一种新开发的内侧半月板后根修复引导系统的准确性：两种瞄准引导器的比较
The accuracy of a newly developed guide system in medial meniscus posterior root repair: a comparison between two aiming guides.
作者信息
Furumatsu Takayuki, Okazaki Yuki, Kodama Yuya, Okazaki Yoshiki, Kamatsuki Yusuke, Masuda Shin, Hiranaka Takaaki, Ozaki Toshifumi
机构信息
Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
出版信息
Knee Surg Relat Res. 2019 Aug 7;31(1):7. doi: 10.1186/s43019-019-0007-1.
PURPOSE
Posterior root repair of the medial meniscus (MM) can prevent rapid progression of knee osteoarthritis in patients with a MM posterior root tear (MMPRT). The anatomic reattachment of the MM posterior root is considered to be critical in a transtibial pullout repair. However, tibial tunnel creation at the anatomic attachment is technically difficult. We hypothesized that a newly developed point-contact aiming guide [Unicorn Meniscal Root (UMR) guide] can create the tibial tunnel at a better position rather than a previously designed MMPRT guide. The aim of this study was to compare the position of the created tibial tunnel between the two meniscal root repair guides.
MATERIALS AND METHODS
Thirty-eight patients underwent transtibial pullout repairs. Tibial tunnel creation was performed using the UMR guide (19 cases) or MMPRT guide (19 cases). Three-dimensional computed tomography images of the tibial surface were evaluated using the Tsukada's measurement method postoperatively. The expected anatomic center of the MM posterior root attachment was defined as the center of three tangential lines referring to three anatomic bony landmarks (anterior border of the posterior cruciate ligament, lateral margin of the medial tibial plateau, and retro-eminence ridge). The expected anatomic center and tibial tunnel center were evaluated using the percentage-based posterolateral location on the tibial surface. The distance between the anatomic center and tunnel center was calculated.
RESULTS
The anatomic center of the MM posterior root footprint was located at a position of 79.2% posterior and 39.5% lateral. The mean of the tunnel center in the UMR guide was similar to that in the MMPRT guide (posterior direction, P = 0.096; lateral direction, P = 0.280). The mean distances between the tunnel center and the anatomic center were 4.06 and 3.99 mm in the UMR and MMPRT guide group, respectively (P = 0.455).
CONCLUSIONS
The UMR guide, as well as the MMPRT guide, is a useful device to create favorable tibial tunnels at the MM posterior root attachment for pullout repairs in patients with MMPRTs.
LEVEL OF EVIDENCE
IV.
目的
内侧半月板（MM）后根修复可预防内侧半月板后根撕裂（MMPRT）患者膝关节骨关节炎的快速进展。在经胫骨拉出修复术中，MM后根的解剖学重新附着被认为至关重要。然而，在解剖附着点创建胫骨隧道在技术上具有挑战性。我们假设一种新开发的点接触瞄准导向器[独角兽半月板后根（UMR）导向器]能够在比先前设计的MMPRT导向器更好的位置创建胫骨隧道。本研究的目的是比较两种半月板后根修复导向器创建的胫骨隧道位置。
材料与方法
38例患者接受了经胫骨拉出修复术。使用UMR导向器（19例）或MMPRT导向器（19例）进行胫骨隧道创建。术后采用冢田测量法评估胫骨表面的三维计算机断层扫描图像。MM后根附着的预期解剖中心定义为参照三个解剖骨性标志（后交叉韧带前缘、胫骨内侧平台外侧缘和后隆起嵴）的三条切线的中心。使用基于百分比的胫骨表面后外侧位置评估预期解剖中心和胫骨隧道中心。计算解剖中心与隧道中心之间的距离。
结果
MM后根足迹的解剖中心位于后方79.2%、外侧39.5%的位置。UMR导向器组的隧道中心平均值与MMPRT导向器组相似（后方方向，P = 0.096；外侧方向，P = 0.280）。UMR导向器组和MMPRT导向器组中隧道中心与解剖中心之间的平均距离分别为4.06和3.99毫米（P = 0.455）。
结论
UMR导向器与MMPRT导向器一样，是一种有用的装置，可在MMPRT患者的MM后根附着处创建有利的胫骨隧道，用于拉出修复。
证据等级
IV级。
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