Department of Orthopaedic Surgery, Jichi Medical University, Shimotsuke, Japan.
Department of Orthopaedic Surgery, Haga Red Cross Hospital, Moka, Japan.
J Knee Surg. 2022 Aug;35(10):1132-1137. doi: 10.1055/s-0040-1722568. Epub 2021 Jan 22.
Few studies have determined whether a femoral bone tunnel could be created behind the resident's ridge by using a transtibial (TT) technique-single bundle (SB)-anterior cruciate ligament (ACL) reconstruction. The aim of this study was to clarify (1) whether it is possible to create a femoral bone tunnel behind the resident's ridge by using the TT technique with SB ACL reconstruction, (2) to define the mean tibial and femoral tunnel angles during anatomic SB ACL reconstruction, and (3) to clarify the tibial tunnel inlet location when the femoral tunnel is created behind resident's ridge. Arthroscopic TT-SB ACL reconstruction was performed on 36 patients with ACL injuries. The point where 2.4-mm guide pin was inserted was confirmed, via anteromedial portal, to consider a location behind the resident's ridge. Then, an 8-mm diameter femoral tunnel with a 4.5-mm socket was created. Tunnel positions were evaluated by using three-dimensional computed tomography (3D-CT) 1 week postoperatively. Quadrant method and the resident's ridge on 3D-CT were evaluated to determine whether femoral tunnel position was anatomical. Radiological evaluations of tunnel positions yielded mean ( ± standard deviation) X- and Y-axis values for the tunnel centers: femoral tunnel, 25.2% ± 5.1% and 41.6% ± 10.2%; tibial tunnel, 49.2% ± 3.5%, and 31.5% ± 7.7%. The bone tunnels were anatomically positioned in all cases. The femoral tunnel angle relative to femoral axis was 29.4 ± 5.5 degrees in the coronal view and 43.5 ± 8.0 degrees in the sagittal view. The tibial tunnel angle relative to tibial axis was 25.5 ± 5.3 degrees in the coronal view and 52.3 ± 4.6 degrees in the sagittal view. The created tibial bone tunnel inlet had an average distance of 13.4 ± 2.7 mm from the medial tibial joint line and 9.7 ± 1.7 mm medial from the axis of the tibia. Femoral bone tunnel could be created behind the resident's ridge with TT-SB ACL reconstruction. The tibial bone tunnel inlet averaged 13.4 mm from the medial tibial joint line and 9.7 mm medial from the tibia axis.
很少有研究确定通过经胫骨（TT）技术-单束（SB）-前交叉韧带（ACL）重建是否可以在居民嵴后面创建股骨骨隧道。本研究的目的是澄清（1）是否可以通过 TT 技术和 SB ACL 重建在居民嵴后面创建股骨骨隧道，（2）定义解剖 SB ACL 重建过程中的胫骨和股骨隧道角度，以及（3）澄清当在居民嵴后面创建股骨隧道时胫骨隧道入口的位置。对 36 例 ACL 损伤患者进行关节镜 TT-SB ACL 重建。通过前内侧入路确认 2.4mm 导针插入的位置，以考虑位于居民嵴后面的位置。然后，用 8mm 直径和 4.5mm 套接的股骨隧道。术后 1 周通过三维 CT（3D-CT）评估隧道位置。使用象限法和 3D-CT 上的居民嵴评估股骨隧道位置是否为解剖学位置。隧道位置的放射学评估得出隧道中心 X 和 Y 轴值的平均值（ ± 标准偏差）：股骨隧道为 25.2% ± 5.1%和 41.6% ± 10.2%；胫骨隧道为 49.2% ± 3.5%和 31.5% ± 7.7%。所有情况下，骨隧道均定位解剖学位置。冠状视图中股骨隧道相对于股骨轴的角度为 29.4 ± 5.5 度，矢状视图中为 43.5 ± 8.0 度。冠状视图中胫骨隧道相对于胫骨轴的角度为 25.5 ± 5.3 度，矢状视图中为 52.3 ± 4.6 度。创建的胫骨骨隧道入口距内侧胫骨关节线平均距离为 13.4 ± 2.7 mm，距胫骨轴内侧距离为 9.7 ± 1.7 mm。TT-SB ACL 重建可在居民嵴后面创建股骨骨隧道。胫骨骨隧道入口距内侧胫骨关节线平均距离为 13.4mm，距胫骨轴内侧距离为 9.7mm。
