Hodel Sandro, Mania Sylvano, Vlachopoulos Lazaros, Fürnstahl Philipp, Fucentese Sandro F
Department of Orthopedics, University of Zurich, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland.
Research in Orthopedic Computer Science (ROCS), University Hospital Balgrist, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
J Exp Orthop. 2021 Jun 25;8(1):44. doi: 10.1186/s40634-021-00364-9.
PURPOSE: To quantify the influence of the femoral tunnel exit (FTE) on the graft bending angle (GBA) and GBA-excursion throughout a full range of motion (ROM) in single-bundle anterior cruciate ligament (ACL) reconstruction. METHODS: Three-dimensional (3D) surface models of five healthy knees were generated from a weight-bearing CT obtained throughout a full ROM (0, 30, 60, 90, 120°) and femoral and tibial ACL insertions were computed. The FTE was simulated for 16 predefined positions, referenced to the Blumensaat's line, for each patient throughout a full ROM (0, 30, 60, 90, 120°) resulting in a total of 400 simulations. 3D GBA was calculated between the 3D directional vector of the ACL and the femoral tunnel, while the intra-articular ACL insertions remained unchanged. For each simulation the 3D GBA, GBA-excursion, tunnel length and posterior tunnel blow-out were analysed. RESULTS: Overall, mean GBA decreased with increasing knee flexion for each FTE (p < 0.001). A more distal location of the FTE along the Blumensaat's line resulted in an increase of GBA and GBA-excursion of 8.5 ± 0.6° and 17.6 ± 1.1° /cm respectively (p < 0.001), while a more anterior location resulted in a change of GBA and GBA-excursion of -2.3 ± 0.6° /cm (+ 0.6 ± 0.4°/ cm from 0-60° flexion) and 9.8 ± 1.1 /cm respectively (p < 0.001). Mean tunnel length was 38.5 ± 5.2 mm (range 29.6-50.5). Posterior tunnel blow-out did not occur for any FTE. CONCLUSION: Aiming for a more proximal and posterior FTE, with respect to Blumensaat's line, reliably reduces GBA and GBA-excursion, while preserving adequate tunnel length. This might aid to reduce excessive graft stress at the femoral tunnel aperture, decrease femoral tunnel widening and promote graft-healing. LEVEL OF EVIDENCE: IV.
目的:量化在单束前交叉韧带(ACL)重建的全关节活动范围(ROM)中,股骨隧道出口(FTE)对移植物弯曲角度(GBA)和GBA偏移的影响。 方法:从在全ROM(0、30、60、90、120°)下获得的负重CT生成五个健康膝关节的三维(3D)表面模型,并计算股骨和胫骨ACL附着点。在全ROM(0、30、60、90、120°)中,针对每位患者,将FTE模拟为相对于布卢门萨特线的16个预定义位置,共产生400次模拟。在ACL的3D方向向量与股骨隧道之间计算3D GBA,而关节内ACL附着点保持不变。对每次模拟分析3D GBA、GBA偏移、隧道长度和后隧道破裂情况。 结果:总体而言,每个FTE的平均GBA均随膝关节屈曲增加而降低(p <0.001)。FTE沿布卢门萨特线越靠远端的位置,分别导致GBA和GBA偏移增加8.5±0.6°和17.6±1.1°/cm(p <0.001),而越靠前的位置分别导致GBA和GBA偏移变化为-2.3±0.6°/cm(从0至60°屈曲为+0.6±0.4°/cm)和9.8±1.1 /cm(p <0.001)。平均隧道长度为38.5±5.2毫米(范围29.6 - 50.5)。未发生任何FTE的后隧道破裂情况。 结论:相对于布卢门萨特线,将FTE定位在更靠近近端和后方,可可靠地降低GBA和GBA偏移,同时保留足够的隧道长度。这可能有助于减少股骨隧道开口处移植物的过度应力,减少股骨隧道增宽并促进移植物愈合。 证据水平:IV级
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