Femoral Tunnel Apertures on the Lateral Cortex in Anterior Cruciate Ligament Reconstruction: An Analysis of Cortical Button Fixation

被引:10
作者
Okazaki, Ken [1 ]
Matsubara, Hirokazu [1 ]
Osaki, Kanji [1 ]
Tashiro, Yasutaka [1 ]
Mizu-uchi, Hideki [1 ]
Hamai, Satoshi [1 ]
Doi, Toshio [1 ]
Iwamoto, Yukihide [1 ]
机构
[1] Kyushu Univ, Grad Sch Med Sci, Dept Orthopaed Surg, Fukuoka 8120054, Japan
关键词
3-DIMENSIONAL COMPUTED-TOMOGRAPHY; OUTSIDE-IN TECHNIQUES; ACL RECONSTRUCTION; LENGTH; ATTACHMENT; FOOTPRINT;
D O I
10.1016/j.arthro.2014.03.004
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
100224 [整形外科学];
摘要
Purpose: If the aperture of the oval-shaped femoral tunnel on the lateral cortex becomes bigger than half the size of the cortical button, the risk of fixation failure increases. This study investigated the effect of the location of the entry point and diameter of the femoral tunnel on the length of the major axis of the tunnel aperture in anterior cruciate ligament (ACL) reconstruction using an outside-in technique. Methods: Simulation of femoral tunnel drilling was performed on computed tomography (CT)-based 3-dimensional (3D) bone models obtained from 40 participants. The tunnel connected the center of the ACL footprint and various points on the lateral femoral surface. The diameter of the tunnel was set at 4.2 mm, 5.2 mm, or 6 mm, depending on the commercially available outside-in surgical systems (Arthrex, Naples, FL and Smith & Nephew, Andover, MA). The length of the major axis of the oval-shaped aperture on the lateral femoral surface was measured. Results: When the tunnel was introduced at 2 cm from the lateral epicondyle in a 45 degrees anteroproximal direction, the major axis was lengthened to 130.7% +/- 9.0% (P < .001) of the tunnel diameter, and it was more than 6.5 mm in 65% of participants in whom a 5.2-mm-diameter tunnel was drilled. When the entry point was 3 cm from the lateral epicondyle, 60% of participants had an oval-shaped aperture with a major axis of more than 6.5 mm, even though the diameter of the tunnel was only 4.2 mm. Conclusions: The risk of fixation failure of a cortical button increases if the entry point for drilling is 2 cm or further from the lateral epicondyle and the tunnel diameter is more than 5 mm.
引用
收藏
页码:841 / 848
页数:8
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