Multiple Ligament Reconstruction Femoral Tunnels.
Background: Knee dislocations often require multiple concurrent ligament reconstructions, which involve creating several tunnels in the distal femur. Therefore, the risk of tunnel convergence is increased because of the limited bone volume within the distal aspect of the femur. Purpose: To assess th...
| Publicado en: | American Journal of Sports Medicine Vol. 45; no. 3; pp. 563 - 570 |
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| Autores principales: | , , , , , , |
| Formato: | pictorial research tables/charts Journal Article |
| Publicado: |
Sage Publications Inc.
Mar2017
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=121815368&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 121815368 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 03635465 ASM jtl: American Journal of Sports Medicine issn: 03635465 maglogo: Y pubinfo: dt: Mar2017 vid: 45 iid: 3 pid: 344 pub: Sage Publications Inc. place: Thousand Oaks, California artinfo: ui: 121815368 121815368 121815368 10.1177/0363546516673616 121815368 ppf: 563 ppct: 7 formats: tig: atl: Multiple Ligament Reconstruction Femoral Tunnels. aug: au: Moatshe, Gilbert Brady, Alex W. Slette, Erik L. Chahla, Jorge Turnbull, Travis Lee LaPrade, Robert F. Engebretsen, Lars affil: Steadman Philippon Research Institute, Vail, Colorado, USA sug: subj: Femur Anatomy and Histology Surgery, Reconstructive Ligaments Surgery Anterior Cruciate Ligament Arthroscopy Cadaver Human Knee Dislocation Knee Joint Posterior Cruciate Ligament Tendons Tomography, X-Ray Computed Descriptive Research Protocols Paired T-Tests ab: Background: Knee dislocations often require multiple concurrent ligament reconstructions, which involve creating several tunnels in the distal femur. Therefore, the risk of tunnel convergence is increased because of the limited bone volume within the distal aspect of the femur. Purpose: To assess the risk of tunnel convergence and determine the optimal reconstruction tunnel orientations for multiple ligament reconstructions in the femur. Study Design: Descriptive laboratory study. Methods: Three-dimensional knee models were developed from computed tomography scans of 21 patients. Medical image processing software was used to create tunnels for each of the primary ligamentous structures, replicating a surgical approach that would be used in multiple ligament reconstructions. Thereafter, the tunnel orientation was varied in surgically relevant directions to determine orientations that minimized the risk of tunnel convergence. The orientation of the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) tunnels was held constant throughout the study, while the orientation of the fibular collateral ligament (FCL), popliteus tendon (PLT), superficial medial collateral ligament (sMCL), and posterior oblique ligament (POL) tunnels was varied to avoid convergence. Results: A high risk of tunnel convergence was observed between the FCL and ACL tunnels when the FCL tunnel was aimed at 0° in the axial and coronal planes. Aiming the FCL tunnel 35° anteriorly minimized convergence with the ACL tunnel. No tunnel convergence was observed for the PLT tunnel aimed 35° anteriorly and parallel to the FCL tunnel. To avoid convergence between the sMCL and PCL tunnels, the sMCL tunnels should be aimed 40° proximally in the coronal plane and 20° to 40° anteriorly. During concomitant POL reconstruction, the sMCL should be aimed 40° proximally and anteriorly and the POL 20° proximally and anteriorly. The PLT and POL tunnels aimed at 0° in both the coronal and axial planes had an increased risk of violating the intercondylar notch. Conclusion: Femoral tunnel orientations during multiple ligament reconstructions need to be adjusted to avoid tunnel convergence. On the lateral side, aiming the FCL and PLT tunnels 35° anteriorly eliminated convergence with the ACL tunnel. On the medial side, tunnel convergence was avoided by orienting the sMCL tunnel 40° proximally and anteriorly and the POL tunnel 20° proximally and anteriorly. The POL and PLT tunnels aimed at 0° in the axial plane had an increased risk of violating the intercondylar notch. Clinical Relevance: The risk of tunnel convergence with the ACL and PCL femoral tunnels can be reduced by adjusting the orientation of the FCL and PLT tunnels and the sMCL and POL tunnels, respectively. pubtype: Academic Journal doctype: pictorial research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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