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High Variability of Lateral Extra-articular Tenodesis Femoral Tunnel Position With Landmark-Based Techniques
The American Journal of Sports Medicine ( IF 4.2 ) Pub Date : 2024-11-20 , DOI: 10.1177/03635465241289417 Ajay C. Kanakamedala, Bradley M. Kruckeberg, Olivia M. Jochl, Ryan J. Whalen, Mark E. Cinque, Thomas R. Hackett, Jonathan A. Godin, Armando F. Vidal
The American Journal of Sports Medicine ( IF 4.2 ) Pub Date : 2024-11-20 , DOI: 10.1177/03635465241289417 Ajay C. Kanakamedala, Bradley M. Kruckeberg, Olivia M. Jochl, Ryan J. Whalen, Mark E. Cinque, Thomas R. Hackett, Jonathan A. Godin, Armando F. Vidal
Background:The utilization of lateral extra-articular tenodesis (LET) augmentation for anterior cruciate ligament reconstruction has increased. Various fixation points have been recommended based on tactile and anatomic landmarks; however, there is limited reporting of the accuracy or precision of these techniques in clinical practice.Purpose/Hypothesis:The purpose of this study was to evaluate whether LET fixation points identified using anatomic landmarks and tactile techniques would fall within a predefined radiographic zone. It was hypothesized that the majority of LET fixation points would be inside the radiographic zone.Study Design:Cross-sectional study; Level of evidence, 4.Methods:Postoperative lateral knee radiographs of patients who underwent anterior cruciate ligament reconstruction with LET using a landmark-based technique without fluoroscopy between January 2018 and September 2023 were reviewed. Fixation points were measured by 2 raters based on their distance from an extension of the posterior femoral cortex line (PFCL) distally and a line perpendicular to the PFCL at the posterior condylar flare (PCF). Patients were excluded if the tunnel position could not be identified or if postoperative radiographs were malrotated. The mean LET position and percentage of points within the radiographic isometric zone, defined as 4 ± 4 mm posterior and 4 ± 3 mm anterior to the PFCL and 6 ± 4 mm distal and 20 ± 5 mm proximal to the PCF were calculated.Results:Complete data sets were obtained for 47 cases. The mean LET position was 6.4 ± 7.1 mm (range, –9 to 27.3 mm) anterior to the PFCL and 1.8 ± 7.6 mm (range, –16.7 to 12.6 mm) proximal to the PCF. Overall, 53% of LET fixation points were within the predefined radiographic zone. Of the malpositioned tunnels (n = 22), their locations relative to the radiographic zone were anterior (n = 18), posterior (n = 2), proximal (n = 1), and anterior and distal (n = 1).Conclusion:This study found large variation in the location of LET fixation points, and almost half of fixation points were outside the predefined radiographic zone. Accurate and precise tunnel placement is one of multiple factors that may be important to minimize the risk of lateral compartment overconstraint, anterior cruciate ligament graft failure, and anisometry leading to LET graft loosening.
中文翻译:
使用基于 Landmark 的技术实现外侧关节外肌腱固定术股骨管位置的高度可变性
背景: 外侧关节外肌腱固定术 (LET) 增强术在前交叉韧带重建中的应用有所增加。根据触觉和解剖标志推荐了各种注视点;然而,关于这些技术在临床实践中的准确性或精密度的报道有限。目的/假设: 本研究的目的是评估使用解剖标志和触觉技术识别的 LET 固定点是否属于预定义的放射学区域。假设大多数 LET 固定点位于放射区内。研究设计: 横断面研究;证据水平, 4.方法: 回顾了 2018年1月至 2023年9月期间使用基于地标的技术进行 LET 前交叉韧带重建而不进行透视的患者的术后膝关节外侧 X 线片。2 名评分者根据他们与股后皮层线 (PFCL) 远端延伸的距离和垂直于髁后髁突口 (PCF) 处的线的距离测量注定点。如果无法确定隧道位置或术后 X 线片旋转不良,则排除患者。计算放射学等长区内的平均 LET 位置和点百分比,定义为 PFCL 后 4 ± 4 mm 和 4 ± 3 mm 以及 PCF 远端 6 ± 4 mm 和 20 ± 5 mm。结果: 获得 47 例的完整数据集。平均 LET 位置为 PFCL 前方 6.4 ± 7.1 mm(范围,-9 至 27.3 mm),PCF 近端 1.8 ± 7.6 mm(范围,-16.7 至 12.6 mm)。总体而言,53% 的 LET 固定点位于预定义的影像学区内。 在错位的隧道 (n = 22) 中,它们相对于放射区的位置是前部 (n = 18)、后部 (n = 2)、近端 (n = 1) 以及前部和远端 (n = 1)。结论: 本研究发现 LET 固定点位置变化较大,几乎一半的固定点在预定的影像学区之外。准确和精确的隧道放置是可能重要的多个因素之一,这些因素对于最大限度地降低外侧隔室过度约束、前交叉韧带移植物失败和导致 LET 移植物松动的屈光参差的风险可能很重要。
更新日期:2024-11-20
中文翻译:
使用基于 Landmark 的技术实现外侧关节外肌腱固定术股骨管位置的高度可变性
背景: 外侧关节外肌腱固定术 (LET) 增强术在前交叉韧带重建中的应用有所增加。根据触觉和解剖标志推荐了各种注视点;然而,关于这些技术在临床实践中的准确性或精密度的报道有限。目的/假设: 本研究的目的是评估使用解剖标志和触觉技术识别的 LET 固定点是否属于预定义的放射学区域。假设大多数 LET 固定点位于放射区内。研究设计: 横断面研究;证据水平, 4.方法: 回顾了 2018年1月至 2023年9月期间使用基于地标的技术进行 LET 前交叉韧带重建而不进行透视的患者的术后膝关节外侧 X 线片。2 名评分者根据他们与股后皮层线 (PFCL) 远端延伸的距离和垂直于髁后髁突口 (PCF) 处的线的距离测量注定点。如果无法确定隧道位置或术后 X 线片旋转不良,则排除患者。计算放射学等长区内的平均 LET 位置和点百分比,定义为 PFCL 后 4 ± 4 mm 和 4 ± 3 mm 以及 PCF 远端 6 ± 4 mm 和 20 ± 5 mm。结果: 获得 47 例的完整数据集。平均 LET 位置为 PFCL 前方 6.4 ± 7.1 mm(范围,-9 至 27.3 mm),PCF 近端 1.8 ± 7.6 mm(范围,-16.7 至 12.6 mm)。总体而言,53% 的 LET 固定点位于预定义的影像学区内。 在错位的隧道 (n = 22) 中,它们相对于放射区的位置是前部 (n = 18)、后部 (n = 2)、近端 (n = 1) 以及前部和远端 (n = 1)。结论: 本研究发现 LET 固定点位置变化较大,几乎一半的固定点在预定的影像学区之外。准确和精确的隧道放置是可能重要的多个因素之一,这些因素对于最大限度地降低外侧隔室过度约束、前交叉韧带移植物失败和导致 LET 移植物松动的屈光参差的风险可能很重要。