Steven Heylen, Annemieke Van Haver, Peter Verdonk, Matthias Krause, Jozef Michielsen
{"title":"多韧带膝关节重建术中胫骨隧道碰撞的风险分析-关节镜下腘肌腱重建术与胫骨前内侧隧道钻孔。","authors":"Steven Heylen, Annemieke Van Haver, Peter Verdonk, Matthias Krause, Jozef Michielsen","doi":"10.1016/j.otsr.2025.104335","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Drilling the tibial tunnel in tibiofibular-based posterolateral corner (PLC) reconstructions is usually performed with a starting point from Gerdy's tubercle. Drilling this tunnel from the anteromedial tibial cortex could reduce the risk of popliteal neurovascular injury but increase the risk of tunnel collision.</p><p><strong>Hypothesis: </strong>The purpose of this study is to assess the risk of tunnel collision in tibiofibular based reconstructions with a tibial tunnel drilled from the anteromedial cortex versus drilled from the anterolateral cortex.</p><p><strong>Methods: </strong>A total of 18 Computed Tomography scans were performed postoperatively in patients with an anterior cruciate ligament (ACL) reconstruction. Imageprocessing software was used to make a 3D model of the tibia and the trajectory and volume of the ACL tunnel was integrated into the model. Virtual posterior cruciate ligament (PCL) and PLC tunnels were added to the model according to the ideal location of the exit points in the current literature. The starting point for the PCL tunnel was inferomedial to the ACL tunnel. Five virtual tunnel locations for PLC reconstruction were added to the model: lateral, inferolateral, inferior, inferomedial and medial. Tunnel collision and distances were calculated.</p><p><strong>Results: </strong>There was no collision with the lateral, inferolateral or inferior PLC tunnels. The inferomedial and medial PLC tunnels collided with the ACL and/or PCL tunnels in 13 patients. One-way ANOVA test did not show a significantly significant difference in mean distance to the ACL or PCL tunnel for the lateral, inferolateral or inferior PLC tunnels (p > 0.05).</p><p><strong>Discussion: </strong>When drilling the PLC reconstruction tunnel from the anteromedial cortex in case of a multiligamentous knee reconstruction, our study shows that drilling should start from the lateral, inferolateral or inferior position relative to the ACL and PCL reconstruction tunnels to avoid tunnel collision.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104335"},"PeriodicalIF":2.2000,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Risk analysis of tibial tunnel collision in multiligamentous knee reconstructions - Arthroscopic popliteus tendon reconstruction with anteromedial tibial tunnel drilling.\",\"authors\":\"Steven Heylen, Annemieke Van Haver, Peter Verdonk, Matthias Krause, Jozef Michielsen\",\"doi\":\"10.1016/j.otsr.2025.104335\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Drilling the tibial tunnel in tibiofibular-based posterolateral corner (PLC) reconstructions is usually performed with a starting point from Gerdy's tubercle. Drilling this tunnel from the anteromedial tibial cortex could reduce the risk of popliteal neurovascular injury but increase the risk of tunnel collision.</p><p><strong>Hypothesis: </strong>The purpose of this study is to assess the risk of tunnel collision in tibiofibular based reconstructions with a tibial tunnel drilled from the anteromedial cortex versus drilled from the anterolateral cortex.</p><p><strong>Methods: </strong>A total of 18 Computed Tomography scans were performed postoperatively in patients with an anterior cruciate ligament (ACL) reconstruction. Imageprocessing software was used to make a 3D model of the tibia and the trajectory and volume of the ACL tunnel was integrated into the model. Virtual posterior cruciate ligament (PCL) and PLC tunnels were added to the model according to the ideal location of the exit points in the current literature. The starting point for the PCL tunnel was inferomedial to the ACL tunnel. Five virtual tunnel locations for PLC reconstruction were added to the model: lateral, inferolateral, inferior, inferomedial and medial. Tunnel collision and distances were calculated.</p><p><strong>Results: </strong>There was no collision with the lateral, inferolateral or inferior PLC tunnels. The inferomedial and medial PLC tunnels collided with the ACL and/or PCL tunnels in 13 patients. One-way ANOVA test did not show a significantly significant difference in mean distance to the ACL or PCL tunnel for the lateral, inferolateral or inferior PLC tunnels (p > 0.05).</p><p><strong>Discussion: </strong>When drilling the PLC reconstruction tunnel from the anteromedial cortex in case of a multiligamentous knee reconstruction, our study shows that drilling should start from the lateral, inferolateral or inferior position relative to the ACL and PCL reconstruction tunnels to avoid tunnel collision.</p><p><strong>Level of evidence: </strong>IV.</p>\",\"PeriodicalId\":54664,\"journal\":{\"name\":\"Orthopaedics & Traumatology-Surgery & Research\",\"volume\":\" \",\"pages\":\"104335\"},\"PeriodicalIF\":2.2000,\"publicationDate\":\"2025-07-17\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Orthopaedics & Traumatology-Surgery & Research\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.otsr.2025.104335\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Orthopaedics & Traumatology-Surgery & Research","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.otsr.2025.104335","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
Risk analysis of tibial tunnel collision in multiligamentous knee reconstructions - Arthroscopic popliteus tendon reconstruction with anteromedial tibial tunnel drilling.
Background: Drilling the tibial tunnel in tibiofibular-based posterolateral corner (PLC) reconstructions is usually performed with a starting point from Gerdy's tubercle. Drilling this tunnel from the anteromedial tibial cortex could reduce the risk of popliteal neurovascular injury but increase the risk of tunnel collision.
Hypothesis: The purpose of this study is to assess the risk of tunnel collision in tibiofibular based reconstructions with a tibial tunnel drilled from the anteromedial cortex versus drilled from the anterolateral cortex.
Methods: A total of 18 Computed Tomography scans were performed postoperatively in patients with an anterior cruciate ligament (ACL) reconstruction. Imageprocessing software was used to make a 3D model of the tibia and the trajectory and volume of the ACL tunnel was integrated into the model. Virtual posterior cruciate ligament (PCL) and PLC tunnels were added to the model according to the ideal location of the exit points in the current literature. The starting point for the PCL tunnel was inferomedial to the ACL tunnel. Five virtual tunnel locations for PLC reconstruction were added to the model: lateral, inferolateral, inferior, inferomedial and medial. Tunnel collision and distances were calculated.
Results: There was no collision with the lateral, inferolateral or inferior PLC tunnels. The inferomedial and medial PLC tunnels collided with the ACL and/or PCL tunnels in 13 patients. One-way ANOVA test did not show a significantly significant difference in mean distance to the ACL or PCL tunnel for the lateral, inferolateral or inferior PLC tunnels (p > 0.05).
Discussion: When drilling the PLC reconstruction tunnel from the anteromedial cortex in case of a multiligamentous knee reconstruction, our study shows that drilling should start from the lateral, inferolateral or inferior position relative to the ACL and PCL reconstruction tunnels to avoid tunnel collision.
期刊介绍：
Orthopaedics & Traumatology: Surgery & Research (OTSR) publishes original scientific work in English related to all domains of orthopaedics. Original articles, Reviews, Technical notes and Concise follow-up of a former OTSR study are published in English in electronic form only and indexed in the main international databases.
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