Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association · 2010
Femoral cross-pin safety in anterior cruciate ligament reconstruction as a function of femoral tunnel position and insertion angle.
Сравнительное исследованиеСтатьяРандомизированное исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Ошибки и ограничения
История · было → стало
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Krupp Ryan, Scovell Field, Cook Chad, Nyland John, Wyland Doug
Аннотация
PURPOSE: To compare femoral cross-pin guidewire insertion at differing angles to identify "safe zones" relative to saphenous nerve, popliteus tendon, fibular collateral ligament, peroneal nerve, and femoral artery/vein locations between transtibial and medial-portal femoral tunnel drilling methods.
METHODS: Five paired cadaveric knees were randomly assigned to a transtibial or medial-portal femoral (anatomic) tunnel drilling group. Guidewires were inserted at differing frontal plane angles (+10°, 0°, -10°, and -20°). Distances between the guidewire and the anatomic structure of interest were measured with an electronic caliper.
RESULTS: Two-way analysis of variance showed that guidewire angle, not tunnel drilling method, created significant differences between guidewire-saphenous nerve (P < .001) and guidewire-femoral artery/vein (P < .001) distances. The +10° angle showed a shorter guidewire-saphenous nerve distance than the 0°, -10°, and -20° angles. The +10° angle also showed a shorter guidewire-femoral artery/vein distance than the -10° and -20° angles, and the 0° insertion angle created a shorter guidewire-femoral artery/vein distance than the -10° and -20° angles. Fisher exact tests showed that guidewires inserted at a +10° angle showed a greater incidence of safe-zone violations for the saphenous nerve (P = .04) and femoral artery/vein (P < .0001).
CONCLUSIONS: Insertion angle, not tunnel drilling method, influenced saphenous nerve and femoral artery/vein injury risk. At the +10° angle, the saphenous nerve and femoral artery/vein are at greater risk for surgically induced injury. Guidewire insertion at -10° or -20° angles should increase concerns about potential popliteus tendon and fibular collateral ligament injury.
CLINICAL RELEVANCE: Insertion angle, not tunnel drilling method, influenced saphenous nerve and femoral artery/vein injury risk.
METHODS: Five paired cadaveric knees were randomly assigned to a transtibial or medial-portal femoral (anatomic) tunnel drilling group. Guidewires were inserted at differing frontal plane angles (+10°, 0°, -10°, and -20°). Distances between the guidewire and the anatomic structure of interest were measured with an electronic caliper.
RESULTS: Two-way analysis of variance showed that guidewire angle, not tunnel drilling method, created significant differences between guidewire-saphenous nerve (P < .001) and guidewire-femoral artery/vein (P < .001) distances. The +10° angle showed a shorter guidewire-saphenous nerve distance than the 0°, -10°, and -20° angles. The +10° angle also showed a shorter guidewire-femoral artery/vein distance than the -10° and -20° angles, and the 0° insertion angle created a shorter guidewire-femoral artery/vein distance than the -10° and -20° angles. Fisher exact tests showed that guidewires inserted at a +10° angle showed a greater incidence of safe-zone violations for the saphenous nerve (P = .04) and femoral artery/vein (P < .0001).
CONCLUSIONS: Insertion angle, not tunnel drilling method, influenced saphenous nerve and femoral artery/vein injury risk. At the +10° angle, the saphenous nerve and femoral artery/vein are at greater risk for surgically induced injury. Guidewire insertion at -10° or -20° angles should increase concerns about potential popliteus tendon and fibular collateral ligament injury.
CLINICAL RELEVANCE: Insertion angle, not tunnel drilling method, influenced saphenous nerve and femoral artery/vein injury risk.