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中华关节外科杂志(电子版) ›› 2022, Vol. 16 ›› Issue (01) : 79 -85. doi: 10.3877/cma.j.issn.1674-134X.2022.01.013

综述

前交叉韧带重建股骨骨隧道定位的理论依据及演变
周天平1, 徐一宏1, 徐卫东1,()   
  1. 1. 200433 上海,海军军医大学附属长海医院关节骨病外科
  • 收稿日期:2021-04-27 出版日期:2022-02-01
  • 通信作者: 徐卫东
  • 基金资助:
    2020年上海市体育科技"备战攻关"项目(20J017)

Theoretical basis and evolution of femoral tunnel localization in anterior cruciate ligament reconstruction

Tianping Zhou1, Yihong Xu1, Weidong Xu1,()   

  1. 1. Department of Orthopedics, Changhai Hospital, The Navy Medical University, Shanghai 200433, China
  • Received:2021-04-27 Published:2022-02-01
  • Corresponding author: Weidong Xu
引用本文:

周天平, 徐一宏, 徐卫东. 前交叉韧带重建股骨骨隧道定位的理论依据及演变[J]. 中华关节外科杂志(电子版), 2022, 16(01): 79-85.

Tianping Zhou, Yihong Xu, Weidong Xu. Theoretical basis and evolution of femoral tunnel localization in anterior cruciate ligament reconstruction[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2022, 16(01): 79-85.

前交叉韧带损伤是一种常见的膝关节运动损伤,关节镜下前交叉韧带重建术是目前的主要治疗手段。前交叉韧带重建术后效果受到多种因素影响,其中股骨骨隧道定位是决定手术成败的关键因素。经过近一个世纪的不断探索和发展,相继出现了等长定位点、解剖单束定位点、解剖双束定位点、低张力区定位点、直接纤维定位点、椭圆骨道定位点、理想定位点(ideal point)和类等长点等一系列理论。本文就这些股骨骨道定位理论的产生、发展、特点及演变进程进行系统性总结和分析,以期给临床实践和后续研究提供借鉴。

Anterior cruciate ligament injury is a common sport injury of the knee with anterior cruciate ligament reconstruction under arthroscopy being the main treatment methods. The results of anterior cruciate ligament reconstruction are affected by many factors, among which the positioning of the femoral tunnel is the determinant factor. A series of theories about femoral tunnel location have been raised over the past century, including isometric point, anatomical single-bundle point, anatomical double-bundle point, low-tension point, direct-fiber-insertion point, oval-tunnel point, isometric-direct fiber-eccentric-anatomic-low tension(IDEAL) point and near-isometric point. The formation, development, characters, and evolution process of these theories were systematacially analyzed in this article for clinical reference and further research.

图1 Laboureau[11]法确定等长定位点
图2 ACL(前交叉韧带)解剖结构示意图(左侧)和ACL解剖单束、解剖双束重建位点(右侧)注:左图中橙色部分代表AM止点,青色部分代表PL束止点;AM(前内侧束);PL(后外侧束);SB(解剖单束)
图3 低张力区定位点(图中紫色部分所示)
图4 直接纤维止点(图中蓝色区域所示)
图5 椭圆骨道定位点(图中青色区域所示)
图6 IDEAL点示意图(图中橙色区域所示)
图7 类等长定位点(图中紫色区域所示)
图8 前交叉韧带重建股骨骨隧道定位理论演变过程图
[1]
Ithurburn MP, Longfellow MA, Thomas S, et al. Knee function, strength, and resumption of preinjury sports participation in young athletes following anterior cruciate ligament reconstruction[J]. J Orthop Sports Phys Ther, 2019, 49(3): 145-153.
[2]
Vermeijden HD, Yang XA, Van DJ, et al. Trauma and femoral tunnel position are the most common failure modes of anterior cruciate ligament reconstruction: a systematic review[J]. Knee Surg Sports Traumatol Arthrosc, 2020, 28(11): 3666-3675.
[3]
Morgan JA, Dahm D, Levy B, et al. Femoral tunnel malposition in ACL revision Reconstruction[J]. J Knee Surg, 2012, 25(5): 361-368.
[4]
Matthewson G, Macdonald P. Techniques for femoral socket creation in ACL reconstruction[J]. Sports Med Arthrosc Rev, 2020, 28(2): 56-65.
[5]
Vaienti E, Scita G, Ceccarelli F, et al. Understanding the human knee and its relationship to total knee replacement[J]. Acta Biomed, 2017, 88(2S): 6-16.
[6]
Rao Z, Zhou C, Kernkamp WA, et al. In vivo kinematics and ligamentous function of the knee during weight-bearing flexion: an investigation on mid-range flexion of the knee[J]. Knee Surg Sports Traumatol Arthrosc, 2020, 28(3): 797-805.
[7]
Hey GE. Operation for the repair of the cruciate ligament[J]. Lancet, 1917, 190(4914): 674-676.
[8]
Smith SA. The diagnosis and treatment of injuries to the crucial ligaments[J]. Br J Surg, 1918, 6(22): 176-189.
[9]
O'brien WR. Isometric placement of anterior cruciate ligament substitutes[J]. Oper Tech Orthop, 1992, 2(2): 49-54.
[10]
Zavras TD, Race A, Bull AM, et al. A comparative study of 'isometric' points for anterior cruciate ligament graft attachment[J]. Knee Surg Sports Traumatol Arthrosc, 2001, 9(1): 28-33.
[11]
Laboureau JP, Marnat-Perrichet F. Isometric reconstruction of the anterior cruciate ligament: femoral and tibial tunnel placement//Yahia L. Ligaments and Ligamentoplasties. Berlin,Heidelberg:Springer, 1997:209-210.
[12]
Ruffilli A, Buda R, Pagliazzi G, et al. Over-the-top anterior cruciate ligament reconstruction using single- or double-strand hamstrings autograft [J]. Orthopedics, 2015, 38(7): e635-e643.
[13]
Lanzetti RM, Pace V, Ciompi A, et al. Over the top anterior cruciate ligament reconstruction in patients with open physes: a long-term follow-up study[J]. Int Orthop, 2020, 44(4): 771-778.
[14]
Tulloch SJ, Devitt BM, Porter T, et al. Primary ACL reconstruction using the LARS device is associated with a high failure rate at minimum of 6-year follow-up[J]. Knee Surg Sports Traumatol Arthrosc, 2019, 27(11): 3626-3632.
[15]
Tashiro Y, Okazaki K, Murakami K, et al. Anterolateral rotatory instability in vivo correlates tunnel position after anterior cruciate ligament reconstruction using bone-patellar tendon-bone graft[J]. World J Orthop, 2017, 8(12): 913-921.
[16]
Sciarretta FV. History of anterior cruciate ligament surgery[J]. J ArthroscSurg Sport Med, 2020, 1(1): 90-97.
[17]
Mochizuki T, Muneta T, Nagase T, et al. Cadaveric knee observation study for describing anatomic femoral tunnel placement for two-bundle anterior cruciate ligament reconstruction[J]. Arthroscopy, 2006, 22(4): 356-361.
[18]
Schindler OS. Surgery for anterior cruciate ligament deficiency: a historical perspective[J]. Knee Surg Sports Traumatol Arthrosc, 2012, 20(1): 5-47.
[19]
Vignos MF, Smith CR, Roth JD, et al. Anterior cruciate ligament graft tunnel placement and graft angle are primary determinants of internal knee mechanics after reconstructive surgery[J]. Am J Sports Med, 2020, 48(14): 3503-3514.
[20]
Lubowitz JH, Hwang M, Piefer J, et al. Anterior cruciate ligament femoral footprint anatomy: systematic review of the 21st century literature[J]. Arthroscopy, 2014, 30(5): 539-541.
[21]
Iriuchishima T, Goto B. Systematic review of surgical technique and tunnel target points and placement in anatomical single-bundle ACL reconstruction[J/OL]. J Knee Surg, 2020. DOI:10.1055/s-0040-1710521.
[22]
Dong Z, Niu Y, Qi J, et al. Long term results after double and single bundle ACL reconstruction: Is there any difference? A meta-analysis of randomized controlled trials[J]. Acta Orthop Traumatol Turc, 2019, 53(2): 92-99.
[23]
Järvelä S, Kiekara T, Suomalainen P, et al. Double-Bundle versus single-bundle anterior cruciate ligament reconstruction: a prospective randomized study with 10-Year results[J]. Am J Sports Med, 2017, 45(11): 2578-2585.
[24]
Iwama G, Iriuchishima T, Horaguchi T, et al. Measurement of the whole and midsubstance femoral insertion of the anterior cruciate ligament: the comparison with the elliptically calculated femoral anterior cruciate ligament footprint area[J]. Indian J Orthop, 2019, 53(6): 727-731.
[25]
Howell SM, Gittins ME, Gottlieb JE, et al. The relationship between the angle of the tibial tunnel in the coronal plane and loss of flexion and anterior laxity after anterior cruciate ligament reconstruction[J]. Am J Sports Med, 2001, 29(5): 567-574.
[26]
Simmons R, Howell SM, Hull ML. Effect of the angle of the femoral and tibial tunnels in the coronal plane and incremental excision of the posterior cruciate ligament on tension of an anterior cruciate ligament graft: an in vitro study[J]. J Bone Joint Surg Am, 2003, 85(6): 1018-1029.
[27]
李文俊,孙健,刘葛君.关节镜下全内技术股骨双隧道重建膝关节前交叉韧带[J/CD].中华关节外科杂志(电子版),201812(6): 21-24.
[28]
Iwahashi T, Shino K, Nakata K, et al. Direct anterior cruciate ligament insertion to the femur assessed by histology and 3-dimensional volume-rendered computed tomography[J]. Arthroscopy, 2010, 26(9 Suppl): S13-S20.
[29]
Sasaki N, Ishibashi Y, Tsuda E, et al. The femoral insertion of the anterior cruciate ligament: discrepancy between macroscopic and histological observations[J]. Arthroscopy, 2012, 28(8): 1135-1146.
[30]
Suzuki D, Otsubo H, Adachi T, et al. Functional adaptation of the fibrocartilage and bony trabeculae at the attachment sites of the anterior cruciate ligament[J]. Clin Anat, 2020, 33(7): 988-996.
[31]
Zhang J, Hu X, Liu Z, et al. Anatomical single bundle anterior cruciate ligament Reconstruction with rounded rectangle tibial tunnel and oval femoral tunnel: a prospective comparative study versus conventional surgery[J]. Am J Transl Res, 2019, 11(3): 1908-1918.
[32]
Zantop T, Petersen W, Sekiya JK, et al. Anterior cruciate ligament anatomy and function relating to anatomical Reconstruction[J]. Knee Surg Sports Traumatol Arthrosc, 2006, 14(10): 982-992.
[33]
Śmigielski R, Zdanowicz U, Drwięga M, et al. The anatomy of the anterior cruciate ligament and its relevance to the technique of Reconstruction[J]. Bone Joint J, 2016, 98-B(8): 1020-1026.
[34]
Petersen W, Forkel P, Achtnich A, et al. Technique of anatomical footprint reconstruction of the ACL with oval tunnels and medial portal aimers[J]. Arch Orthop Trauma Surg, 2013, 133(6): 827-833.
[35]
Pearle AD, Mcallister D, Howell SM. Rationale for strategic graft placement in anterior cruciate ligament Reconstruction: I.D.E.A.L. femoral tunnel position[J]. Am J Orthop (Belle Mead NJ), 2015, 44(6): 253-258.
[36]
Smith JO, Yasen S, Risebury MJ, et al. Femoral and tibial tunnel positioning on graft isometry in anterior cruciate ligament reconstruction: a cadaveric study[J]. J Orthop Surg (Hong Kong), 2014, 22(3): 318-324.
[37]
Englander ZA, Martin JT, Ganapathy PK, et al. Automatic registration of MRI-based joint models to high-speed biplanarradiographs for precise quantification of in vivo anterior cruciate ligament deformation during gait[J]. J Biomech, 201881(16): 36-44.
[38]
Wan F, Chen T, Ge Y, et al. Effect of nearly isometric ACL reconstruction on Graft-Tunnel motion: a quantitative clinical study[J/OL]. Orthop J Sports Med, 2019, 7(12): 2325967119890382. DOI:10.1177/2325967119890382.
[39]
周天平,徐一宏,徐卫东.前交叉韧带重建相关研究的文献计量学分析[J/CD].中华关节外科杂志(电子版),202014(5): 612-618.
[40]
陈世益,李国平,敖英芳,等.功能至上、早期康复与重返运动是骨科运动医学的灵魂[J].中国运动医学杂志,202039(5): 339-340.
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