Department of Orthopaedic Surgery and Sports Medicine, DMC Sports Medicine Orthopaedic Surgery Fellowship Program, Detroit Medical Center, 3990 John R Street, PO Box 137, Detroit, MI, 48201, USA.
Knee Surg Sports Traumatol Arthrosc. 2021 Mar;29(3):881-888. doi: 10.1007/s00167-020-06043-z. Epub 2020 May 13.
To compare a femoral physeal sparing anterior cruciate ligament (ACL) reconstruction technique utilizing a posteromedial portal to traditional transphyseal techniques with regards to anatomic tunnel positioning and proximity to important neurovascular structures.
Eight cadaveric knees were obtained for the study. Femoral tunnel guide pins were placed utilizing four different techniques: accessory anterior medial portal, posteromedial portal, trans-tibial, and figure-4 methods. The knees were then dissected and the following measurements taken: distance of each pin to the saphenous and peroneal nerve, popliteus tendon, neurovascular bundle, femoral ACL footprint and articular cartilage, and the angle of the guide pin entering the lateral femoral condyle. Fluoroscopic imaging was taken to determine the disruption of the physeal scar.
Posteromedial portal guide pin was significantly closer to the neurovascular bundle, popliteal tendon and saphenous nerve when compared to the other 3 techniques, but was further from the peroneal nerve. It also had the smallest distance from the anatomic footprint of the ACL, and the largest angle to the lateral femoral condyle. The posteromedial portal guide pin had similar distance from the articular cartilage as the accessory anterior medial portal and figure-4 guide pin, with the trans-tibial guide pin being the farthest. The posteromedial portal guide pin failed to disrupt the physeal scar in all specimens, while the other three techniques consistently violated the physeal scar.
The posteromedial portal technique offers an appropriate method for anatomic ACL reconstruction while protecting the distal femoral physis from injury. Care needs to be taken with this technique as it comes in closer proximity to some of the important neurovascular structures. This study indicates that posteromedial portal technique is a less technically challenging approach for physeal-sparing ACL repair with special attention required for the protection of neurovascular bundle from potential injury.
比较经后内侧入路保留骺板的前交叉韧带（ACL）重建技术与传统经骺板技术在解剖学隧道定位和接近重要神经血管结构方面的差异。
本研究共使用 8 具尸体膝关节。使用 4 种不同的技术（辅助前内侧入路、后内侧入路、经胫骨和“8”字形方法）放置股骨隧道导针。然后对膝关节进行解剖，并测量以下各项：每个导针到隐神经和腓总神经、腘肌腱、神经血管束、股骨 ACL 止点和关节软骨的距离，以及导针进入外侧股骨髁的角度。进行荧光透视成像以确定骺板瘢痕的破坏情况。
与其他 3 种技术相比，后内侧入路导针明显更接近神经血管束、腘肌腱和隐神经，但与腓总神经的距离更远。它还与 ACL 的解剖止点距离最近，与外侧股骨髁的角度最大。后内侧入路导针与辅助前内侧入路和“8”字形导针的关节软骨距离相似，而经胫骨导针的距离最远。后内侧入路导针在所有标本中均未破坏骺板瘢痕，而其他 3 种技术均持续破坏骺板瘢痕。
后内侧入路技术为 ACL 重建提供了一种合适的解剖学方法，同时保护了股骨远端骺板免受损伤。由于该技术与一些重要的神经血管结构更接近，因此需要谨慎操作。本研究表明，后内侧入路技术是一种更具挑战性的骺板保留 ACL 修复技术，需要特别注意保护神经血管束免受潜在损伤。
