后交叉韧带3D模型技术获取低位胫骨隧道解剖参数研究

doi:10.13418/j.issn.1001-165x.2023.5.01

Abstract

Abstract: Objective To establish the low tibial tunnel based on the posterior cruciate ligament (PCL) 3D virtual technology to measure its anatomical parameters. Methods CT image data of 101 patients with healthy knee joints were selected, and PCL 3D virtual surgery model was established by using mimics21.0 (Materialise, Belgium) software. Low tibial tunnels of anteromedial and anterolateral approaches were established respectively. The anatomical parameters included the length of the posterior cruciate ligament tibial tunnel (LTT), the 3D included angle between tibial medial axis extension line and tibial plateau (3D ATPT) and perpendicular distance of the tunnel’s entry point to the tibial plateau (PTT). SPSS 25.0 was used for statistical analysis. Results The average length of PCL tibial tunnel was greater in the anteromedial group than the anterolateral group was (45.56±4.27) mm versus (43.93±4.10) mm, P<0.05. The average 3D angle between tunnel and tibial plateau was greater in the anterolateral than the anteromedial (54.49±5.81)° versus (48.17±6.12) °, P<0.05. The PTT in the anteromedial group and the anterolateral group were (61.86±6.80) mm and (63.51±6.32) mm, respectively (P<0.05). All the above parameters had statistical differences. Conclusions The parameters related to the low tibial tunnel measured in this study can provide theoretical reference for PCL reconstruction surgery in clinical practice.

Key words: Posterior cruciate ligament; , , 3D surgical simulation; , , Knee joint; , , Tibial tunnel

CLC Number:

R686.5

Chen Sijie, Guo Laiwei, Wang Zunlin, Tan Nian, Zhang Kangrui, Yun Xiangdong, Xia Yayi, Teng Yuanjun. Study on anatomical parameters of low tibial tunnel in posterior cruciate ligament reconstruction based on 3D surgical simulation technology[J]. Chinese Journal of Clinical Anatomy, 2023, 41(5): 505-510.

References 25

[1]	Papannagari R, Defrate LE, Nha KW, et al. Function of posterior cruciate ligament bundles during in vivo knee flexion[J]. Am J Sports Med, 2007, 35(9): 1507-1512. DOI: 10.1177/0363546507300061.
[2]	胡岩君, 余斌, 苏秀云, 等. 基于MRI、CT影像下膝关节及交叉韧带重建可视化的初步应用研究[J]. 中华创伤骨科杂志, 2007, (5): 469-472. DOI: 10.3760/cma.j.issn.1671-7600.2007.05.018.
[3]	Ahn JH, Bae JH, Lee YS, et al. An anatomical and biomechanical comparison of anteromedial and anterolateral approaches for tibial tunnel of posterior cruciate ligament reconstruction: evaluation of the widening effect of the anterolateral approach[J]. Am J Sports Med, 2009, 37(9): 1777-1783. DOI: 10.1177/0363546509332508.
[4]	Fanelli GC, Edson CJ. Surgical treatment of combined PCL-ACL medial and lateral side injuries (global laxity): surgical technique and 2- to 18-year results[J]. J Knee Surg, 2012, 25(4): 307-316. DOI: 10.1055/s-0032-1326997.
[5]	Huang TW, Wang CJ, Weng LH, et al. Reducing the “killer turn” in posterior cruciate ligament reconstruction[J]. Arthroscopy, 2003, 19(7): 712-716. DOI: 10.1016/s0749-8063(03)00394-3.
[6]	Lee YS, Jung YB. Posterior cruciate ligament: focus on conflicting issues[J]. Clin Orthop Surg, 2013, 5(4): 256-262. DOI: 10.4055/cios.2013.5.4.256.
[7]	Ansari AS, Dennis BB, Horner NS, et al. Influence of graft source on postoperative activity and joint laxity in posterior cruciate ligament reconstruction: a systematic review[J]. Arthroscopy, 2019, 35(1): 262-274.e6. DOI: 10.1016/j.arthro.2018.07.027.
[8]	Teng Y, Da L, Jia G, et al. What is the maximum tibial tunnel angle for transtibial PCL reconstruction? A comparison based on virtual radiographs, CT images, and 3D knee models[J]. Clin Orthop Relat Res, 2022, 480(5): 918-928. DOI: 10.1097/CORR.0000000000002111.
[9]	陈航, 顾海峰. 由后向前建立胫骨隧道的全内后交叉韧带重建治疗后交叉韧带损伤的近期疗效[J]. 中华创伤骨科杂志, 2019, (1): 76-80. DOI: 10.3760/cma.j.issn.1671-7600.2019.01.014.
[10]	Wang Z, Xiong Y, Li Q, et al. Evaluation of tibial tunnel placement in single case posterior cruciate ligament reconstruction: reducing the graft peak stress may increase posterior tibial translation[J]. BMC Musculoskelet Disord, 2019, 20(1): 521-528. DOI: 10.1186/s12891-019-2862-z.
[11]	Weimann A, Wolfert A, Zantop T, et al. Reducing the "killer turn" in posterior cruciate ligament reconstruction by fixation level and smoothing the tibial aperture[J]. Arthroscopy, 2007, 23(10): 1104-1111. DOI: 10.1016/j.arthro.2007.04.014.
[12]	夏亚一, 滕元君, 呼杰, 等. 后交叉韧带损伤重建术中“杀伤角”效应的研究进展[J]. 中华创伤杂志, 2022, 38(1): 86-91. DOI: 10.3760/cma.j.cn501098-20210901-00473.
[13]	Shin YS, Han SB, Hwang YK, et al. Tibial tunnel aperture location during single-bundle posterior cruciate ligament reconstruction: comparison of tibial guide positions[J]. Arthroscopy, 2015, 31(5): 874-881. DOI: 10.1016/j.arthro.2014.12.004.
[14]	Zhang X, Teng Y, Yang X, et al. Evaluation of the theoretical optimal angle of the tibial tunnel in transtibial anatomic posterior cruciate ligament reconstruction by computed tomography[J]. BMC Musculoskelet Disord, 2018, 19(1): 436-441. DOI: 10.1186/s12891-018-2348-4.
[15]	Fanelli GC, Beck JD, Edson CJ. Double bundle posterior cruciate ligament reconstruction: surgical technique and results[J]. Sports Med Arthrosc Rev, 2010, 18(4): 242-248. DOI: 10.1097/JSA.0b013e3181f2faa1.
[16]	Fanelli GC, Giannotti BF, Edson CJ. The posterior cruciate ligament arthroscopic evaluation and treatment[J]. Arthroscopy, 1994, 10(6): 673-688. DOI: 10.1016/s0749-8063(05)80067-2.
[17]	Okoroafor UC, Saint-Preux F, Gill SW, et al. Nonanatomic tibial tunnel placement for single-bundle posterior cruciate ligament reconstruction leads to greater posterior tibial translation in a biomechanical model[J]. Arthroscopy, 2016,32(7): 1354-1358. DOI: 10.1016/j.arthro. 2016. 01.019.
[18]	Fanelli GC. Arthroscopic transtibial tunnel posterior cruciate ligament reconstruction[J]. Oper Tech Sports Med, 2015, 23(4): 289-297. DOI: 10.1053/j.otsm.2015.06.005.
[19]	Wang Z, Xiong Y, Chen G, et al. Modified tibial tunnel placement for single-bundle posterior cruciate ligament reconstruction reduces the "Killer Turn" in a biomechanical model[J]. Medicine (Baltimore), 2019, 98(52): e18439-e18435. DOI: 10.1097/MD.0000000000018439.
[20]	Lin Y, Huang Z, Zhang K, et al. Lower tibial tunnel placement in isolated posterior cruciate ligament reconstruction: clinical outcomes and quantitative radiological analysis of the killer turn[J]. Orthop J Sports Med, 2020, 8(8): 2325967120923950-2325967120923960. DOI: 10.1177/2325967120923950.
[21]	Yoon KH, Kim JS, Park JY, et al. Comparable clinical and radiologic outcomes between an anatomic tunnel and a low tibial tunnel in remnant-preserving posterior cruciate ligament reconstruction[J]. Orthop J Sports Med, 2021, 9(2): 2325967120985153-2325967120 985160. DOI: 10.1177/2325967120985153.
[22]	Jarvis DL, Waterman BR. Editorial commentary: stump sparing or footprint exposing? Management of the tibial remnant during posterior cruciate ligament reconstruction[J]. Arthroscopy, 2019, 35(9): 2669-2670. DOI: 10.1016/j.arthro.2019.05.035.
[23]	陆文杰, 成立, 施绒舟, 等. 胫骨骨道定位对后交叉韧带重建“杀伤角”的影响[J]. 中华创伤杂志, 2012, (8): 712-717. DOI: 10.3760/cma.j.issn.1001-8050.2012.08.013.
[24]	Fanelli GC. Transtibial posterior cruciate ligament reconstruction[J]. J Knee Surg, 2021, 34(5): 486-492. DOI: 10.1055/s-0040-1722696.
[25]	Teng Y, Zhang X, Ma C, et al. Evaluation of the permissible maximum angle of the tibial tunnel in transtibial anatomic posterior cruciate ligament reconstruction by computed tomography[J]. Arch Orthop Trauma Surg, 2019, 139(4): 547-552. DOI: 10.1007/s00402-018-3092-9.

Study on anatomical parameters of low tibial tunnel in posterior cruciate ligament reconstruction based on 3D surgical simulation technology

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