Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
Department of Orthopedic Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea.
Knee Surg Sports Traumatol Arthrosc. 2022 Nov;30(11):3805-3817. doi: 10.1007/s00167-022-07007-1. Epub 2022 May 29.
To (1) evaluate the optimal drill orientation of the anterolateral ligament (ALL) femoral tunnel to minimize collision with the anterior cruciate ligament (ACL) femoral tunnel during anatomical ACL reconstruction according to the need for far-cortex drilling and (2) investigate the geometric factors that affect tunnel collision secondary to drill orientation of the ALL femoral tunnel.
A three-dimensional femoral model of patients who underwent anatomical single-bundle ACL reconstruction between 2015 and 2016 was constructed, and the geometric factors were evaluated. Virtual ALL femoral tunnels were created to simulate 45 drilling conditions. For each condition, whether the virtual ALL femoral tunnel and its trajectory violated the femoral cortex and the minimum distance between tunnels was investigated.
Thirty-nine subjects were included. Overall violation rates of the femoral cortex by the ALL tunnels and its trajectories were 11.1% (195 of 1755 conditions) and 40.7% (714 of 1755 conditions), respectively. A drilling angle of axial 0° and coronal - 40° showed the longest minimum distance between tunnels without femoral cortex violation by the ALL tunnel (6.3 ± 4.0 mm; collision rate 2.6% [1 of 39 subjects]). With simultaneous consideration of the ALL tunnel's trajectory representing far-cortex drilling, a drill angle of axial 40° and coronal 10° showed the longest minimum distance between tunnels without femoral cortex violation (0.6 ± 3.9 mm; collision rate 38.5% [15 of 39 subjects]). For surgical techniques requiring far-cortex drilling, regression analyses were performed on geometric factors that could affect tunnel collision, which revealed that the sagittal inclination angle of the ACL and the distance between the ACL femoral tunnel's outlet and ALL's femoral attachment were associated with tunnel collision.
The optimal drill orientations of the ALL femoral tunnel to minimize collision with the ACL femoral tunnel were axial 0° and coronal - 40° for surgical techniques not requiring far-cortex drilling and axial 40° and coronal 10° for techniques requiring far-cortex drilling. For techniques requiring far-cortex drilling, additional adjustment for orientation of the ACL femoral tunnel is required to reduce the risk of tunnel collision. Therefore, an individualized surgical strategy should be applied according to the graft fixation method of the ALL femoral tunnel.
（1）根据远皮质钻孔的需要，评估前外侧韧带（ALL）股骨隧道的最佳钻孔方向，以最大限度地减少在解剖学 ACL 重建过程中与前交叉韧带（ACL）股骨隧道发生碰撞；（2）研究影响 ALL 股骨隧道钻孔方向后隧道碰撞的几何因素。
构建了 2015 年至 2016 年间接受解剖学单束 ACL 重建的患者的三维股骨模型，并对几何因素进行了评估。创建了虚拟 ALL 股骨隧道，以模拟 45 种钻孔条件。对于每种情况，都检查了虚拟 ALL 股骨隧道及其轨迹是否侵犯了股骨皮质以及隧道之间的最小距离。
共纳入 39 例患者。总体上，ALL 隧道及其轨迹侵犯股骨皮质的发生率分别为 11.1%（1755 个条件中的 195 个）和 40.7%（1755 个条件中的 714 个）。轴向 0°和冠状 -40°的钻孔角度显示出最长的 ALL 隧道之间无股骨皮质侵犯的最小距离（6.3±4.0mm；碰撞率 2.6%[39 例患者中的 1 例]）。同时考虑到 ALL 隧道的轨迹代表远皮质钻孔，轴向 40°和冠状 10°的钻孔角度显示出最长的 ALL 隧道之间无股骨皮质侵犯的最小距离（0.6±3.9mm；碰撞率 38.5%[39 例患者中的 15 例]）。对于需要远皮质钻孔的手术技术，对可能影响隧道碰撞的几何因素进行了回归分析，结果表明 ACL 的矢状倾斜角和 ACL 股骨隧道出口与 ALL 股骨附着点之间的距离与隧道碰撞有关。
对于不需要远皮质钻孔的手术技术，ALL 股骨隧道的最佳钻孔方向为轴向 0°和冠状 -40°，对于需要远皮质钻孔的技术，最佳钻孔方向为轴向 40°和冠状 10°。对于需要远皮质钻孔的技术，需要对 ACL 股骨隧道的方向进行额外调整，以降低隧道碰撞的风险。因此，应根据 ALL 股骨隧道的移植物固定方法应用个体化手术策略。
