Femoral Tunnel Drilling Angles for Posteromedial Corner Reconstructions of the Knee
Por:
Gelber, PE, Masferrer-Pino, A, Erquicia, JI, Abat, F, Pelfort, X, Rodriguez-Baeza, A, Monllau, JC
Publicada:
1 sep 2015
Resumen:
Purpose: To determine the best angle to drill the femoral tunnels of the superficial medial collateral ligament (sMCL) and posterior oblique ligament (POL) with concomitant posterior cruciate ligament (PCL) reconstruction to avoid either short tunnels or tunnel collisions. Methods: Eight cadaveric knees were studied. Double-bundle PCL femoral tunnels were arthroscopically drilled. Drilling of the sMCL and POL tunnels was performed in 4 different combinations of 0 degrees and 30 degrees axial (anteriorly directed) and coronal (proximally directed) angulations. Specimens were scanned with computed tomography to document the relations of the sMCL and POL tunnels to the intercondylar notch and PCL tunnels. A minimum tunnel length of 25 mm was required. Results: When the sMCL femoral tunnel was drilled at 0 degrees axial and 30 degrees coronal (proximally directed) angulations or 30 degrees axial (anteriorly directed) and 0 degrees coronal angulations, the risk of tunnel collision with the PCL tunnels increased in comparison with the remaining evaluated angulations (P < .001). No POL tunnels collided with either PCL tunnel bundle with the exception of tunnels drilled at 0 degrees axial and 30 degrees coronal (proximally directed) angulations, which did so in 3 of 8 cases (P < .001). The minimum required tunnel length was obtained in all the sMCL and POL tunnels (P < .001 and P = .02, respectively). However, some of those angled at 0 degrees on the axial plane violated the intercondylar notch. Conclusions: When one is performing posteromedial reconstructions with concomitant PCL procedures, the sMCL and POL femoral tunnels should be drilled anteriorly and proximally at both 30 degrees axial and 30 degrees coronal angulations. The POL femoral tunnel may also be angled 0 degrees in the coronal plane. Tunnels at 0 degrees axial angulations showed a shorter distance to the intercondylar notch and a higher risk of collision with the PCL tunnels.
Filiaciones:
Gelber, PE:
Univ Autonoma Barcelona, Dept Orthopaed Surg, Hosp Santa Creu & St Pau, Barcelona 08041, Spain
Univ Autonoma Barcelona, ICATME Hosp Univ Quiron Dexeus, Barcelona 08041, Spain
Masferrer-Pino, A:
Univ Autonoma Barcelona, ICATME Hosp Univ Quiron Dexeus, Barcelona 08041, Spain
Erquicia, JI:
Univ Autonoma Barcelona, ICATME Hosp Univ Quiron Dexeus, Barcelona 08041, Spain
Abat, F:
ReSport Clin, Dept Sport Orthopaed, Barcelona, Spain
Pelfort, X:
Univ Autonoma Barcelona, ICATME Hosp Univ Quiron Dexeus, Barcelona 08041, Spain
Rodriguez-Baeza, A:
Univ Autonoma Barcelona, Dept Morphol Sci, Barcelona 08041, Spain
Monllau, JC:
Univ Autonoma Barcelona, ICATME Hosp Univ Quiron Dexeus, Barcelona 08041, Spain
Univ Autonoma Barcelona, Dept Orthoped Surg, Parc Salut Mar, Barcelona 08041, Spain
Green Accepted
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