Marchwiany Daniel A, Lee Cody, Ghobrial Philip, Lawley Richard, Chudik Steven C
Department of Orthopaedics, University of North Carolina Medical Center, Chapel Hill, North Carolina, U.S.A.
Pritzker School of Medicine at University of Chicago, Chicago, Illinois, U.S.A.
Arthrosc Sports Med Rehabil. 2020 Aug 20;2(5):e435-e442. doi: 10.1016/j.asmr.2020.04.002. eCollection 2020 Oct.
The purpose of this study was to use 3-dimensional magnetic resonance imaging modeling of the skeletally immature knee to help characterize safe and reproducible tunnel positions, diameters, lengths, trajectories, and distances from anatomic landmarks and the physeal and articular cartilage for physeal-sparing anterior cruciate ligament (ACL) reconstructive surgery.
Magnetic resonance imaging from 19 skeletally immature knees with normal anatomy were gathered. The 3-dimensional models were created, and the relevant anatomic structures were identified. Cylinders simulating tunnel length, diameter and trajectory were superimposed onto the models, and descriptive measurements were performed.
A safe position for the creation of an 8 mm diameter femoral tunnel was described in the lateral femoral condyle. The femoral tunnel length averaged 25.5 ± 2.6 mm. The bony entry point was located 3.8 ± 2.4 mm proximally and 12.7 ± 2.2 mm posteriorly to the lateral epicondyle. The shortest distance from the tunnel edge to the physis and femoral articular cartilage was 2.8 ± 0.7 mm and 3.7 ± 0.9 mm, respectively. The safe position for an 8 mm diameter tibial tunnel was also identified and described in the proximal tibia. The epiphyseal tibial tunnel length from the ACL footprint to the physis averaged 15.5 ± 1.6 mm. The proximal tibial epiphysis was found to accommodate a tibial crosspin measuring 63.5 ± 5.9 mm in length and 8.2 ± 1.5 mm in diameter without disrupting the physis or articular cartilage.
Three-dimensional modeling created from magnetic resonance imaging can help define important anatomic relationships for physeal-sparing ACL reconstructive surgery in skeletally immature knees and may assist in reducing the risk of injury to local anatomic structures.
Knowledge of the anatomic relationships in skeletally immature knees serves as a valuable reference for surgeons performing physeal-sparing ACL reconstruction surgery.
本研究的目的是利用骨骼未成熟膝关节的三维磁共振成像建模，以帮助确定安全且可重复的隧道位置、直径、长度、轨迹，以及与解剖标志、骨骺和关节软骨之间的距离，用于保留骨骺的前交叉韧带（ACL）重建手术。
收集了19例解剖结构正常的骨骼未成熟膝关节的磁共振成像。创建三维模型，并识别相关的解剖结构。将模拟隧道长度、直径和轨迹的圆柱体叠加到模型上，并进行描述性测量。
描述了在股骨外侧髁创建直径8 mm股骨隧道的安全位置。股骨隧道长度平均为25.5±2.6 mm。骨入口点位于外侧髁近端3.8±2.4 mm和后方12.7±2.2 mm处。从隧道边缘到骨骺和股骨关节软骨的最短距离分别为2.8±0.7 mm和3.7±0.9 mm。还确定并描述了在胫骨近端创建直径8 mm胫骨隧道的安全位置。从ACL足迹到骨骺的胫骨骨骺隧道长度平均为15.5±1.6 mm。发现胫骨近端骨骺可容纳长度为63.5±5.9 mm、直径为8.2±1.5 mm的胫骨交叉钉，而不会破坏骨骺或关节软骨。
由磁共振成像创建的三维建模可以帮助确定骨骼未成熟膝关节保留骨骺的ACL重建手术的重要解剖关系，并可能有助于降低局部解剖结构损伤的风险。
了解骨骼未成熟膝关节的解剖关系，对进行保留骨骺的ACL重建手术的外科医生具有重要的参考价值。
