Li Xiaobo, Li Hanlin, Lu Jiajun, Ding Ran
Department of Orthopaedics, General Hospital of Central Theater Command of Chinese PLA, Wuhan Hubei, 430070, P. R. China.
The First School of Clinical Medicine, Southern Medical University, Guangzhou Guangdong, 510515, P. R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2024 Apr 15;38(4):498-504. doi: 10.7507/1002-1892.202401121.
To review the concept and methods of femoral bone tunnel positioning in anterior cruciate ligament (ACL) reconstruction, in order to provide a reference for clinical treatment.
The relevant literature on the concept and methods of femoral bone tunnel positioning in ACL reconstruction in domestic and international research was extensively reviewed.
The position of the femoral bone tunnel is a key factor in determining the prognosis of ACL reconstruction. The concept of femoral bone tunnel positioning in ACL reconstruction has experienced isometric reconstruction, anatomical reconstruction, Ribbon-like theory, I.D.E.A.L. theory, and nearly isometric reconstruction theory. The femoral bone tunnel positioning technique is also changing with the in-depth study of the anatomy and biomechanics of the ACL, and each bone tunnel positioning technique has its own advantages and disadvantages. Over-The-Top technique is now mainly used for ACL revision; the clock-face positioning method is basically no longer applicable due to the large error, poor stability, and low retrievability; the bone landmarks positioning method (the lateral condyle of the femur's Resident's ridge and bifurcation ridge, and the the apex of the deep cartilage), which is now mostly used clinically due to the more constant anatomical landmarks. The quadrant method under X-ray fluoroscopy is more cumbersome to implement intraoperatively, so it is mainly used for academic research; computer navigation-assisted positioning has gradually become popular in recent years, which is highly accurate, avoids the influence of human factors on the positioning of the bone tunnel, and has a very good prospect of application; three-dimensional printing-assisted positioning technology, which is accurate in positioning, with a high degree of reproducibility and a short learning curve.
The concept of femoral bone tunnel positioning for ACL reconstruction has undergone several evolutions, reflecting the deepening of the understanding of ACL and the improvement of the clinical results of reconstruction. The precision, personalization, and intelligence of positioning techniques are the focus of current and future development.
回顾前交叉韧带（ACL）重建中股骨骨隧道定位的概念和方法，为临床治疗提供参考。
广泛查阅国内外有关ACL重建中股骨骨隧道定位概念和方法的相关文献。
股骨骨隧道的位置是决定ACL重建预后的关键因素。ACL重建中股骨骨隧道定位的概念经历了等长重建、解剖重建、带状理论、IDEAL理论和近等长重建理论。股骨骨隧道定位技术也随着对ACL解剖学和生物力学研究的深入而不断变化，每种骨隧道定位技术都有其优缺点。过顶技术目前主要用于ACL翻修；时钟面定位法因误差大、稳定性差、可重复性低，基本不再适用；骨标志定位法（股骨外侧髁的住院医师嵴和分叉嵴以及深层软骨顶点），因其解剖标志较为恒定，目前在临床上应用较多。X线透视下的象限法术中实施较为繁琐，主要用于学术研究；计算机导航辅助定位近年来逐渐普及，定位精确，避免了人为因素对骨隧道定位的影响，应用前景良好；三维打印辅助定位技术定位准确，重复性高，学习曲线短。
ACL重建中股骨骨隧道定位的概念经历了多次演变，反映了对ACL认识的不断深入和重建临床效果的提高。定位技术的精准化、个性化和智能化是当前及未来发展的重点。
