Editorial Commentary: Preferred Strategies to Avoid Collision Between Tunnels for Lateral Extra-articular Procedures and Anterior Cruciate Ligament Reconstruction Include Outside-In Drilling, Cortical Fixation, and Use of a Single Femoral Tunnel.

IF 4.4 1区 医学 Q1 ORTHOPEDICS
Adnan Saithna
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引用次数: 0

Abstract

When performing lateral extra-articular procedures (LEAPs) at the time of anterior cruciate ligament (ACL) reconstruction, it is essential to be aware of the possibility of tunnel collision and understand strategies to avoid it. The risk of tunnel collision is high, especially if an anteromedial portal ACL femoral tunnel is drilled. Tunnel collision can be avoided by using a single femoral tunnel for both procedures, outside-in femoral tunnel drilling to place the ACL tunnel a safe distance away from the LEAP, and cortical fixation techniques. Other strategies that have been explored have included anteromedial portal drilling in low degrees of flexion, anterior angulation of LEAP tunnels, and the use of an "anterior Lemaire" position. These alternative strategies are not preferred because they are associated with an increased risk of iatrogenic injuries to important posterolateral structures, penetration of trochlea articular cartilage, and overconstraint, respectively.

避免外侧关节外手术和前交叉韧带重建中隧道间碰撞的首选策略包括外侧钻孔、皮质固定和使用单一股骨隧道。
在前交叉韧带(ACL)重建术中进行侧方关节外手术(LEAP)时,必须意识到隧道碰撞的可能性,并了解避免碰撞的策略。隧道碰撞的风险很高,尤其是在前交叉韧带股骨隧道前内侧入口处钻孔时。可通过以下方法避免隧道碰撞:在两种手术中均使用单一股骨隧道;在股骨隧道外侧钻孔,使前交叉韧带隧道与LEAP保持安全距离;采用皮质固定技术。已探索过的其他策略包括在低屈曲度时进行前内侧入口钻孔、LEAP隧道前方成角以及使用 "前Lemaire "体位。这些替代策略并不可取,因为它们分别会增加对重要后外侧结构造成先天性损伤、穿透套状关节软骨和过度约束的风险。
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来源期刊
CiteScore
9.30
自引率
17.00%
发文量
555
审稿时长
58 days
期刊介绍: Nowhere is minimally invasive surgery explained better than in Arthroscopy, the leading peer-reviewed journal in the field. Every issue enables you to put into perspective the usefulness of the various emerging arthroscopic techniques. The advantages and disadvantages of these methods -- along with their applications in various situations -- are discussed in relation to their efficiency, efficacy and cost benefit. As a special incentive, paid subscribers also receive access to the journal expanded website.
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