School of Exercise and Health, Shanghai University of Sport, Shanghai, China.
Department of Sports Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China.
Med Eng Phys. 2024 Jul;129:104190. doi: 10.1016/j.medengphy.2024.104190. Epub 2024 May 29.
Numerous studies have suggested that the primary cause of failure in transtibial anterior cruciate ligament reconstruction (ACLR) is often attributed to non-anatomical placement of the bone tunnels, typically resulting from improper tibial guidance. We aimed to establish the optimal tibial tunnel angle for anatomical ACLR by adapting the transtibial (TT) technique. Additionally, we aimed to assess graft bending angle (GBA) and length changes during in vivo dynamic flexion of the knee. Twenty knee joints underwent a CT scan and dual fluoroscopic imaging system (DFIS) to reproduce relative knee position during dynamic flexion. For the single-legged lunge, subjects began in a natural standing position and flexed the right knee beyond 90° When performing the lunge task, the subject supported the body weight on the right leg, while the left leg was used to keep the balance. The tibial and femoral tunnels were established on each knee using a modified TT technique for single-bundle ACLR. The tibial tunnel angulation to the tibial axis and the sagittal plane were measured. Considering that ACL injuries tend to occur at low knee flexion angles, GBA and graft length were measured between 0° and 90° of flexion in this study. The tibial tunnel angulated the sagittal plane at 42.8° ± 3.4°, and angulated the tibial axis at 45.3° ± 5.1° The GBA was 0° at 90° flexion of the knee and increased substantially to 76.4 ± 5.5° at 0° flexion. The GBA significantly increased with the knee extending from 90° to 0° (p < 0.001). The ACL length was 30.2mm±3.0 mm at 0° flexion and decreased to 27.5mm ± 2.8 mm at 90° flexion (p = 0.072). To achieve anatomic single-bundle ACLR, the optimal tibial tunnel should be angulated at approximately 43° to the sagittal plane and approximately 45° to the tibial axis using the modified TT technique. What's more, anatomical TT ACLR resulted in comparable GBA and a relatively constant ACL length from 0° to 90° of flexion. These findings provide theoretical support for the clinical application and the promotion of the current modified TT technique with the assistance of a robot to achieve anatomical ACLR.
大量研究表明，前交叉韧带重建（ACL）失败的主要原因通常归因于骨隧道的非解剖位置，这通常是由于胫骨引导不当所致。我们旨在通过适应经胫骨（TT）技术来确定解剖 ACLR 的最佳胫骨隧道角度。此外，我们旨在评估在膝关节体内动态屈曲过程中移植物弯曲角度（GBA）和长度的变化。二十个膝关节接受 CT 扫描和双荧光透视成像系统（DFIS）以复制膝关节在动态屈曲过程中的相对位置。对于单腿弓步，受试者从自然站立姿势开始，将右膝弯曲超过 90°。当执行弓步任务时，受试者将身体重量支撑在右腿上，而左腿用于保持平衡。使用改良的 TT 技术在每个膝关节上建立单束 ACLR 的胫骨和股骨隧道。测量胫骨隧道相对于胫骨轴和矢状面的角度。考虑到 ACL 损伤往往发生在膝关节低屈曲角度，因此本研究在 0°至 90°的屈曲范围内测量 GBA 和移植物长度。胫骨隧道在矢状面的角度为 42.8°±3.4°，在胫骨轴的角度为 45.3°±5.1°。GBA 在膝关节屈曲 90°时为 0°，在膝关节屈曲 0°时显著增加到 76.4°±5.5°。随着膝关节从 90°伸展到 0°，GBA 显著增加（p<0.001）。GBA 在 0°屈曲时为 30.2mm±3.0mm，在 90°屈曲时减小至 27.5mm±2.8mm（p=0.072）。为了实现解剖学上的单束 ACLR，使用改良的 TT 技术，最佳的胫骨隧道应相对于矢状面成约 43°，相对于胫骨轴成约 45°。此外，解剖 TT ACLR 导致 GBA 相似，并且从 0°到 90°的屈曲过程中 ACL 长度相对恒定。这些发现为当前改良 TT 技术的临床应用和推广提供了理论支持，该技术在机器人的辅助下可实现解剖学 ACLR。
