Division of Sports Medicine, Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, U.S.A.
USC Epstein Family Center For Sports Medicine, Keck Medicine of USC, Los Angeles, California, U.S.A..
Arthroscopy. 2020 Jul;36(7):1875-1881. doi: 10.1016/j.arthro.2020.01.050. Epub 2020 Feb 13.
The purpose of this study was to compare the percentage of native femoral anterior cruciate ligament (ACL) footprint covered by the 2 most clinically relevant bone plug/graft orientations used with interference screw fixation in ACL reconstruction. A secondary purpose was to assess whether a transtibial or tibia-independent drilling technique would affect this outcome.
Five matched pairs of cadaver knees were used. Each matched pair had 1 knee assigned to a 10-mm femoral socket prepared via a transtibial (TT) drilling technique and the other via an anteromedial (AM) drilling technique. The bone plug of each graft was press-fitted into the femoral socket with the graft collagen in 2 distinct clinically relevant orientations (collagen inferior or posterior). The digitized graft collagen cross-sectional area (CSA) in each orientation was overlaid onto the native femoral ACL footprint CSA to generate a percentage of native ACL footprint covered by graft collagen.
The average native ACL femoral footprint CSA was 110.5 ± 9.1 mm, with no difference between knees assigned to TT or AM drilling (112.6 ± 2.7 vs 108.4 ± 13.0 mm, P = .49). The average femoral socket CSA was 95.4 ± 8.7 mm, with no difference between TT and AM tunnels (95.5 ± 9.9 vs 95.3 ± 8.4 mm, P = .96). There was no difference between the percentage of native footprint covered between TT and AM sockets (76.8% ± 7.8% vs 82.2% ± 13.7%, P = .47). Irrespective of drilling technique, there was significantly greater native ACL footprint covered by graft collagen when the bone plug was oriented with graft collagen inferior rather than posterior (75.6% ± 6.3% vs 65.4% ± 11.4%, P = .02).
Orienting the femoral bone plug such that the graft collagen is inferior rather than posterior significantly increases native ACL femoral footprint coverage in bone-patellar tendon-bone ACL reconstruction. This effect is consistent across AM and TT drilling techniques.
Surgeons attempting to restore an anatomic ACL footprint should consider bone plug-graft orientation when performing ACL reconstruction.
Controlled laboratory study.
本研究旨在比较两种最常用于 ACL 重建的骨栓/移植物的临床相关骨栓/移植物方向，比较其固定后对前交叉韧带（ACL）股骨止点的覆盖百分比。次要目的是评估经胫骨（TT）或胫骨独立钻孔技术是否会影响该结果。
使用 5 对匹配的尸体膝关节。每对膝关节的 1 条膝关节通过 TT 钻孔技术制备 10mm 股骨插座，另 1 条通过前内侧（AM）钻孔技术制备。将每个移植物的骨栓用移植物胶原以 2 种不同的临床相关方向（胶原下或后）压入股骨插座。在每个方向上，数字化的移植物胶原横截面积（CSA）叠加到天然 ACL 股骨止点 CSA 上，生成移植物胶原覆盖的天然 ACL 止点的百分比。
天然 ACL 股骨止点 CSA 的平均大小为 110.5±9.1mm，TT 和 AM 钻孔组之间无差异（112.6±2.7 vs 108.4±13.0mm，P=0.49）。股骨插座 CSA 的平均大小为 95.4±8.7mm，TT 和 AM 隧道之间无差异（95.5±9.9 vs 95.3±8.4mm，P=0.96）。TT 和 AM 插座之间的天然足迹覆盖率无差异（76.8%±7.8% vs 82.2%±13.7%，P=0.47）。无论钻孔技术如何，当骨栓的方向为移植物胶原在下而不是在后时，ACL 股骨止点的天然覆盖范围明显更大（75.6%±6.3% vs 65.4%±11.4%，P=0.02）。
将股骨骨栓定向，使移植物胶原位于下方而非后方，可显著增加骨-髌腱-骨 ACL 重建中 ACL 股骨止点的天然覆盖范围。这种效果在 AM 和 TT 钻孔技术中是一致的。
尝试恢复解剖学 ACL 足迹的外科医生在进行 ACL 重建时应考虑骨栓-移植物的方向。
对照实验室研究。
