Acriche Maureen Mae, Ohuchi Hiroshi, Okada Takuya, Takazawa Shuzo, Yamada Shin, Kato Yuki
Department of Sports Medicine, Kameda Medical Center, Kamogawa, Chiba, Japan.
Arthrosc Tech. 2025 Jan 22;14(5):103434. doi: 10.1016/j.eats.2025.103434. eCollection 2025 May.
Femoral tunnel malposition is the main cause of failure in anterior cruciate ligament reconstruction. It not only contributes to the failure of initial anterior cruciate ligament reconstruction but is also of importance during the revision surgery. Tunnel positions can either be completely anatomic, completely nonanatomic, or partially anatomic. Cases with completely anatomic tunnels can make use of the same tunnel during the revision surgery, whereas cases with completely nonanatomic tunnels can make a new circular-shaped tunnel within the anatomic footprint. However, cases with partially anatomic tunnels raises concern as to where to create the new femoral tunnel within the anatomic footprint while avoiding overlap with the initial tunnel. By making the new femoral tunnel in an oval shape, we can prevent this from overlapping with the old partially anatomic tunnel while staying entirely within the anatomic footprint. The oval shape is achieved through an outside-in drilling technique using a FlipCutter and tilting the stepped drill sleeve. We present this surgical technique herein.
股骨隧道位置不当是前交叉韧带重建失败的主要原因。它不仅导致初次前交叉韧带重建失败，在翻修手术中也很重要。隧道位置可以是完全解剖学的、完全非解剖学的或部分解剖学的。完全解剖学隧道的病例在翻修手术中可利用相同的隧道，而完全非解剖学隧道的病例可在解剖足迹内制作新的圆形隧道。然而，部分解剖学隧道的病例引发了这样的担忧，即在解剖足迹内何处创建新的股骨隧道，同时避免与初始隧道重叠。通过将新的股骨隧道制成椭圆形，我们可以防止其与旧的部分解剖学隧道重叠，同时完全保留在解剖足迹内。椭圆形是通过使用FlipCutter并倾斜阶梯钻套的由外向内钻孔技术实现的。我们展示这种手术方法。
