Moon Dong-Kyu, Jo Ho-Seung, Lee Dong-Yeong, Kang Dong-Geun, Byun June-Ho, Hwang Sun-Chul
Korean Armed Forces Capital Hospital, Republic of Korea.
Department of Orthopaedic Surgery, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea.
Acta Orthop Traumatol Turc. 2017 May;51(3):227-232. doi: 10.1016/j.aott.2017.02.004. Epub 2017 Mar 31.
The purpose of this study was to evaluate the effect of femoral tunnel orientation, drilled through the accessory anteromedial (AAM) portal or the high AM portal in anatomic anterior cruciate ligament (ACL) reconstruction.
In 16 cadaver knees, using o'clock method, centers of the ACL femoral footprint were drilled with an 8-mm reamer via an AAM portal (eight knees) or a high AM portal (eight knees). Computed tomography (CT) scans were taken of each knee. Three-dimensional (3D) models were constructed to identify the femoral tunnel orientation and to create femoral tunnel virtual cylinders for measuring tunnel angles and length.
In two of the 16 specimens, we observed a posterior femoral cortex blowout (PFCB) when drilling through a high AM portal. When drilled through the high AM portal, the femoral tunnel length was significantly shorter than when using an AAM portal (30.3 ± 3.8 mm and 38.2 ± 3.1 mm, p < 0.001). The femoral tunnel length was significantly shorter in the group with PFCB compared to the group with no PFCB (25.9 ± 0.6 mm and 35.5 ± 4.5 mm, p = 0.011). The axial obliquity of the high AM portal was significantly higher than that of the AAM portal (52.2 ± 5.9° and 43.0 ± 2.3°, p = 0.003).
In anatomic ACL reconstruction, a mal-positioned AM portal can cause abnormal tunnel orientation, which may lead to mechanical failure during ACL reconstruction. Therefore, it is important to select accurate AM portal positioning, and possibly using an AAM portal by measuring an accurate position when drilling a femoral tunnel in anatomic ACL reconstruction.
本研究旨在评估在解剖学前交叉韧带（ACL）重建中，通过辅助前内侧（AAM）入路或高位前内侧（high AM）入路钻出的股骨隧道方向的影响。
在16具尸体膝关节中，采用时钟方法，通过AAM入路（8个膝关节）或高位前内侧入路（8个膝关节），用8毫米扩孔钻钻出ACL股骨足迹中心。对每个膝关节进行计算机断层扫描（CT）。构建三维（3D）模型以确定股骨隧道方向，并创建股骨隧道虚拟圆柱体以测量隧道角度和长度。
在16个标本中的2个中，当通过高位前内侧入路钻孔时，我们观察到股骨后皮质破裂（PFCB）。当通过高位前内侧入路钻孔时，股骨隧道长度明显短于使用AAM入路时（30.3±3.8毫米和38.2±3.1毫米，p<0.001）。与无PFCB的组相比，有PFCB的组股骨隧道长度明显更短（25.9±0.6毫米和35.5±4.5毫米，p = 0.011）。高位前内侧入路的轴向倾斜度明显高于AAM入路（52.2±5.9°和43.0±2.3°，p = 0.003）。
在解剖学ACL重建中，AM入路位置不当会导致隧道方向异常，这可能导致ACL重建期间的机械故障。因此,在解剖学ACL重建中钻出股骨隧道时，选择准确的AM入路位置很重要，并且可能需要通过测量准确位置来使用AAM入路。
