Orthopaedics Department, Parc Taulí Hospital Universitari, Institut d'Investigació I Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain.
3D Surgical Planning Lab., Parc Taulí Hospital Universitari, Institut d'Investigació I Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, 08208, Sabadell, Spain.
Int Orthop. 2023 May;47(5):1213-1219. doi: 10.1007/s00264-023-05712-1. Epub 2023 Feb 17.
Multiple-ligament knee reconstruction techniques often involve the creation of several bone tunnels for various reconstruction grafts. A critical step in this procedure is to avoid short tunnels or convergences among them. Currently, no specific template guide to reproduce these angulations has been reported in the literature, and the success of the technique still depends on the experience of the surgeon. The aim of this study is to analyze the accuracy and reliability of 3D-printed patient-specific instrumentation (PSI) for lateral and medial anatomical knee reconstructions.
Ten cadaveric knees were scanned by computed tomography (CT). Using specific computer software, anatomical femoral attachments were identified: (1) on the lateral side the lateral collateral ligament (LCL) and the popliteal tendon (PT) and (2) on the medial side the medial collateral ligament (MCL) and the posterior oblique ligament (POL). Four bone tunnels were planned for each knee, and PSI with different directions were designed as templates to reproduce the planned tunnels during surgery. Twenty 3D-printed PSI were used: ten were tailored to the medial side for reconstructing MCL and POL tunnels, and the other ten were tailored to the lateral side for reconstructing LCL and PT tunnels. Postoperative CT scans were made for each cadaveric knee. The accuracy of the use of 3D-printed PSI was assessed by superimposing post-operative CT images onto pre-operative images and analyzing the deviation of tunnels performed based on the planning, specifically the entry point and the angular deviations.
The median entry point deviations for the tunnels were as follows: LCL tunnel, 1.88 mm (interquartile range (IQR) 2.2 mm); PT tunnel, 2.93 mm (IQR 1.17 mm); MCL tunnel, 1.93 mm (IQR 4.26 mm); and POL tunnel, 2.16 mm (IQR 2.39). The median angular deviations for the tunnels were as follows: LCL tunnel, 2.42° (IQR 6.49°); PT tunnel, 4.15° (IQR 6.68); MCL tunnel, 4.50° (IQR 6.34°); and POL tunnel, 4.69° (IQR 3.1°). No statistically significant differences were found in either the entry point or the angular deviation among the different bone tunnels.
The use of 3D-printed PSI for lateral and medial anatomical knee reconstructions provides accurate and reproducible results and may be a promising tool for use in clinical practice.
多韧带膝关节重建技术通常涉及为各种重建移植物创建多个骨隧道。该手术过程中的一个关键步骤是避免隧道过短或彼此汇聚。目前，文献中尚无报道专门用于复制这些角度的特定模板引导器，该技术的成功仍然取决于外科医生的经验。本研究旨在分析用于外侧和内侧解剖膝关节重建的 3D 打印患者特异性器械（PSI）的准确性和可靠性。
对 10 个尸体膝关节进行计算机断层扫描（CT）扫描。使用特定的计算机软件，确定解剖股骨附着点：（1）外侧为外侧副韧带（LCL）和腘肌腱（PT），（2）内侧为内侧副韧带（MCL）和后斜韧带（POL）。为每个膝关节计划了四个骨隧道，并设计了具有不同方向的 PSI 作为模板，以在手术中复制计划的隧道。使用了 20 个 3D 打印 PSI：十个用于重建 MCL 和 POL 隧道的内侧 PSI，另十个用于重建 LCL 和 PT 隧道的外侧 PSI。对每个尸体膝关节进行术后 CT 扫描。通过将术后 CT 图像与术前图像叠加并分析基于计划的隧道偏差，特别是入口点和角度偏差，评估使用 3D 打印 PSI 的准确性。
隧道的中位入口点偏差如下：LCL 隧道，1.88mm（四分位距（IQR）2.2mm）；PT 隧道，2.93mm（IQR 1.17mm）；MCL 隧道，1.93mm（IQR 4.26mm）；和 POL 隧道，2.16mm（IQR 2.39mm）。隧道的中位角度偏差如下：LCL 隧道，2.42°（IQR 6.49°）；PT 隧道，4.15°（IQR 6.68°）；MCL 隧道，4.50°（IQR 6.34°）；和 POL 隧道，4.69°（IQR 3.1°）。不同骨隧道之间在入口点或角度偏差方面均无统计学差异。
使用 3D 打印 PSI 进行外侧和内侧解剖膝关节重建可提供准确且可重复的结果，可能是临床实践中一种有前途的工具。
