Department of Orthopedic Surgery, McGill University Health Centre, Montreal, Canada.
Department of Diagnostic Radiology, McGill University Health Centre, Montreal, Canada.
Am J Sports Med. 2018 Jan;46(1):192-199. doi: 10.1177/0363546517730577. Epub 2017 Oct 3.
The recent emphasis on anatomic reconstruction of the anterior cruciate ligament (ACL) is well supported by clinical and biomechanical research. Unfortunately, the location of the native femoral footprint can be difficult to see at the time of surgery, and the accuracy of current techniques to perform anatomic reconstruction is unclear.
To use 3-dimensional magnetic resonance imaging (3D MRI) to prospectively evaluate patients with torn ACLs before and after reconstruction and thereby assess the accuracy of graft position on the femoral condyle.
Cohort study; Level of evidence, 3.
Forty-one patients with unilateral ACL tears were recruited into the study. Each patient underwent 3D MRI of both the injured and uninjured knees before surgery. The contralateral (uninjured) knee was used to define the patient's native footprint. Patients then underwent ACL reconstruction, and the injured knee underwent reimaging after surgery. The location and percentage overlap of the reconstructed femoral footprint were compared with the patient's native footprint.
The center of the native ACL femoral footprint was a mean 12.0 ± 2.6 mm distal and 9.3 ± 2.2 mm anterior to the apex of the deep cartilage. The position of the reconstructed graft was significantly different, with a mean distance of 10.8 ± 2.2 mm distal ( P = .02) and 8.0 ± 2.3 mm anterior ( P = .01). The mean distance between the center of the graft and the center of the native ACL femoral footprint (error distance) was 3.6 ± 2.6 mm. Comparing error distances among the 4 surgeons demonstrated no significant difference ( P = .10). On average, 67% of the graft overlapped within the native ACL femoral footprint.
Despite contemporary techniques and a concerted effort to perform anatomic ACL reconstruction by 4 experienced sports orthopaedic surgeons, the position of the femoral footprint was significantly different between the native and reconstructed ACLs. Furthermore, each surgeon used a different technique, but all had comparable errors in their tunnel placements.
临床和生物力学研究充分支持前交叉韧带（ACL）解剖重建的最新重点。不幸的是，在手术时，很难看到原始的股骨附着点的位置，并且目前进行解剖重建的技术的准确性尚不清楚。
使用三维磁共振成像（3D MRI）前瞻性评估 ACL 撕裂患者重建前后的情况，从而评估移植物在股骨髁上的位置准确性。
队列研究；证据水平，3 级。
41 例单侧 ACL 撕裂患者入组研究。每位患者均在术前对双侧膝关节（患侧和健侧）进行 3D MRI 检查。利用对侧（健侧）膝关节来确定患者的原始附着点。然后患者接受 ACL 重建，术后对患侧膝关节进行再次成像。比较重建的股骨附着点的位置和与患者原始附着点的重叠百分比。
原始 ACL 股骨附着点的中心距离软骨深面顶点远侧 12.0 ± 2.6mm，前侧 9.3 ± 2.2mm。重建移植物的位置明显不同，距离远侧平均 10.8 ± 2.2mm（P =.02），前侧平均 8.0 ± 2.3mm（P =.01）。移植物中心与原始 ACL 股骨附着点中心之间的距离（误差距离）的平均值为 3.6 ± 2.6mm。比较 4 位外科医生的误差距离，差异无统计学意义（P =.10）。平均而言，67%的移植物覆盖在原始 ACL 股骨附着点内。
尽管采用了现代技术和 4 位经验丰富的运动骨科医生集中精力进行 ACL 解剖重建，但在原始和重建的 ACL 之间，股骨附着点的位置仍存在显著差异。此外，每位外科医生使用的技术不同，但他们的隧道定位误差都相当。
