Moon Dong-Kyu, Jo Ho-Seung, Lee Dong-Yeong, Kang Dong-Geun, Won Hee-Chan, Seo Min-Seok, Hwang Sun-Chul
Department of Orthopaedic Surgery and Institute of Health Science, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Republic of Korea.
Department of Orthopaedic Surgery, Barun Hospital, Jinju, Republic of Korea.
Knee Surg Relat Res. 2021 Apr 14;33(1):13. doi: 10.1186/s43019-021-00092-5.
Notchplasty is a surgical technique often performed during anterior cruciate ligament reconstruction (ACLR) with widening of the intercondylar notch of the lateral distal femur to avoid graft impingement. The purpose of this study was to correlate femoral-tunnel length with 3-dimensional (3D) drilling angle through the anteromedial (AM) portal with and without notchplasty.
Computer data were collected from an anatomical study using 16 cadaveric knees. The anterior cruciate ligament (ACL) femoral insertion was dissected and outlined for gross anatomical observation. The dissected cadaveric knees were scanned by computed tomography (CT). Three-dimensional measurements were calculated using software (Geomagic, Inc., Research Triangle Park, NC, USA) and included the center of the ACL footprint and the size of the ACL femoral footprint. The femoral-tunnel aperture centers were measured in the anatomical posterior-to-anterior and proximal-to-distal directions using Bernard's quadrant method. The ACL tunnel was created 3-demensionally in the anatomical center of femoral foot print of ACL using software (SolidWorks®, Corp., Waltham, MA, USA). The 8-mm cylinder shaped ACL tunnel was rested upon the anatomical center of the ACL footprint and placed in three different positions: the coronal plane, the sagittal plane, and the axial plane. Finally, the effect of notchplasty on the femoral-tunnel length and center of the ACL footprint were measured. All the above-mentioned studies performed ACLR using the AM portal.
The length of the femoral tunnels produced using the low coronal and high axial angles with 5-mm notchplasty became significantly shorter as the femoral starting position became more horizontal. The result was 30.38 ± 2.11 mm on average at 20° in the coronal plane/70° in the axial plane/45° in the sagittal plane and 31.26 ± 2.08 mm at 30° in the coronal plane/60° in the axial plane/45° in the sagittal plane, respectively, comparing the standard technique of 45° in the coronal/45° in the axial/45° in the sagittal plane of 32.98 ± 3.04 mm (P < 0.001). The tunnels made using the high coronal and low axial angles with notchplasty became longer than those made using the standard technique: 40.31 ± 3.36 mm at 60° in the coronal plane/30° in the axial plane/45° in the sagittal plane and 50.46 ± 3.13 mm at 75° in the coronal plane/15° in the axial plane/45° in the sagittal plane (P < 0.001).
Our results show that excessive notchplasty causes the femoral tunnel to be located in the non-anatomical center of the ACL footprint and reduces the femoral-tunnel length. Therefore, care should be taken to avoid excessive notchplasty when performing this operation.
髁间窝成形术是在前交叉韧带重建（ACLR）过程中常采用的一种手术技术，通过扩大股骨外侧髁间窝来避免移植物撞击。本研究的目的是比较在有或没有髁间窝成形术的情况下，经前内侧（AM）入路时股骨隧道长度与三维（3D）钻孔角度的关系。
从一项使用16具尸体膝关节的解剖学研究中收集计算机数据。解剖前交叉韧带（ACL）的股骨附着点并勾勒轮廓，以便进行大体解剖观察。对解剖后的尸体膝关节进行计算机断层扫描（CT）。使用软件（美国北卡罗来纳州三角研究园的Geomagic公司）进行三维测量，包括ACL足迹中心和ACL股骨足迹大小。使用伯纳德象限法在解剖学的前后方向和近端到远端方向测量股骨隧道开口中心。使用软件（美国马萨诸塞州沃尔瑟姆的SolidWorks公司）在ACL股骨足迹的解剖学中心三维创建ACL隧道。将8毫米圆柱形ACL隧道置于ACL足迹的解剖学中心，并放置在三个不同位置：冠状面、矢状面和轴位面。最后，测量髁间窝成形术对股骨隧道长度和ACL足迹中心的影响。上述所有研究均通过AM入路进行ACLR。
在进行5毫米髁间窝成形术时，使用低冠状角和高轴角产生的股骨隧道长度随着股骨起始位置变得更水平而显著缩短。在冠状面20°/轴位面70°/矢状面45°时，平均结果为30.38±2.11毫米，在冠状面30°/轴位面60°/矢状面45°时为31.26±2.08毫米，而标准技术在冠状面4
