Lamplot Joseph D, Petit Camryn B, Thompson Dan, Xerogeanes John W, Gonzalez Felix M, Diekfuss Jed A, Myer Gregory D, Jimenez Megan Lisset
Emory Sports Performance And Research Center (SPARC), Flowery Branch, Atlanta, Georgia.
Emory Sports Medicine Center, Atlanta, Georgia.
Arthrosc Sports Med Rehabil. 2022 Dec 28;5(1):e217-e224. doi: 10.1016/j.asmr.2022.11.017. eCollection 2023 Feb.
To evaluate the reliability and accuracy of a method of placing the femoral fixation location for lateral extra-articular tenodesis (LET) within a safe isometric area using anatomic landmarks.
Using a pilot cadaveric specimen, the center of the radiographic safe isometric area for femoral fixation of LET, defined as a 1 cm (proximal-distal) area located proximal to the metaphyseal flare and posterior to the posterior cortical extension line (PCEL), was located using fluoroscopy and found to be 20 mm directly proximal to the center of the fibular collateral ligament (FCL) origin. Using 10 additional specimens, the center of the FCL origin and a location 20 mm directly proximal was identified. K-wires were placed at each location. A lateral radiograph was obtained, and distances of the proximal K-wire relative to the PCEL and metaphyseal flare were measured. The location of the proximal K-wire relative to the radiographic safe isometric area was assessed by 2 independent observers. Intrarater and inter-rater reliability was calculated for all measurements using intraclass coefficients (ICCs).
There was excellent intrarater and inter-rater reliability for all radiographic measurements (.908 to .975 and .968 to .988, respectively). In 5/10 specimens, the proximal K-wire was outside of the radiographic safe isometric area, with 4/5 anterior to the PCEL. Overall, the mean distance from the PCEL was 1 mm ± 4 mm (anterior), and the mean distance from the metaphyseal flare was 7.4 mm ± 2.9 mm (proximal).
A landmark-based technique referencing the FCL origin was inaccurate in the placement of femoral fixation within a radiographic safe isometric area for LET. Therefore intraoperative imaging should be considered to ensure accurate placement.
These findings may help to decrease the likelihood of misplacement of femoral fixation during LET by showing that landmark-based methods without intraoperative image guidance may be unreliable.
评估一种利用解剖标志将股骨固定位置放置在外侧关节外肌腱固定术（LET）安全等距区域内的方法的可靠性和准确性。
使用一具尸体标本作为试点，通过透视定位LET股骨固定的X线安全等距区域的中心，该区域定义为位于干骺端膨大近端且在皮质后延伸线（PCEL）后方的1厘米（近端 - 远端）区域，发现其位于腓侧副韧带（FCL）起点中心直接近端20毫米处。使用另外10个标本，确定FCL起点中心和直接近端20毫米处的位置。在每个位置放置克氏针。获取一张侧位X线片，测量近端克氏针相对于PCEL和干骺端膨大的距离。由2名独立观察者评估近端克氏针相对于X线安全等距区域的位置。使用组内相关系数（ICC）计算所有测量的观察者内和观察者间可靠性。
所有X线测量的观察者内和观察者间可靠性都非常好（分别为0.908至0.975和0.968至0.988）。在10个标本中的5个中，近端克氏针位于X线安全等距区域之外，其中4/5位于PCEL前方。总体而言，距PCEL的平均距离为1毫米±4毫米（前方），距干骺端膨大的平均距离为7.4毫米±2.9毫米（近端）。
在LET的X线安全等距区域内，基于FCL起点的标志技术在股骨固定位置放置上不准确。因此应考虑术中成像以确保准确放置。
这些发现表明在没有术中图像引导的情况下基于标志的方法可能不可靠，这可能有助于降低LET期间股骨固定位置错误的可能性。
