Femoral Screw Divergence via the Anteromedial Portal Using an Outside-In Retrograde Drill in Bone-Patella Tendon-Bone Anterior Cruciate Ligament Reconstruction: A Cadaveric Study

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• 作者：Jason Capo ; M.D. ; Daniel J. Kaplan ; B.A. ; ^{danieljameskaplan@gmail.com} ; David J. Fralinger ; M.D. ; Soterios Gyftopolous ; M.D. ; Eric J. Strauss ; M.D. ; Laith M. Jazrawi ; M.D. ; Michael J. Alaia ; M.D.
• 刊名：Arthroscopy: The Journal of Arthroscopic & Related Surgery
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：33
• 期：2
• 页码：355-361
• 全文大小：881 K
• 卷排序：33

文摘

To assess screw divergence when inserting an interference screw for a bone–patellar tendon–bone graft using an outside-in technique with a retrograde drill to create the femoral tunnel.MethodsTen cadaver specimens underwent anterior cruciate ligament reconstruction with a bone–patellar tendon–bone autograft, with 23-mm-deep tunnels created by a retrograde drill outside-in technique. Drilling angles were based on a previous study that established the optimal angles to recreate the anterior cruciate ligament footprint. To ensure that screw insertion angles matched the angle of socket drilling, a marking pen was used to transpose 2 lines on the skin of the anterior knee corresponding to the drill in both the coronal and axial planes with the knee held at 90° of flexion. The femoral-sided bone plug was affixed with a 7 × 23 mm interference screw through an anteromedial portal. Computed tomography scans were used to calculate coronal and sagittal screw-tunnel divergence.ResultsThe median screw divergence in the coronal plane was 2.79°, with a range of 1.1° to 17.2°. Of 10 specimens, 8 had no divergence (0° to 5°), 0 screws were between 5° and 10°, 1 screw was between 10° and 15°, and 1 screw was between 15° and 20°. The 95% confidence interval was 3.73° to 11.69°. No screws had ≥20° of divergence. In the sagittal plane, the median screw divergence was 5.68°, with a range of 1.2° to 18.7°. Five specimens had no divergence (0° to 5°), 3 screws were between 5° and 10°, 0 screws were between 10° and 15°, and 2 screws were between 15° and 20° of divergence. The 95% confidence interval was 3.73° to 11.69°. No screws had ≥20° of divergence.ConclusionsThe results of this study showed that 80% of screws diverted less than 5° in the coronal plane. In the sagittal plane, only 50% of screws were found to have divergence of 5° or less. No screw in either plane had divergence of greater than or equal to 20°.Clinical RelevanceWhen using a retrograde drill, a skin marking technique is a useful aid in placing interference screws with acceptable angles of divergence when using an inside-out technique.