Hart Adam, Han Yung, Martineau Paul A
Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, Quebec, Canada.
Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, Quebec, Canada.
Arthroscopy. 2015 Sep;31(9):1777-83. doi: 10.1016/j.arthro.2015.03.026. Epub 2015 May 15.
The purpose of this study was to evaluate the apex of the deep cartilage (ADC) as a landmark to help guide femoral tunnel placement during anatomic single-bundle anterior cruciate ligament (ACL) reconstruction. Our secondary purpose was to assess whether or not the endoscopic transtibial femoral offset drill guide could reach the center of the ACL's femoral footprint.
Eight formalin-injected cadaveric knees were dissected and the center of the ACL femoral footprints identified. The ADC was selected as an easily identifiable landmark during arthroscopy and was used to reference the position of the ACL femoral footprint with the knee flexed at 90°. Next, a 7-mm transtibial femoral ACL drill guide was used to engage the posterior aspect of the lateral condyle at the level of the femoral footprint. This position was marked, and the distance from the center of the femoral footprint was recorded for each specimen. Descriptive statistics were used to report our measurements.
The median high and shallow measurements were 3 mm (range, 1 to 4 mm) and 12 mm (range, 11 to 17 mm), respectively. The femoral offset guide never reached the center of the femoral footprint in all specimens; the median distance between the 2 measurements was 4.5 mm (range, 2 to 9 mm).
If the anatomy is difficult to delineate at the time of reconstruction, our study suggests using the ADC as a landmark to guide anatomic placement. The dissection of 8 cadavers showed that the center of the ACL femoral footprint had a median position of 3 mm high and 12 mm shallow to the ADC. We also showed that the transtibial femoral offset guide did not reach the center of the ACL footprint on all specimens and should therefore not be used for anatomic ACL reconstruction.
Current commercially available transtibial femoral offset guides cannot reach the center of the ACL's femoral footprint and therefore should not be used. Alternative techniques, such as referencing from the ADC through an anteromedial (AM) portal, are recommended.
本研究的目的是评估深层软骨顶点（ADC）作为一个标志，以帮助在解剖单束前交叉韧带（ACL）重建过程中指导股骨隧道的放置。我们的次要目的是评估关节镜下经胫骨股骨偏移钻导向器是否能够到达ACL股骨足迹的中心。
对8具用福尔马林注射的尸体膝关节进行解剖，并确定ACL股骨足迹的中心。ADC被选为关节镜检查时易于识别的标志，并用于在膝关节屈曲90°时参考ACL股骨足迹的位置。接下来，使用7毫米经胫骨股骨ACL钻导向器在股骨足迹水平与外侧髁的后侧接合。标记该位置，并记录每个标本到股骨足迹中心的距离。使用描述性统计来报告我们的测量结果。
高位和低位测量的中位数分别为3毫米（范围1至4毫米）和12毫米（范围11至17毫米）。在所有标本中，股骨偏移导向器从未到达股骨足迹的中心；两次测量之间的中位数距离为4.5毫米（范围2至9毫米）。
如果在重建时解剖结构难以描绘，我们的研究建议使用ADC作为标志来指导解剖位置的放置。对8具尸体的解剖显示，ACL股骨足迹的中心相对于ADC的中位位置为高位3毫米和低位12毫米。我们还表明，经胫骨股骨偏移导向器在所有标本上均未到达ACL足迹的中心，因此不应将其用于解剖性ACL重建。
目前市售的经胫骨股骨偏移导向器无法到达ACL股骨足迹的中心，因此不应使用。建议采用替代技术，例如通过前内侧（AM）入路参考ADC。
