Department of Orthopaedic Surgery and Traumatology, Hospital Clinic, 170 Villarroel Street, 08036, Barcelona, Spain.
Division of Musculoskeletal Radiology, Department of Radiology, Hospital Clinic, Barcelona, Spain.
Knee Surg Sports Traumatol Arthrosc. 2019 Nov;27(11):3411-3417. doi: 10.1007/s00167-019-05388-4. Epub 2019 Feb 2.
To determine the best angle to drill the femoral tunnels of an anterolateral ligament (ALL) anatomic reconstruction combined with a single-bundle anterior cruciate ligament (ACL) reconstruction to avoid tunnel collisions and cortical disruption.
Ten cadaveric knees were studied. Single-bundle anatomic ACL femoral tunnels were arthroscopically drilled. The starting point of the ALL femoral tunnel was located posterior and superior to the lateral epicondyle. ALL tunnels were drilled at four different angulations: (1) 0° axial/0° coronal, (2) 0° axial/30° coronal superior, (3) 30° axial anterior/0° coronal, and (4) 30° axial anterior 30° coronal superior. Specimens were scanned by computed tomography to measure the relations of each trajectory with the ACL socket and the nearest cortical bone.
None of the four trajectories studied presented risk of collision with the ACL. The tunnel at 30° anterior/30° proximal presented the safest distance to the ACL socket (P = 0.01) [mean distance 18.6 mm (SD ± 6.7)]. However, both tunnels angled at 0° in the axial plane presented a high risk of posterior femoral cortex disruption (P = 0.01), either by close proximity or direct contact in some specimens (mean distance 3.1 mm (SD ± 2.8) at 0° axial/0° coronal and 3.7 mm (SD ± 2.2) at 0° axial/30° coronal).
When performing simultaneous ACL and ALL ligament reconstruction, the ALL femoral tunnel should be drilled with an angle of 30° anterior in the axial plane and 30° proximal in the coronal plane. Tunnels with an angle of 0° in the axial plane showed high risk of contact and disruption of the posterior femoral cortex; thus, these angles should be avoided. The clinical relevance of this work is that an ALL anatomical reconstruction does not represent a risk when performing a simultaneous ACL reconstruction as long as the ALL tunnel is reamed with a proximal and anterior angulation.
确定在进行前外侧韧带（ALL）解剖重建联合单束前交叉韧带（ACL）重建时，钻取股骨隧道的最佳角度，以避免隧道碰撞和皮质破裂。
本研究共对 10 具尸体膝关节进行了研究。关节镜下钻取单束解剖 ACL 股骨隧道。ALL 股骨隧道的起点位于外上髁的后方和上方。ALL 隧道以 4 种不同的角度进行钻取：（1）0°轴向/0°冠状位，（2）0°轴向/30°冠状位上方，（3）30°轴向前方/0°冠状位，和（4）30°轴向前方 30°冠状位上方。对标本进行计算机断层扫描以测量每条轨迹与 ACL 窝和最近皮质骨的关系。
在所研究的 4 种轨迹中，均无与 ACL 发生碰撞的风险。30°前向/30°近端角度的隧道与 ACL 窝的距离最安全（P = 0.01）[平均距离 18.6 毫米（标准差 ± 6.7）]。然而，轴向平面中角度为 0°的两条隧道均存在较高的后股骨皮质破裂风险（P = 0.01），在一些标本中表现为接近或直接接触（0°轴向/0°冠状位的平均距离为 3.1 毫米（标准差 ± 2.8），0°轴向/30°冠状位的平均距离为 3.7 毫米（标准差 ± 2.2））。
在进行 ACL 和 ALL 韧带重建的同时，应采用轴向 30°前向和冠状位 30°近端的角度钻取 ALL 股骨隧道。轴向平面中角度为 0°的隧道存在与后股骨皮质接触和破裂的高风险；因此，应避免使用这些角度。这项研究的临床意义在于，只要使用近端和前向的角度扩髓 ALL 隧道，进行同时的 ACL 重建时，进行 ALL 解剖重建并不代表风险。
