Sanada Takaki, Iwaso Hiroshi, Honda Eisaburo, Yoshitomi Hiroki, Inagawa Miyu
Department of Sports Orthopedic Surgery, Kanto-Rosai Hospital, Kanagawa, Japan.
Arthrosc Sports Med Rehabil. 2021 Dec 24;4(2):e435-e445. doi: 10.1016/j.asmr.2021.10.021. eCollection 2022 Apr.
To evaluate the femoral and tibial tunnel positions via a modified anatomic transtibial double-bundle anterior cruciate ligament (ACL) reconstruction.
Patients who underwent double-bundle ACL reconstruction using the transtibial tunnel creation technique were identified. Double-bundle ACL reconstruction was performed for 94 knees using the transtibial tunnel creation technique. Tunnel aperture configurations and center positions of the anteromedial (AM) and posterolateral (PL) tunnels via postoperative 3-dimensional computed tomography were evaluated.
There were 94 knees included. Regarding the intra-articular tunnel aperture configurations, the AM and PL tunnels overlapped at the femoral and tibial aperture in 66.0% and 94.7% cases, respectively. The mean femoral bone tunnel center was located at 23.0 ± 3.9% in the posterior-to-anterior ratio and 28.7 ± 6.0% in the proximal-to-distal ratio for the AM tunnels and at 32.8 ± 4.7% and 51.2 ± 5.2% for the PL tunnels, respectively. In the tibial tunnels, the mean AM tunnel center was located at 31.4 ± 3.6% in the anterior-to-posterior ratio and 44.3 ± 1.8% in the medial-to-lateral ratio and at 47.5 ± 3.8% and 44.3 ± 1.9% in the PL tunnel center, respectively. The femoral tunnels of outliers, both those created in nonanatomic positions as well as the posterior wall blowouts, were revealed in 7.4% cases. The nonanatomical bone tunnel group had significant heavier weight patients, lower tibial posterior slope, and were anterior in the AM and PL tunnel position. Posterior wall blowouts were related to posterior and proximal PL bone tunnel positions.
Modified transtibial double-bundle ACL reconstruction is a reliable tunnel creation technique with anatomic placement in 92.6% of the cases. The modification required that partially superimposing configuration of the 2 tibial tunnel apertures. The nonanatomic tunnels were related to patients of heavier weight and lower tibial posterior sloped knees, whereas the posterior wall blowouts were related to the posterior and proximal PL bone tunnel positions.
Level IV, therapeutic case series.
通过改良解剖经胫骨双束前交叉韧带（ACL）重建术评估股骨和胫骨隧道位置。
纳入采用经胫骨隧道创建技术进行双束ACL重建的患者。对94例膝关节采用经胫骨隧道创建技术进行双束ACL重建。通过术后三维计算机断层扫描评估前内侧（AM）和后外侧（PL）隧道的隧道孔径形态及中心位置。
共纳入94例膝关节。关于关节内隧道孔径形态，AM和PL隧道在股骨和胫骨孔径处的重叠率分别为66.0%和94.7%。AM隧道的平均股骨骨隧道中心位于前后比的23.0±3.9%和远近比的28.7±6.0%处，PL隧道分别位于32.8±4.7%和51.2±5.2%处。在胫骨隧道中，AM隧道平均中心位于前后比的31.4±3.6%和内外比的44.3±1.8%处，PL隧道中心分别位于47.5±3.8%和44.3±1.9%处。7.4%的病例中发现了异常值的股骨隧道，包括非解剖位置创建的以及后壁爆裂的情况。非解剖骨隧道组患者体重显著更重，胫骨后倾角度更低，且AM和PL隧道位置靠前。后壁爆裂与PL骨隧道的后部和近端位置有关。
改良经胫骨双束ACL重建是一种可靠的隧道创建技术，92.6%的病例中隧道位置符合解剖学要求。改良要求两个胫骨隧道孔径部分重叠。非解剖隧道与体重较重和胫骨后倾角度较低的膝关节患者有关，而后壁爆裂与PL骨隧道的后部和近端位置有关。
IV级，治疗性病例系列。
