Sporthopaedicum Berlin, Berlin, Germany.
Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Münster, Germany.
Knee Surg Sports Traumatol Arthrosc. 2018 May;26(5):1384-1391. doi: 10.1007/s00167-017-4759-4. Epub 2017 Oct 23.
Femoral tunnel placement is essential for good outcome in anterior cruciate ligament (ACL) reconstruction. In the past, several attempts have been made to optimize femoral tunnel placement. It was observed that the posterior horn of the lateral meniscus was always located directly below to the desired femoral ACL tunnel position, when the knee was brought to deep flexion (> 120°). The goal of the present study was to verify the hypothesis that the posterior horn of the lateral meniscus can be used as a landmark for femoral tunnel placement.
Out of a consecutive series of ACL reconstructions done by a single surgeon, 55 lateral radiographs were evaluated according to the quadrant method by Bernard and Hertel. Additionally, on anterior-posterior radiographs the femoral tunnel angle was determined.
In the present case series the posterior horn of the lateral meniscus could be identified and used as a landmark for femoral tunnel placement in all cases. The mean tunnel depth was 24 ± 5.1% and the mean tunnel height was 31.3 ± 5.7%. The mean femoral tunnel angle was 41 ± 4.9° using the anatomical axis as a reference. Compared to previous cadaver studies the data of the present study were within their anatomical range of the native ACL insertion site.
The suggested technique using the posterior horn of the lateral meniscus as a landmark for femoral tunnel placement showed reproducible results and matches the native ACL insertion site compared to previous cadaveric studies. In particular, non-experienced ACL surgeons will benefit from this apparent landmark and the corresponding easy-to-use ACL reconstruction method.
IV.
在前交叉韧带（ACL）重建中，股骨隧道的位置对于获得良好的结果至关重要。过去，人们已经尝试了多种方法来优化股骨隧道的位置。当膝关节被深屈（>120°）时，外侧半月板的后角总是直接位于所需的股骨 ACL 隧道位置下方，这一现象被观察到。本研究的目的是验证外侧半月板后角可以用作股骨隧道定位的标志物这一假设。
从一位外科医生连续进行的 ACL 重建系列中，根据 Bernard 和 Hertel 的象限法评估了 55 个外侧 X 线片。此外，在前后 X 线片上确定了股骨隧道的角度。
在本病例系列中，在所有情况下，均可以识别和使用外侧半月板的后角作为股骨隧道定位的标志物。隧道的平均深度为 24±5.1%，平均隧道高度为 31.3±5.7%。以解剖轴为参照，股骨隧道的平均角度为 41±4.9°。与之前的尸体研究相比，本研究的数据在其解剖学范围内与自然 ACL 插入点相吻合。
使用外侧半月板后角作为股骨隧道定位标志物的建议技术显示出可重复的结果，并且与之前的尸体研究相比，与自然 ACL 插入点相匹配。特别是，非经验丰富的 ACL 外科医生将受益于这种明显的标志物和相应的易于使用的 ACL 重建方法。
IV。
