Department of Orthopaedics, Montefiore Medical Center/Albert Einstein College of Medicine, New York, New York, USA.
Orthop J Sports Med. 2014 Apr 25;2(4):2325967114530075. doi: 10.1177/2325967114530075. eCollection 2014 Apr.
Surgical reconstruction of the anterior cruciate ligament (ACL) can be complicated by incorrect and variable tunnel placement, graft tunnel mismatch, cortical breaches, and inadequate fixation due to screw divergence. This is the first report describing the use of a C-arm with image intensifier employed for the sole purpose of eliminating those complications during transtibial ACL reconstruction.
To determine if the use of a C-arm with image intensifier during arthroscopically assisted transtibial ACL reconstruction (IIAA-TACLR) eliminated common complications associated with bone-patellar tendon-bone ACL reconstruction, including screw divergence, cortical breaches, graft-tunnel mismatch, and improper positioning of the femoral and tibial tunnels.
Case series; Level of evidence, 4.
A total of 110 consecutive patients (112 reconstructed knees) underwent identical IIAA-TACLR using a bone-patellar tendon-bone autograft performed by a single surgeon. Intra- and postoperative radiographic images and operative reports were evaluated for each patient looking for evidence of cortical breeching and screw divergence. Precision of femoral tunnel placement was evaluated using a sector map modified from Bernard et al. Graft recession distance and tibial α angles were recorded.
There were no femoral or tibial cortical breaches noted intraoperatively or on postoperative images. There were no instances of loss of fixation screw major thread engagement. There were no instances of graft-tunnel mismatch. The positions of the femoral tunnels were accurate and precise, falling into the desired sector of our location map (sector 1). Tibial α angles and graft recession distances varied widely.
The use of the C-arm with image intensifier enabled accurate and precise tunnel placement and completely eliminated cortical breach, graft-tunnel mismatch, and screw divergence during IIAA-TACLR by allowing incremental adjustment of the tibial tunnel and knee flexion angle. Incremental adjustment was essential to accomplish this. Importantly, a C-arm with image intensifier can be used with any ACL reconstruction that incorporates tunnels in the technique, with the expectation of increase in accuracy and precision and the elimination of common complications.
The use of an image intensifier during transtibial ACL reconstruction will substantially reduce the common complications associated with the procedure and improve both accuracy and precision of tibial and femoral tunnel placement. Use of an image intensifier unit is generalizable to an individual surgeon's preferences for graft choices and drilling techniques and will be especially valuable when the intercondylar architecture is altered from injury, time, or prior surgery.
前交叉韧带（ACL）的外科重建可能会因不正确和可变的隧道位置、移植物隧道不匹配、皮质破裂以及由于螺钉发散而导致的固定不充分而变得复杂。这是首次描述在关节镜辅助下经胫骨 ACL 重建（IIAA-TACLR）中使用带有影像增强器的 C 臂来消除这些并发症的报告。
确定在关节镜辅助下经胫骨 ACL 重建（IIAA-TACLR）中使用 C 臂和影像增强器是否消除了与骨-髌腱-骨 ACL 重建相关的常见并发症，包括螺钉发散、皮质破裂、移植物-隧道不匹配和股骨和胫骨隧道的不当定位。
病例系列；证据水平，4 级。
总共 110 例连续患者（112 例重建膝关节）由同一位外科医生进行了相同的 IIAA-TACLR，使用骨-髌腱-骨自体移植物。对每位患者的术中及术后影像学图像和手术报告进行评估，寻找皮质破裂和螺钉发散的证据。使用 Bernard 等人修改的扇形图评估股骨隧道的放置精度。记录移植物退缩距离和胫骨 α 角。
术中或术后影像学图像均未发现股骨或胫骨皮质破裂。没有固定螺钉主要螺纹啮合丢失的情况。没有移植物-隧道不匹配的情况。股骨隧道的位置准确且精确，落入我们定位图的理想扇形区（1 区）。胫骨 α 角和移植物退缩距离差异很大。
在 IIAA-TACLR 中使用带有影像增强器的 C 臂可以通过逐渐调整胫骨隧道和膝关节弯曲角度来实现，从而实现准确和精确的隧道放置，并完全消除皮质破裂、移植物-隧道不匹配和螺钉发散。逐渐调整是完成此操作的关键。重要的是，带有影像增强器的 C 臂可用于任何包含隧道技术的 ACL 重建，预计会提高准确性和精度，并减少常见并发症。
在经胫骨 ACL 重建中使用影像增强器将大大减少与该手术相关的常见并发症，并提高胫骨和股骨隧道放置的准确性和精度。使用影像增强器单元可以根据外科医生对移植物选择和钻孔技术的个人偏好进行调整，并且在由于受伤、时间或先前手术导致髁间结构改变时特别有价值。
