Werner Brian C, Burrus M Tyrrell, Gwathmey F Winston, Miller Mark D
Department of Orthopaedic Surgery, University of Virginia Health System, PO Box 800159, Charlottesville, VA 22908, USA.
Department of Orthopaedic Surgery, University of Virginia Health System, PO Box 800159, Charlottesville, VA 22908, USA.
Knee. 2016 Jun;23(3):478-81. doi: 10.1016/j.knee.2015.10.009. Epub 2015 Nov 6.
The goal of this study was to prospectively evaluate the accuracy and consistency of the anterior horn of the lateral meniscus as a landmark in achieving the desired tibial tunnel location during primary anterior cruciate ligament (ACL) reconstruction.
One hundred consecutive adult patients undergoing primary ACL reconstruction were enrolled in the study. One sports-fellowship trained surgeon performed all ACL reconstructions using independent tunnel drilling with an accessory anteromedial portal for the femoral tunnel. All guide pins for the tibial tunnel were placed using a 55-degree guide using the posterior border of the anterior horn of the lateral meniscus as a landmark. Following pin placement, a true lateral fluoroscopic image was obtained. These were digitally analyzed to measure the location of the pin along the length of the tibial plateau.
The average anteroposterior (A-P) distance achieved using the posterior border of the anterior horn of the lateral meniscus as a landmark for tibial tunnel placement was 37.0%±5.2% (mean±standard deviation) [range 26.4%-49.2%]. 66% of tibial tunnels were located between 30.0% and 39.9% of the A-P tibial distance. Only 18% of tibial tunnels localized between 40.0% and 44.9%, the area of the anatomic footprint described by Staubli and Rauschning [9] 16% of patients were significant outliers, with tunnels localizing to 25.0%-29.9% (6 patients) or 45.0%-49.9% (10 patients).
Use of the posterior border of the anterior horn of the lateral meniscus as a landmark for tibial tunnel placement during anatomic ACL reconstruction yields an inconsistent tunnel location.
II, Prospective study.
本研究的目的是前瞻性评估外侧半月板前角作为在初次前交叉韧带（ACL）重建过程中实现理想胫骨隧道位置的标志的准确性和一致性。
连续纳入100例接受初次ACL重建的成年患者。由一名接受过运动医学 fellowship 培训的外科医生使用独立隧道钻孔技术进行所有ACL重建，通过辅助前内侧入路制作股骨隧道。所有胫骨隧道导针均使用55度导向器，以外侧半月板前角的后缘作为标志进行放置。导针放置后，获取真正的侧位荧光透视图像。对这些图像进行数字分析，以测量导针在胫骨平台长度上的位置。
以外侧半月板前角的后缘作为胫骨隧道放置标志所达到的平均前后（A-P）距离为37.0%±5.2%（平均值±标准差）[范围26.4%-49.2%]。66%的胫骨隧道位于胫骨A-P距离的30.0%至39.9%之间。只有18%的胫骨隧道位于40.0%至44.9%之间，这是Staubli和Rauschning[9]描述的解剖足迹区域。16%的患者为显著异常值，其隧道位于25.0%-29.9%（6例患者）或45.0%-49.9%（10例患者）。
在解剖学ACL重建过程中，以外侧半月板前角的后缘作为胫骨隧道放置的标志会导致隧道位置不一致。
II，前瞻性研究。
