Department of Orthopedic Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Central R&D Center, Corentec, Cheonan, Republic of Korea.
Arthroscopy. 2019 Apr;35(4):1183-1194. doi: 10.1016/j.arthro.2018.10.145. Epub 2019 Mar 11.
To compare variations in femoral graft bending angle during range of motion (ROM) of the knee between inside-out (IO) and retro-socket outside-in (OI) techniques in posterior cruciate ligament (PCL) reconstruction using in vivo 3-dimensional (3D) computed tomography analysis.
Ten patients underwent PCL reconstruction by the IO technique (5 patients) or the retro-socket OI technique (5 patients) for suspensory femoral fixation. After PCL reconstruction, 3D computed tomography was performed in 0° extension and 90° flexion to reconstruct 3D femur and tibia bone models using Mimics software. Positions of femur and tibia at 30°, 45°, and 60° flexion were reproduced by determining the kinematic factors of anteroposterior translation, mediolateral translation, and internal-external rotation angle of each patient based on previously measured kinematic data. Variation in graft bending angle according to the flexion range of the knee was calculated by the difference in graft angulation measured at each flexion angle. The results were compared between the 2 techniques.
There was significant difference in variation of femoral graft bending angle between IO and retro-socket OI techniques from 0° to 90° flexion of the knee (P = .008). Significant difference was also noticed at 30° to 45° (P = .008), 45° to 60° (P = .008), and 60° to 90° (P = .016) ROM of the knee between the 2 groups.
The retro-socket OI technique resulted in less variation in femoral graft bending angle compared with the IO technique during knee ROM. We recommend the retro-socket OI technique for femoral tunnel placement to reduce the graft motion at the intra-articular femoral tunnel aperture.
The retro-socket OI technique produces significantly less variation in femoral graft bending angle when compared with the IO technique. Such reduction in variation of femoral graft bending angle might be related to lower stress at the femoral tunnel aperture.
通过活体三维（3D）计算机断层扫描分析，比较后交叉韧带（PCL）重建中关节内（IO）和关节外后侧（OI）技术在膝关节活动范围（ROM）过程中股骨移植物弯曲角度的变化。
10 例患者因悬吊股骨固定而行 PCL 重建，采用 IO 技术（5 例）或 retro-socket OI 技术（5 例）。PCL 重建后，采用 Mimics 软件在 0°伸展和 90°屈曲时进行 3D 计算机断层扫描，重建 3D 股骨和胫骨骨模型。根据先前测量的运动学数据，通过确定每位患者的前后平移、内外平移和内外旋转角度的运动学因素，再现 30°、45°和 60°屈曲时的股骨和胫骨位置。通过在每个屈曲角度测量的移植物角度差异计算移植物弯曲角度随膝关节屈曲范围的变化。比较两种技术的结果。
从膝关节 0°到 90°屈曲，IO 和 retro-socket OI 技术的股骨移植物弯曲角度变化有显著差异（P =.008）。在膝关节 30°至 45°（P =.008）、45°至 60°（P =.008）和 60°至 90°（P =.016）ROM 时，两组之间也存在显著差异。
与 IO 技术相比，retro-socket OI 技术在膝关节 ROM 过程中股骨移植物弯曲角度变化较小。我们建议采用 retro-socket OI 技术进行股骨隧道定位，以减少关节内股骨隧道开口处移植物的运动。
与 IO 技术相比，retro-socket OI 技术使股骨移植物弯曲角度的变化明显减小。股骨移植物弯曲角度变化的减少可能与股骨隧道开口处的应力降低有关。
