Systematic review of bone tunnel placement in anterior cruciate ligament near-isometric reconstruction / 中华骨科杂志

ABSTRACT

Objective@#To identify the optimal placement of bone tunnel during near-isometric anterior cruciate ligament reconstruction (ACLR), and its dimensional relationship with knee anatomic structure after summarizing published researches.@*Methods@#PubMed, Embase, and CNKI were screened for Chinese or English articles on clinical studies, cadaveric studies of knee and reviews on bone tunnel placement in anterior cruciate ligament near-isometric reconstruction and isometry of native anatomic fibers. Related articles were extracted and systematically reviewed.@*Results@#A total of 21 articles were finally included after screening. This systematic review found that most of the literatures were cadaveric studies, among which three dimensional imaging techniques, combined with cadaveric studies, were commonly used as a method of determining the length change between spots on the tibial plateau and lateral condyle of femur in recent years. There were 3 case series and 1 prospective cohort study. On the side of lateral condyle of femur, Blumensaat's line, lateral intercondylar ridge and insertion of intact anterior cruciate ligament were commonly used as reference to describe the near isometric area, while on the side of tibial plateau, the anterior horn of lateral meniscus were used as reference for reconstruction. The bone tunnel on tibial side was ignored compared with the femoral side when considering the isometry of reconstruction. There were overlaps among areas of bone tunnel placement found by different studies in near-isometric reconstruction. Not all native anterior cruciate ligament fibers were near-isometric.@*Conclusion@#The present study found that the area of femoral bone tunnel of anterior cruciate ligament near-isometric reconstruction were near the anterior part of lateral intercondylar ridge, deeply positioned with longitudinal axis close to the extension line of posterior cortical part of femur, coinciding with the distribution of direct fibers. There was contradiction on whether anterior cruciate ligament near-isometric reconstruction areas and anterior cruciate ligament anatomic insertion sites overlapped with each other. The most isometric area within the anatomic insertion site was the area of anterior fibers near lateral intercondylar ridge, which carried a large portion of the total anterior cruciate ligament load. Generally, there was a scarce of clinical researches in the field of isometry of ACLR. For the purpose of attesting the accuracy of the results we found, a combination of intra-operative observation on the displacement of graft relative to bone-tunnel and post-operative imaging such as MRI and three dimensional CT should be considered.