Department of Sports Medicine, the Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China.
Knee Surg Sports Traumatol Arthrosc. 2023 Aug;31(8):3390-3398. doi: 10.1007/s00167-023-07412-0. Epub 2023 Apr 11.
To investigate the relationship between the medial and posteromedial femoral anatomic structures and the femoral tunnel exit produced by different tunnel orientations when creating the femoral tunnel for posterior cruciate ligament reconstruction (PCLR) using the inside-out (IO) technique and to estimate safe tunnel orientations to minimize the risk of iatrogenic injury to these structures.
Eleven cadaveric knees were used. The medial and posteromedial aspects of each knee joint were dissected to reveal the "safe zone," which is a bony area that avoids the distribution or attachment of at-risk structures (MCL, PMC structures, and articular cartilage), while remaining 10 mm away from the articular cartilage. The hypothesis of this study was that by creating the femoral tunnel at specific angles using the IO technique, the tunnel outlet would be as close to the safe zone as possible, protecting the at-risk structures from damage. Femoral tunnels were drilled at 20 different angle combinations on each specimen: 0°, 15°, 30°, 45°, and 60° relative to a line parallel to the transepicondylar axis in the axial plane, as well as 15°, 30°, 45°, and 60° relative to a line parallel to the femoral axis in the coronal plane. The positional relationship between each tunnel exit and the safe zone was recorded, and the shortest distance between the exit center and the safe zone boundary was measured.
The risk of iatrogenic injury differed depending on the drilling orientation (χ = 168.880, P < 0.001). Femoral drilling angle combinations of 45/45°, 45/60°, 60/30°, 60/45°, and 60/60° (axial/coronal) were considered relatively safer than other orientations (P < 0.05). The shortest distance between the tunnel exit and the safe zone boundary was negatively correlated with the angle in the axial plane (P < 0.001, r = - 0.810).
When creating the IO femoral tunnel for single-bundle PCL reconstruction, angle combinations of 45/45°, 45/60°, 60/30°, 60/45°, and 60/60° (axial/oblique coronal) could be utilized to prevent at-risk structures from being damaged. The drilling angles and the safe zone can be employed to optimize the femoral tunnel in PCLR.
研究使用经皮内固定（IO）技术进行后交叉韧带重建（PCLR）时，不同隧道方向下股骨内侧和后内侧解剖结构与股骨隧道出口之间的关系，并估计安全的隧道方向，以最大程度地降低对这些结构造成医源性损伤的风险。
本研究使用了 11 个尸体膝关节。每个膝关节的内侧和后内侧均进行解剖，以显露“安全区”，这是一个避开高危结构（MCL、PMC 结构和关节软骨）分布或附着的骨区，同时距关节软骨 10mm 以上。本研究的假设是，通过使用 IO 技术以特定角度创建股骨隧道，隧道出口将尽可能接近安全区，从而保护高危结构免受损伤。在每个标本上以 20 种不同的角度组合钻取股骨隧道：矢状面中与髁间轴平行的线的 0°、15°、30°、45°和 60°，以及冠状面中与股骨干平行的线的 15°、30°、45°和 60°。记录每个隧道出口与安全区之间的位置关系，并测量出口中心与安全区边界之间的最短距离。
医源性损伤的风险因钻孔方向而异（χ=168.880，P<0.001）。45/45°、45/60°、60/30°、60/45°和 60/60°（轴向/冠状）的股骨钻取角度组合被认为比其他方向更安全（P<0.05）。隧道出口与安全区边界之间的最短距离与矢状面中的角度呈负相关（P<0.001，r=-0.810）。
在进行单束 PCL 重建的 IO 股骨隧道时，可采用 45/45°、45/60°、60/30°、60/45°和 60/60°（轴向/斜冠状）的角度组合来防止高危结构受损。可以利用钻孔角度和安全区来优化 PCLR 中的股骨隧道。
