Department of Orthopedics, Sun Yat-Sen Memorial Hospital, No. 107 on Yanjiang Road West, Guangzhou, 510120, Guangdong, China.
Sun Yat-Sen University, Guangzhou, Guangdong, China.
Knee Surg Sports Traumatol Arthrosc. 2023 Oct;31(10):4546-4550. doi: 10.1007/s00167-023-07452-6. Epub 2023 Jun 12.
There is currently no consensus on the optimal drilling direction of the fibular bone tunnel for anterior talofibular ligament (ATFL) reconstruction, and few studies have investigated the potential injury to the peroneus longus and brevis tendons and the possibility of fibular fractures during the drilling process. The aim of this study was to assess the potential risk of drilling the tunnel from different directions and determine the most appropriate tunnel direction. The hypothesis was that drilling the tunnel in the 45-degree direction would be the safest and most suitable for the fibular tunnel.
Forty-eight fibular tunnels were drilled on fresh ankle specimens using a K-wire guide and a 5.0 mm hollow drill. Three tunnel orientations were created, parallel to the sagittal plane of the long axis of the fibula and angled 30°, 45°, and 60° to the coronal plane. The length of the fibular tunnel and the distances from the outlet of the K-wire to the peroneus longus and brevis tendons were measured. The occurrence of a fibula fracture was also observed.
The lengths of the bone tunnels in the three groups were 32.9 ± 6.1 mm (30°), 27.2 ± 4.4 mm (45°) and 23.6 ± 4.0 mm (60°). The length of the tunnel drilled at 30° was the longest when compared with that of the tunnels drilled at 45° and 60° (all p values < 0.05). The distances from the outlet of the K-wire to the peroneus longus tendon were 3.0 ± 3.8 mm (30°), 3.8 ± 3.2 mm (45°) and 5.3 ± 1.8 mm (60°), and the distances to the peroneus brevis tendon were 4.2 ± 4.0 mm (30°), 6.1 ± 3.8 mm (45°), 7.9 ± 3.5 mm (60°). In terms of protecting the peroneus longus and brevis tendons, drilling in the 60° direction was better than drilling in the 30° and 45° directions (all p values < 0.05). The risk of injury to the peroneal longus and brevis tendons was 62.5% (30°), 31.3% (45°), and 0% (60°). Although no fibular fractures were observed in any of the three directions, drilling the bone tunnel in the 60° direction disrupted the lateral cortex of the fibula.
This study shows that drilling the tunnel in the 45° direction is less likely to cause injury to the peroneus longus and brevis tendons, while ensuring that the tunnel has a sufficient length and avoiding fracturing the distal fibula. Drilling a fibular bone tunnel in a 45° direction is safer and recommended for ATFL reconstruction.
目前对于前距腓韧带（ATFL）重建中腓骨骨隧道的最佳钻孔方向尚无共识，并且很少有研究探讨在钻孔过程中对腓骨长短肌的潜在损伤以及腓骨骨折的可能性。本研究旨在评估从不同方向钻孔的潜在风险，并确定最合适的隧道方向。假设以 45 度角钻孔隧道是最安全和最适合腓骨隧道的。
使用 K 线引导和 5.0 毫米空心钻在新鲜的踝关节标本上钻 48 个腓骨隧道。创建了三个隧道方向，与腓骨长轴的矢状面平行，并与冠状面成 30°、45°和 60°角。测量腓骨隧道的长度以及 K 线出口到腓骨长短肌的距离。还观察了腓骨骨折的发生情况。
三组骨隧道的长度分别为 32.9±6.1mm（30°）、27.2±4.4mm（45°）和 23.6±4.0mm（60°）。与 45°和 60°相比，30°钻孔的隧道长度最长（所有 p 值均<0.05）。K 线出口到腓骨长肌的距离分别为 3.0±3.8mm（30°）、3.8±3.2mm（45°）和 5.3±1.8mm（60°），到腓骨短肌的距离分别为 4.2±4.0mm（30°）、6.1±3.8mm（45°）、7.9±3.5mm（60°）。在保护腓骨长肌和腓骨短肌方面，60°方向钻孔优于 30°和 45°方向钻孔（所有 p 值均<0.05）。腓骨长肌和腓骨短肌损伤的风险分别为 62.5%（30°）、31.3%（45°）和 0%（60°）。尽管在这三个方向都没有观察到腓骨骨折，但 60°方向的骨隧道钻孔会破坏腓骨的外侧皮质。
本研究表明，45°方向钻孔不太可能损伤腓骨长短肌，同时确保隧道有足够的长度，并避免远端腓骨骨折。45°方向的腓骨骨隧道钻孔更安全，推荐用于 ATFL 重建。
