Khan Shehzaad A, Spalding Tim
University Hospitals Coventry and Warwickshire National Health Services Trust, Coventry, UK.
Cleveland Clinic London, London, UK.
Video J Sports Med. 2024 Sep 4;4(5):26350254241233595. doi: 10.1177/26350254241233595. eCollection 2024 Sep-Oct.
Anterior cruciate ligament (ACL) tunnel placement has been long debated for many years. Femoral tunnel mal-position is the commonest technical error resulting in early ACL laxity and failure. There are many different methods to achieve accurate femoral tunnel position. In this video, we describe use of a novel femoral jig aiming device to drill a reliably and easily reproducible femoral tunnel for primary ACL reconstruction (ACLR).
This femoral jig aiming device is indicated for all patients undergoing primary ACLR with any graft chosen by the surgeon. This jig is particularly useful for the inexperienced and low volume ACLR surgeon.
An appropriate graft is harvested and prepared according to preferred techniques and the diameter of the graft to be inserted in the femoral tunnel is measured. The femoral notch is prepared, ensuring appropriate tissue is cleared to view the apex of the deep cartilage (ADC). The Infinity anteromedial (AM) femoral guide (Conmed), is inserted through the AM portal and hooked onto the notch just proximal to the ADC. In deep flexion, the guide wire is advanced and the tunnel reamed, aiming to preserve 2.0 to 2.5 mm of bone.
19 consecutive patients were operated on. There were no complications during the intra- and postoperative period. There have been no reported failures or graft ruptures. All tunnels (100%) were centered in the footprint. The mean tunnel position was 25:20 on the superimposed Bernard-Hertel grid with tight grouping.
DISCUSSION/CONCLUSION: We have shown that this new femoral guide accurately locates the femoral tunnel close to the AM bundle position and gives a reliable and reproducible femoral tunnel position, thereby reducing the risk of intra-operative error. This may assist accuracy of tunnel position for surgeons starting out performing ACLR or for low-volume surgeons.
The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
前交叉韧带（ACL）隧道定位多年来一直备受争议。股骨隧道位置不佳是导致早期ACL松弛和失效的最常见技术失误。有许多不同的方法可实现精确的股骨隧道定位。在本视频中，我们描述了一种新型股骨夹具瞄准装置的使用，该装置可用于为初次ACL重建（ACLR）可靠且易于重复地钻出股骨隧道。
该股骨夹具瞄准装置适用于所有接受初次ACLR的患者，外科医生可选择任何移植物。该夹具对于经验不足和手术量少的ACLR外科医生特别有用。
根据首选技术获取并准备合适的移植物，并测量要插入股骨隧道的移植物直径。准备股骨切迹，确保清除适当的组织以观察深层软骨（ADC）的顶点。将Infinity前内侧（AM）股骨导向器（Conmed）通过AM入口插入，并钩在ADC近端的切迹上。在极度屈曲时，推进导丝并扩孔，目标是保留2.0至2.5毫米的骨质。
连续19例患者接受了手术。术中和术后均无并发症。未报告失败或移植物破裂情况。所有隧道（100%）均位于足迹中心。在叠加的伯纳德 - 赫特尔网格上，平均隧道位置为25:20，分组紧密。
讨论/结论：我们已经证明，这种新型股骨导向器能够准确地将股骨隧道定位在靠近AM束的位置，并提供可靠且可重复的股骨隧道位置，从而降低术中误差风险。这可能有助于刚开始进行ACLR手术的外科医生或手术量少的外科医生提高隧道定位的准确性。
作者证明已获得本出版物中出现的任何患者的同意。如果个体可能被识别，作者已随本提交的出版物附上患者的豁免声明或其他书面批准形式。
