Eljaja Salameh, Tranum-Jensen Jørgen, Tavlo Mette, Siersma Volkert, Krogsgaard Michael Rindom
Section for Sports Traumatology M51, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark.
Department of Cellular and Molecular Medicine (ICMM), University of Copenhagen, Copenhagen, Denmark.
Bone Jt Open. 2025 Jun 2;6(6):618-625. doi: 10.1302/2633-1462.66.BJO-2025-0011.R1.
Structured knowledge on the combined effect of various positions of femoral and tibial tunnels in reconstruction of the anterior cruciate ligament (ACL) on knee range of motion, rotatory stability, and anterior translatory laxity is limited. The aim was to test this for 15 regularly used tunnel combinations and identify combinations that should be avoided.
A total of 60 cadaveric knees had the ACL removed and reconstructed. Flexion/extension, tibial rotation, and anterior tibial translation were measured with intact ACL, after ACL resection, and after ACL reconstructions with 15 tunnel combinations, based on five different femoral tunnels and three different tibial tunnels.
With a posterior tibial tunnel, the anterior tibial translation and tibial rotation increased when combined with most femoral tunnels. A transtibially positioned femoral tunnel when combined with any tibial tunnel caused flexion deficiency. Any femoral tunnel positioned by anteromedial technique combined with anterior or posterior tibia tunnels caused flexion deficiency. Severe extension deficiency was observed with an anterior tibial tunnel, in particular combined with a transtibially positioned femoral tunnel or an anterior femoral tunnel by anteromedial technique. Least anterior tibial translation combined with normal extension was achieved with a femoral tunnel by anteromedial technique as far posterior as possible, and an anatomically positioned tibial tunnel.
In conclusion, tunnel combinations with the steepest (sagittal plane) and/or least oblique (frontal plane) grafts resulted in increased anterior tibial translation and tibial rotation, and should therefore be avoided. Anterior positioning of the graft caused extension deficiency, and there was flexion deficit with most grafts. A femoral tunnel as far posterior as possible by anteromedial technique is preferable in combination with an anatomically positioned tibial tunnel.
关于在重建前交叉韧带（ACL）时股骨和胫骨隧道的不同位置对膝关节活动范围、旋转稳定性和前向平移松弛度的联合影响的结构化知识有限。本研究旨在对15种常用的隧道组合进行测试，并识别应避免的组合。
总共60具尸体膝关节的ACL被切除并重建。基于五种不同的股骨隧道和三种不同的胫骨隧道，在ACL完整时、ACL切除后以及使用15种隧道组合进行ACL重建后，测量屈伸、胫骨旋转和胫骨前向平移。
采用后胫骨隧道时，与大多数股骨隧道组合时，胫骨前向平移和胫骨旋转增加。经胫骨定位的股骨隧道与任何胫骨隧道组合时均导致屈曲受限。通过前内侧技术定位的任何股骨隧道与前或后胫骨隧道组合时均导致屈曲受限。在前胫骨隧道时观察到严重的伸展受限，特别是与经胫骨定位的股骨隧道或通过前内侧技术的前股骨隧道组合时。通过尽可能向后的前内侧技术股骨隧道和解剖定位的胫骨隧道组合，可实现最小的胫骨前向平移并伴有正常伸展。
总之，移植物最陡峭（矢状面）和/或最不倾斜（冠状面）的隧道组合会导致胫骨前向平移和胫骨旋转增加，因此应避免。移植物的前位导致伸展受限，大多数移植物存在屈曲不足。前内侧技术尽可能向后的股骨隧道与解剖定位的胫骨隧道组合更佳。
