Dhawan Aman, Gallo Robert A, Lynch Scott A
From the Department of Orthopaedics and Rehabilitation, Penn State Hershey Medical Center, Penn State College of Medicine, Hershey, PA.
J Am Acad Orthop Surg. 2016 Jul;24(7):443-54. doi: 10.5435/JAAOS-D-14-00465.
The anatomic anterior cruciate ligament (ACL) reconstruction concept has developed in part from renewed interest in the insertional anatomy of the ACL, using surgical techniques that can reproduce this anatomy reliably and accurately during surgical reconstruction. Several technical tools are available to help identify and place the tibial and femoral grafts anatomically, including arthroscopic anatomic landmarks, a malleable ruler device, and intraoperative fluoroscopy. The changes in technique for anatomic tunnel placement in ACL reconstruction follow recent biomechanical and kinematic data that demonstrate improved time zero characteristics. A better re-creation of native ACL kinematics and biomechanics is achieved with independent femoral drilling techniques that re-create a central footprint single-bundle ACL reconstruction or double-bundle reconstruction. However, to date, limited short-term and long-term clinical outcome data have been reported that support using either of these techniques rather than a transtibial drilling technique. This lack of clear clinical advantage for femoral independent and/or double-bundle techniques may arise because of the potentially offsetting biologic incorporation challenges of these grafts when placed using these techniques or could result from modifications made in traditional endoscopic transtibial techniques that allow improved femoral and tibial footprint restoration.
解剖学前交叉韧带（ACL）重建概念的发展部分源于对ACL插入部解剖结构重新产生的兴趣，采用的手术技术能够在手术重建过程中可靠且准确地重现这种解剖结构。有几种技术工具可用于辅助在解剖学上确定和放置胫骨与股骨移植物，包括关节镜解剖标志、可塑形直尺装置以及术中透视。ACL重建中解剖学隧道放置技术的变化遵循了近期的生物力学和运动学数据，这些数据表明初始状态特征有所改善。通过独立股骨钻孔技术可更好地重现天然ACL的运动学和生物力学，该技术可用于单束ACL重建或双束重建的中央足迹重建。然而，迄今为止，所报道的支持使用这些技术而非经胫骨钻孔技术的短期和长期临床结果数据有限。对于股骨独立技术和/或双束技术而言，缺乏明确的临床优势可能是因为使用这些技术放置移植物时存在潜在的抵消性生物学整合挑战，或者可能是由于传统关节镜经胫骨技术的改进使得股骨和胫骨足迹恢复得到改善。
