Ghaffar Ahmed Abdul, Arora Rajesh, Agrawal Atul, Kumar Arvind, Maheshwari Rajesh
Orthopaedics, University College of Medical Science & Guru Teg Bahadur Hospital, New Delhi, IND.
Orthopaedics, Himalayan Institute of Medical Sciences, Dehradun, IND.
Cureus. 2022 Feb 5;14(2):e21948. doi: 10.7759/cureus.21948. eCollection 2022 Feb.
Introduction Transportal techniques for femoral tunnel drilling have the advantage of anatomical anterior cruciate ligament reconstruction, which was earlier difficult to achieve through transtibial femoral tunnels. However, the medial arthroscopic portal used for femoral tunnel drilling in single-bundle anterior cruciate ligament reconstruction (ACLR) has not been uniformly placed in different studies. Therefore, we performed a computed tomography-based analysis to compare the femoral tunnel entry aperture of the ACLR cases that used the standard AM portal and those using a far medial portal for femoral tunnel drilling. Methods We retrospectively reviewed computed tomography images of patients who underwent isolated single-bundle ACLR in our institute with either standard anteromedial portal or the far medial portal used for the femoral tunnel drilling. The femoral tunnel aperture's depth and height, measured using the quadrant method, were compared between the two portal methods. Results A total of forty-two case records were reviewed, sixteen belonging to standard anteromedial portal technique and twenty-six belonging to far medial portal technique. The tunnels created through the far AM portal were significantly shallower (more anterior) and inferior than the standard AM portal-created femoral tunnels. Conclusion The choice of drilling portals can influence transportal femoral tunnel drilling. A tendency towards anterior and inferior positioning of the femoral tunnel entry aperture has been observed when a far medial arthroscopic portal is used for femoral tunnel drilling. Therefore, care must be taken to ensure that the drilling guide pin position does not change when the reamer is passed over it.
股骨隧道钻孔的经髁间技术具有解剖学上重建前交叉韧带的优势，而这在早期通过经胫骨股骨隧道是难以实现的。然而，在单束前交叉韧带重建（ACLR）中用于股骨隧道钻孔的内侧关节镜入路在不同研究中的位置并不统一。因此，我们进行了一项基于计算机断层扫描的分析，以比较使用标准前内侧（AM）入路和远内侧入路进行股骨隧道钻孔的ACLR病例的股骨隧道入口孔径。
我们回顾性分析了在我院接受单纯单束ACLR且分别使用标准前内侧入路或远内侧入路进行股骨隧道钻孔的患者的计算机断层扫描图像。使用象限法测量两种入路方式下股骨隧道孔径的深度和高度，并进行比较。
共回顾了42例病例记录，其中16例属于标准前内侧入路技术，26例属于远内侧入路技术。通过远AM入路创建的隧道比标准AM入路创建的股骨隧道明显更浅（更靠前）且更低。
钻孔入路的选择会影响经髁间股骨隧道钻孔。当使用远内侧关节镜入路进行股骨隧道钻孔时，观察到股骨隧道入口孔径有向前和向下定位的趋势。因此，必须注意确保在扩孔钻穿过导针时其位置不变。
