Institut Universitaire Locomoteur et du Sport, Department of Orthopaedic Surgery, Centre Hospitalo-Universitaire de Nice, Nice, France.
Clinique rive Gauche, Toulouse, France.
Am J Sports Med. 2022 Feb;50(2):415-422. doi: 10.1177/03635465211061137. Epub 2021 Nov 30.
In anterior cruciate ligament (ACL) reconstruction with anterolateral ligament (ALL) reconstruction, precise positioning of the ALL graft on the femur and tibia is key to achieve rotational control. The lateral femoral epicondyle is often used as a reference point for positioning of the ALL graft and can be located by palpation or with ultrasound guidance.
To compare the ALL graft positioning on the femoral side between an ultrasound-guided technique and a palpation technique for the location of the lateral epicondyle.
Cohort study; Level of evidence, 2.
A total of 120 patients receiving a primary combined ACL and ALL reconstruction between June and December 2019 were included. The location of the lateral epicondyle was determined by palpation in the palpation group (n = 60) and with preoperative ultrasound guidance in the ultrasound group (n = 60). Groups were comparable in age, sex, body mass index (BMI), and operated side. The planned positioning of the femoral ALL graft was proximal and posterior to the lateral epicondyle. The effective positioning of the femoral ALL graft was evaluated on postoperative lateral radiographs. The primary outcome was location of the graft in a 10-mm quadrant posterior and proximal to the lateral epicondyle. Results were analyzed in 2 subgroups according to BMI.
All 60 anterolateral grafts (100%) in the ultrasound group were positioned in a 10-mm quadrant posterior and proximal to the lateral epicondyle, as opposed to 52 (87%) in the palpation group ( = .006). Errors in graft positioning with palpation occurred in overweight patients (BMI >25) as well as nonoverweight patients ( = .3).
Femoral positioning of the ALL graft posterior and proximal to the lateral epicondyle is more reproducible with ultrasound guidance when compared with palpation alone, regardless of BMI.
在前交叉韧带（ACL）重建联合前外侧韧带（ALL）重建中，准确将 ALL 移植物定位在股骨和胫骨上是实现旋转控制的关键。外侧股骨髁通常用作 ALL 移植物定位的参考点，可以通过触诊或超声引导来定位。
比较超声引导技术和外侧髁触诊技术在 ALL 移植物股骨侧定位中的效果。
队列研究；证据等级，2 级。
共纳入 2019 年 6 月至 12 月期间接受初次 ACL 和 ALL 联合重建的 120 例患者。触诊组（n = 60）通过触诊确定外侧髁的位置，超声组（n = 60）通过术前超声引导确定外侧髁的位置。两组在年龄、性别、体重指数（BMI）和手术侧方面具有可比性。计划将股骨 ALL 移植物定位于外侧髁的近端和后方。术后侧位 X 线片评估股骨 ALL 移植物的有效定位。主要结局是移植物位于外侧髁后 10mm 近端 10mm 象限内的位置。结果根据 BMI 分为 2 个亚组进行分析。
超声组的 60 个前外侧移植物（100%）均定位于外侧髁后 10mm 近端 10mm 象限内，而触诊组仅有 52 个（87%）（ =.006）。触诊组在超重（BMI >25）和非超重患者（ =.3）中，移植物定位存在误差。
与单独触诊相比，超声引导下 ALL 移植物在外侧髁后和近端的股骨定位更具可重复性，与 BMI 无关。
