Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan.
PLoS One. 2019 May 2;14(5):e0215778. doi: 10.1371/journal.pone.0215778. eCollection 2019.
The purpose of this study was to evaluate the positions of femoral bone sockets and tibial bone tunnels made with the rectangular retro-dilator (RRD), which we manufactured for anterior cruciate ligament reconstruction (ACLR) with a bone-patella tendon-bone (BPTB) graft which is fixed into the rectangular bone socket and tunnel made at anatomical ACL insertion sites.
42 patients who had undergone ACLR with BPTB using the RRD were evaluated to assess bone socket and tunnel positions by the quadrant method and Magnussen classification using three-dimensional (3-D) CT. Intra-operative complications were also investigated in all patients.
3-D CT of the operated knee joints using the RRD showed that the bone socket and tunnel were placed in anatomical positions. In the quadrant method, the mean position of the femoral bone socket aperture was located at 22.0 ± 4.2% along the Blumensaat's line, and 37.4 ± 7.2% across the posterior condylar rim. The mean positions of the tibial bone tunnel aperture were 37.7 ± 5.2% and 46.1 ± 2.2% antero-posteriorly and medio-laterally, respectively. In addition, according to the Magnussen classification, 39 cases were evaluated as type 1, and almost all were located behind the lateral intercondylar ridge (also known as the resident's ridge). 3 cases were classified as type 2, which overlapped with the resident's ridge. A partial fracture of BPTB bone fragment was observed in 2 patients, but no serious complications including neurovascular injury were observed.
The study indicates that the use of RRD achieves a safe anatomical reconstruction of the ACL.
本研究旨在评估使用我们制造的矩形后扩张器（RRD）制作的股骨骨窝和胫骨骨隧道的位置，该 RRD 用于前交叉韧带重建（ACLR），其中使用骨-髌腱-骨（BPTB）移植物固定在解剖学上 ACL 插入部位制成的矩形骨窝和隧道中。
对 42 例使用 RRD 进行 ACLR 并用 BPTB 治疗的患者进行评估，通过四分法和 Magnussen 分类法使用三维（3-D）CT 评估骨窝和隧道位置。所有患者均调查了术中并发症。
使用 RRD 的手术膝关节的 3-D CT 显示骨窝和隧道位于解剖位置。在四分法中，股骨骨窝开口的平均位置位于 Blumensaat 线的 22.0±4.2%，后髁间嵴的 37.4±7.2%。胫骨骨隧道开口的平均位置分别为前后 37.7±5.2%和内外 46.1±2.2%。此外，根据 Magnussen 分类，39 例被评估为 1 型，几乎都位于外侧髁间嵴（也称为居民嵴）后面。3 例被归类为 2 型，与居民嵴重叠。2 例患者观察到 BPTB 骨碎片的部分骨折，但未观察到包括神经血管损伤在内的严重并发症。
研究表明，使用 RRD 可安全地进行 ACL 的解剖重建。
