Shea Kevin G, Cannamela Peter C, Fabricant Peter D, Terhune E Bailey, Polousky John D, Milewski Matthew D, Ganley Theodore J, Anderson Allen F
1St. Luke's Sports Medicine, Boise, Idaho 2Hospital for Special Surgery, New York, NY 3Georgetown University School of Medicine, Washington, DC 4Children's Health Andrews Institute, Plano, Texas 5Elite Sports Medicine, Connecticut Children's Medical Center, Farmington, Connecticut 6Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 7Tennessee Orthopaedic Alliance, Nashville, Tennessee.
J Bone Joint Surg Am. 2017 Mar 15;99(6):506-511. doi: 10.2106/JBJS.16.00641.
This study was conducted to evaluate the spatial relationship of the anterior cruciate ligament (ACL) and lateral collateral ligament (LCL) femoral footprint origins in knee specimens from skeletally immature donors as viewed on lateral radiographs.
Fourteen cadaver specimens of skeletally immature knees from children between 7 and 11 years old at the time of death were examined through gross dissection. Metallic pins were placed at the center of the ACL and LCL femoral footprints, and computed tomography (CT) scans were performed. Sagittal plane CT images were merged to create a view analogous to an intraoperative C-arm image with overlaid ACL and LCL ligament footprints. Ligament origins were then measured as a percent of the epiphyseal depth (% P-A [posterior-anterior]) and height (% P-D [proximal-distal]).
The ACL origin was centered at a point located 14% (14% P-A) of the total lateral femoral condyle (LFC) depth from the most posterior aspect of the LFC and 38% (38% P-D) of the LFC height from the most proximal aspect of the posterior physis. The LCL origin was centered at a point 27% P-A and 37% P-D. When viewed on a sagittal CT reconstruction analogous to a perfect lateral intraoperative fluoroscopic view, the ACL footprint origin is posterior and slightly inferior to the LCL origin. Both origins are distal to the distal femoral physis and are posterior to the origin of the popliteus.
This study demonstrates a consistent relationship between the origin of the ACL and LCL, which may be useful in guiding safe tunnel placement during all-epiphyseal ACL reconstruction in skeletally immature knees.
This anatomic reference can be used intraoperatively to guide and radiographically evaluate ACL tunnel placement while avoiding the LCL origin in skeletally immature patients.
本研究旨在评估在侧位X线片上观察到的骨骼未成熟供体膝关节标本中前交叉韧带（ACL）和外侧副韧带（LCL）股骨足迹起点的空间关系。
对14例死亡时年龄在7至11岁的骨骼未成熟儿童膝关节的尸体标本进行大体解剖检查。将金属针置于ACL和LCL股骨足迹的中心，然后进行计算机断层扫描（CT）。矢状面CT图像合并后生成一个类似于术中C形臂图像的视图，其上叠加有ACL和LCL韧带足迹。然后将韧带起点测量为骨骺深度的百分比（%P-A[前后]）和高度的百分比（%P-D[近端-远端]）。
ACL起点位于从外侧股骨髁（LFC）最后方起占LFC总深度14%（14%P-A）、从后骨骺最近端起占LFC高度38%（38%P-D）的点处。LCL起点位于27%P-A和37%P-D处。在类似于完美的术中侧位透视视图的矢状面CT重建图像上观察时，ACL足迹起点在LCL起点的后方且略低。两个起点均位于股骨远端骨骺的远侧，且在腘肌起点的后方。
本研究证明了ACL和LCL起点之间存在一致的关系，这可能有助于在骨骼未成熟膝关节的全骨骺ACL重建过程中指导安全的隧道置入。
该解剖学参考可在术中用于指导和通过影像学评估ACL隧道置入，同时在骨骼未成熟患者中避免LCL起点。
