The Third Clinical Medical School, Guangzhou University of Chinese Medicine, No. 232, Outer Ring East Road, Guangzhou University City, Panyu District, Guangzhou City, Guangdong Province, China.
Department of Knee Joint Sports Injury, Sichuan Provincial Orthopedic Hospital, No. 132, West Section, First Ring Road, Sichuan Province, Chengdu, China.
BMC Musculoskelet Disord. 2022 Mar 25;23(1):288. doi: 10.1186/s12891-022-05250-8.
To determine the characteristics of cross-pin protrusion in patients treated with the reverse Rigidfix femoral fixation device for femoral tunnel preparation through the anteromedial portal in Arthroscopic anterior cruciate ligament reconstruction (ACLR), analyse the reasons for this outcome, and identify safety hazards of this surgical technique for improvement.
A retrospective analysis of patients who underwent ACLR using this technology at our hospital in 2018 was conducted. Patients with and without cross-pin protrusion were included in the protrusion positive and negative groups, respectively. The sex, age and imaging characteristics of the patients with cross-pin protrusion were identified, and the reasons for cross-pin protrusion were analysed.
There were 64 and 212 patients in the protrusion positive and negative groups, respectively. The proportion of cross-pin protrusion cases was 23.19% (64/276). There was a significant difference in the ratio of males to females (P < 0.001, χ2 = 185.184), the mediolateral femoral condyle diameter (protrusion positive group, 70.59 ± 2.51 mm; protrusion negative group, 82.65 ± 4.16 mm; P < 0.001, t = 28.424), and the anteroposterior diameter of the lateral femoral condyle (protrusion positive group, 58.34 ± 2.89 mm; protrusion negative group, 66.38 ± 3.53 mm; P < 0.001, t = 16.615). The cross-pins did not penetrate the lateral femoral condyle cortex in patients with a mediolateral femoral condyle diameter ≥ 76 mm, but the cross-pins definitely penetrated the cortex when the diameter was ≤ 70 mm. The cross-pins did not penetrate when the anteroposterior lateral femoral condyle diameter was ≥ 66 mm, but the cross-pins definitely penetrated it when the diameter was ≤ 59 mm.
The patients with cross-pin protrusion after reverse Rigidfix femoral fixation treatment to prepare the femoral tunnel through the anteromedial portal in ACLR were mainly females with small femoral condyles. For patients with a mediolateral femoral condyle diameter ≥ 76 mm and an anteroposterior lateral femoral condyle diameter ≥ 66 mm, there is no risk of cross-pin protrusion, so this technique can be used with confidence.
III.
为了确定使用反向 Rigidfix 股骨固定装置通过关节镜前交叉韧带重建（ACLR）前内侧入路制备股骨隧道时出现交叉钉突出的患者的特征，分析该结果的原因，并确定该手术技术的安全隐患，以便改进。
对 2018 年在我院使用该技术进行 ACLR 的患者进行回顾性分析。将有和无交叉钉突出的患者分别纳入突出阳性和阴性组。确定交叉钉突出患者的性别、年龄和影像学特征，并分析交叉钉突出的原因。
突出阳性和阴性组分别有 64 例和 212 例患者。交叉钉突出病例的比例为 23.19%（64/276）。男性与女性的比例有显著差异（P<0.001，χ2=185.184），股骨干内外侧髁直径（突出阳性组为 70.59±2.51mm；突出阴性组为 82.65±4.16mm；P<0.001，t=28.424），以及外侧股骨髁的前后直径（突出阳性组为 58.34±2.89mm；突出阴性组为 66.38±3.53mm；P<0.001，t=16.615）。当股骨干内外侧髁直径≥76mm 时，交叉钉未穿透外侧股骨髁皮质，但当直径≤70mm 时，交叉钉肯定穿透皮质。当外侧股骨髁前后径≥66mm 时，交叉钉未穿透，但当直径≤59mm 时，交叉钉肯定穿透。
使用反向 Rigidfix 股骨固定装置通过前内侧入路治疗后，出现交叉钉突出的 ACLR 患者主要为股骨髁较小的女性。对于股骨干内外侧髁直径≥76mm 且前后外侧股骨髁直径≥66mm 的患者，不存在交叉钉突出的风险，因此可以放心使用该技术。
III 级。
