Iconography Comparision And Evaluation Of Femoral Tuuel Position In Anterior Cruciate Ligament Reconstruction

Objective:At present,the frequently-used methods of locating the femoral tunnel in anterior cruc iate ligament(ACL)reconstruction are the stump and the standard positioning in clinical.There were differences in the location of femoral tunnel with two methods,it may affect the postoperative knee function.In this study,postoperative X-ray and CT three-dimension al model were used to observe and measure the femoral tunnel in two groups.Analyze possible differences and make preliminary evaluation to guide clinical work.Methods:Retrospective and analysis of 76 cases of anterior cruciate ligament reconstruction by arthroscope in our hospital from January 1,2015 to December 31,2016 to the year of arthroscopy.Among them,40 cases located the femoral tunnel by the residual positioning method(set as the residual positioning group).In addition,36 patients were treated with standard positioning method for femoral tunnel(set as the standard positioning group).After the operation,the CT of the knee joint was reconstructed and the three-dimensional reconstruction of the medial femoral condyle was performed.The difference of the locatio n of the bone and the length of the bone between the two groups were compared with the Bernard method.Results:The tunnel length of residual positioning group 37.12±1.69(34.00-41.00)mm.The tu nnel length of standard positioning group 41.23±2.40(38.00-42.60)mm.There were signif icant differences in the length of the stump and the standard positioning group(P<0.001).In the Bernard grid method 4*4 mesh,there were 38 cases of femoral bone location in the stump group in 2b,1case fell in 1b,and the other 1 case fell in 2a.There were 35 cases of femoral bone in the standard positioning group in 1a,1 cases fell in 2a.In the B and h lines,the difference of the femoral tunnel position between the residual and the standard group was statistically significant(P<0.001).On B line and h line,there was no significant differe nce in stump group of the femoral tunnel position and the location of AM and PL(P>0.001).On the B line,there was no significant difference in the standard positioning group of the position and the anteromedial bundle(AMB)(P>0.001).There was significant difference in the position of the posterolateral bundle(PLB)(P<0.001).In h line,the difference of the femoral tunnel position between the standard group and AM 、PLwas statistically significant(P<0.001).On X-ray positive film,there was no difference ibetween the included angle of femoral tunnel centerline and Knee line(α)in stump group and IKDC>90(the international knee documentation committee,IKDC)(P<0.001);There was significant difference between IKDC<90 group;There was significant difference between the standard positioning group and IKDC>90 group(P<0.001);But there was no significant difference between IKDC<90 group.Conclusion:The location of the bone in the standard positioning group was "high" and "deep " than that of the residual positioning group,tunnel length is longer.The location of the b one in the stump was relatively "low" and "shallow",tunnel length is shorter.But the loc ation of the bone graft in the residual group was more close to the original anatomical anatomy of the anterior cruciate ligament.So ACL single bundle reconstruction of the femoral bone positioning method can be based on the patient’s condition and intraoperative view.It can be tentatively concluded that the functional recovery of the knee joint is more close to the normal function of the knee.Single bundle reconstruction of anterior cruciate ligament in clinical,If we can find anterior cruciate ligament stump under arthroscopy,it is more likely to use the stump to locate the femoral tunnel.