Orthopaedic Clinic, University of Florence, AOU Careggi, Florence, Italy.
Phys Sportsmed. 2021 May;49(2):171-175. doi: 10.1080/00913847.2020.1796469. Epub 2020 Jul 27.
Anterior cruciate ligament reconstruction (ACLR) with cortical fixation adjustable-loop devices are associated with high potential risk of button malpositioning or interposition of the soft tissue between lateral femoral cortex and the button. Surgeons usually use X-rays to check and avoid button malposition and soft tissue interposition. Arthroscopic visualization of button position through the lateral gutter has been described. With this technique, it is possible for identification and correction of femoral button malalignment in the setting of soft tissue interposition and it could avoid the use of post-operative X-ray.
A total of 193 ACLR were included and patients were randomized into two groups. The first series (Group A) of 112 patients who sustained an ACLR with post-operative X-ray to assess the position of the femoral button and the second series (Group B) of 81 patients who sustained an ACLR with an arthroscopic exploration of the button followed by post-operative X-ray.
On the post-operative radiographs, tissue interposition between the button and femoral cortex was found in nine cases of 112 in Group A (8%) and in zero case of 81 in Group B (0%). In six cases (7,4%) in Group B, there was a soft tissue interposition between the button and femoral cortex as visualized by arthroscopic confirmation and before post-operative X-ray; in all these cases, the soft tissue was removed, and the button was in contact with the bone in all X-ray made in the Group B.
This technique allows for identification and correction of femoral button malalignment in the setting of soft tissue interposition and reduces the use of post-operative X-ray.
前交叉韧带重建（ACL）采用皮质固定可调环装置，存在较高的纽扣位置不良或软组织嵌顿于股骨外侧皮质和纽扣之间的潜在风险。外科医生通常使用 X 射线检查以避免纽扣位置不良和软组织嵌顿。已经描述了通过外侧隐窝关节镜可视化纽扣位置的技术。通过该技术，可以在软组织嵌顿的情况下识别和纠正股骨纽扣的对线不良，并避免术后 X 射线的使用。
共纳入 193 例 ACL 重建患者，将患者随机分为两组。第一组（A 组）112 例患者接受 ACLR 后行 X 射线检查以评估股骨纽扣的位置，第二组（B 组）81 例患者接受 ACLR 后行关节镜探查纽扣，然后行 X 射线检查。
术后 X 射线片发现，A 组 112 例中有 9 例（8%）纽扣与股骨皮质之间存在软组织嵌顿，B 组 81 例中无 0 例（0%）。B 组中有 6 例（7.4%）患者在关节镜确认和术后 X 射线检查前纽扣与股骨皮质之间存在软组织嵌顿，所有这些病例均切除了软组织，B 组所有 X 射线片均显示纽扣与骨接触。
该技术可在软组织嵌顿的情况下识别和纠正股骨纽扣对线不良，并减少术后 X 射线的使用。
