Okazaki Narihiro, Shino Konsei, Yokoi Hiroyuki, Ohori Tomoki
Sports Orthopaedic Center Yukioka Hospital Osaka Japan.
Department of Orthopaedic Surgery Osaka University Graduate School of Medicine Suita Japan.
J Exp Orthop. 2025 Jan 3;12(1):e70125. doi: 10.1002/jeo2.70125. eCollection 2025 Jan.
To clarify the femoral tunnel location for a virtual anterior cruciate ligament (ACL) graft to simulate the native ACL.
Three-dimensional (3D) computed tomography (CT) and magnetic resonance imaging (MRI) were obtained in 14 normal knees in full extension. Two types of virtual triple bundle ACL grafts (VACLG) were created. In one type, the femoral tunnels for anteromedial bundle (AM = AMM/anteromedial bundle medial part + AML/anteromedial bundle lateral part) and posterolateral bundle (PL) were positioned behind the resident's ridge (RR) based on the bone landmark strategy (BR-VACLG group). In the other type, the tunnels were placed on the RR (OR-VACLG group). VACLG was displayed as three straight lines by connecting the two centres of the femoral attachment areas of AM and PL to those of the three tibial footprints of AMM, AML and PL attachments on 3D CT, and then superimposed on MRI. The ACL/ACL graft-the tibial plateau (ACL-TP) angles were compared among normal ACL (N-ACL), BR-VACLG and OR-VACLG.
The mean ACL-TP angles of N-ACL, BR-VACLG and OR-VACLG were 74.4 ± 3.4°, 75.2 ± 4.5° and 68.7 ± 5.0° for AMM, 81.9 ± 3.8°, 82.9 ± 5.1° and 76.3 ± 4.0° and for AML, 71.1 ± 6.4°, 70.0 ± 7.2° and 61.0 ± 4.7° for PL on the oblique-coronal slices; 55.3 ± 4.9° 53.9 ± 4.4° and 50.5 ± 4.3° for AMM; 54.9 ± 4.5°, 54.7 ± 2.6° and 50.7 ± 3.2° for AML; 51.4 ± 3.3°, 51.2 ± 2.4° and 48.1 ± 2.0° for PL on the oblique-sagittal slices. There was no significant difference in the angles between N-ACL and BR-VACLG, while those of AMM and PL in OR-VACLG were significantly lower compared to N-ACL.
The virtual triple bundle ACL graft via femoral tunnels behind the RR on 3D CT shows equivalent orientation to the native ACL on MRI in full extension.
Level III.
明确虚拟前交叉韧带（ACL）移植物的股骨隧道位置，以模拟天然ACL。
对14例正常膝关节在完全伸直位进行三维（3D）计算机断层扫描（CT）和磁共振成像（MRI）检查。创建了两种类型的虚拟三束ACL移植物（VACLG）。在一种类型中，基于骨标志策略，前内侧束（AM = AMM/前内侧束内侧部分 + AML/前内侧束外侧部分）和后外侧束（PL）的股骨隧道位于髁间嵴（RR）后方（BR-VACLG组）。在另一种类型中，隧道位于RR上（OR-VACLG组）。通过在3D CT上连接AM和PL股骨附着区域的两个中心与AMM、AML和PL附着的三个胫骨足迹的中心，将VACLG显示为三条直线，然后叠加在MRI上。比较正常ACL（N-ACL）、BR-VACLG和OR-VACLG之间的ACL/ACL移植物-胫骨平台（ACL-TP）角度。
在斜冠状面上，N-ACL、BR-VACLG和OR-VACLG的AMM的平均ACL-TP角度分别为74.4±3.4°、75.2±4.5°和68.7±5.0°；AML分别为81.9±3.8°、82.9±5.1°和76.3±4.0°；PL分别为71.1±6.4°、70.0±7.2°和61.0±4.7°；在斜矢状面上，AMM分别为55.3±4.9°、53.9±4.4°和50.5±4.3°；AML分别为54.9±4.5°、54.7±2.6°和50.7±3.2°；PL分别为51.4±3.3°、51.2±2.4°和48.1±2.0°。N-ACL和BR-VACLG之间的角度无显著差异，而OR-VACLG中AMM和PL的角度与N-ACL相比显著更低。
3D CT上RR后方股骨隧道的虚拟三束ACL移植物在完全伸直位的MRI上显示出与天然ACL等效的方向。
III级。
