhen Second People Hospital), Shenzhen 518000, PR China.
Department of Sports Medical, The First Affiliated Hospital of Shenzhen University (Shenzhen Second People Hospital), Shenzhen 518000, PR China.
Knee. 2015 Jun;22(3):169-73. doi: 10.1016/j.knee.2014.10.009. Epub 2014 Nov 13.
The study is aimed to observe the range of variation of the ACL PLB femoral footprint and investigate countermeasures for accurate femoral bone tunnel placement during double-bundle ACL reconstruction.
The femoral insertions of the anteromedial bundle (AMB) and PLB of the ACL were dissected in 30 male cadaveric knees. The ACL footprint on the lateral intercondylar wall (LIW) was observed, and the shape of the LIW, the resident ridge, the angle between the ACL long axis and femoral axis (AA), and the vertical distance from the center of the PLB to the lowest cartilage border of the LIW (PD) were measured.
The area most populated by the ACL fibers was directly under the resident ridge. AA = 18.7°±15.25° with variation from -18° to 56°, and PD=7.02±1.47 mm with variation from 3.75 to 11.08 mm. Both discrete values were very large in both groups of data. There were two kinds of LIW: trapezoidal (8 knees) and triangular (21 knees). Both AA and PD values exhibited significant differences between the two types of LIWs (P=0.00).
AA and PD vary among individuals. The insertions and centers of the PLB cannot be exactly anatomically determined with one size. For double-bundle ACL reconstruction, an individualized intraoperative footprint observation for fresh cases with footprint remnants, or resident ridge and anteromedial bundle-interval identification for old ACL tears, can be reasonable methods for posterolateral tunnel orientation.
Clinical relevance is observe the range of variation of the PLB femoral footprint for clinical double-bundle ACL reconstruction.
本研究旨在观察前交叉韧带后外侧束（PLB）股骨足迹的变异范围，并探讨在双束前交叉韧带重建术中准确放置股骨骨隧道的对策。
在30具男性尸体膝关节上解剖前交叉韧带前内侧束（AMB）和PLB的股骨附着点。观察髁间外侧壁（LIW）上的前交叉韧带足迹，测量LIW的形状、保留嵴、前交叉韧带长轴与股骨轴之间的夹角（AA）以及PLB中心到LIW最低软骨边界的垂直距离（PD）。
前交叉韧带纤维最密集的区域直接位于保留嵴下方。AA为18.7°±15.25°，变异范围为-18°至56°，PD为7.02±1.47mm，变异范围为3.75至11.08mm。两组数据的离散值都非常大。LIW有两种类型：梯形（8个膝关节）和三角形（21个膝关节）。两种类型的LIW之间的AA和PD值均存在显著差异（P=0.00）。
AA和PD因人而异。PLB的附着点和中心无法通过单一尺寸精确解剖确定。对于双束前交叉韧带重建，对于有足迹残留的新鲜病例进行术中个体化足迹观察，或对于陈旧性前交叉韧带撕裂进行保留嵴和前内侧束间隙识别，可能是后外侧隧道定位的合理方法。
临床意义在于观察PLB股骨足迹的变异范围，用于临床双束前交叉韧带重建。
