ВЗАИМОСВЯЗЬ ПОЛОЖЕНИЯ КОСТНЫХ КАНАЛОВ ПРИ АРТРОСКОПИЧЕСКОЙ ПЛАСТИКЕ ПЕРЕДНЕЙ КРЕСТООБРАЗНОЙ СВЯЗКИ, ИНТРАОПЕРАЦИОННЫХ ПОЖЕЛАНИЙ ХИРУРГА И АНТРОПОМЕТРИЧЕСКИХ ДАННЫХ ПАЦИЕНТА

Purpose - to assess the correlation between tunnel position according to radiological data after ACL reconstruction and surgeon’s estimation during surgery. Material and methods. The study included 86 patients who underwent primary ACL reconstruction with the same surgeon and surgical technique in European Clinic of Sports Traumatology and Orthopedics between 2013 and 2015. In all cases hamstring autograft was used and patients received coronal and sagittal radiographs on the first day after surgery. Surgical data on tunnel position were obtained directly from the OR as dictated by the performing surgeon and fixed in the special registry. Radiological data were exported to eFilm, Merge Healthcare software for graphical analysis. Results. The study group included 54 male and 32 female patients, mean age 35.2 ±1,13, range from 17 to 56 years. Analysis of surgical data showed the median femoral tunnel angle on coronal plane to be 45° (IQR 45° - 60°), angle which occurred most often was 45°, median tibial tunnel angle on coronal plane appeared to be 30° (IQR 30° -35°), angle which occurred most often was 30°. According to radiological coronal plane data median femoral tunnel angle accounted 32° (IQR 28° -36°), angle which occurred most often was 35°, while median tibial tunnel angle accounted 20° (IQR 17-25°,) angle which occurred most often was 19°. Coronal plane mean tibial plateau width was 90,2±,1,1mm with tibial tunnel center located on the 48.55% from the medial side. Sagittal plane mean tibial plateau depth was 53,8 ± 0,6 mm with tibial tunnel center located on the 43.95% from the ventral side. Median tibial plateau posterior slope on the sagittal plane accounted 8° (IQR 6°-9°). Conclusion. Tunnel placement during arthroscopic ACL reconstruction could hardly be standardized. Anthropometric differences between patients can lead to different bone tunnel positions even if the procedure is performed by the same surgeon and surgical technique.Цель исследования - оценить зависимость положения каналов на послеоперационных рентгенограммах от интраоперационных пожеланий хирурга при артроскопической пластике передней крестообразной связки (ПКС). Материал и методы. Были проанализированы результаты хирургического лечения 86 пациентов, оперированных по поводу разрыва ПКС в Европейской клинике спортивной травматологии и ортопедии с 2013 по 2015 год одним и тем же хирургом по стандартной методике. Всем пациентам была выполнена первичная артроскопическая пластика ПКС аутотрансплантатом из сухожилий подколенных сгибателей. Интраоперационные данные фиксировались в протоколе операции и соответствующей анкете. Послеоперационные рентгенограммы в двух стандартных проекциях, выполненные на следующие сутки после операции, были импортированы в eFilm, Merge Healthcare для графического построения соответствующих осей и углов с последующим анализом результатов. Результаты. В группу исследования вошли 54 мужчины и 32 женщины в возрасте от 17 до 56 лет (средний возраст составил 35.2±1,13 лет). При анализе интраоперационных данных в коронарной плоскости медиана углов наклона бедренного канала составила 45° (интерквартильный размах 45-60°), наиболее часто встречался угол 45°. Медиана углов наклона большеберцового канала в коронарной плоскости составила 30° (интерквартильный размах 30-35°), наиболее часто встречался угол 30°. При анализе рентгенограмм на прямой проекции медиана углов наклона бедренного канала составила 32° (интерквартильный размах 28-36°), наиболее часто встречался угол 35°; медиана углов наклона большеберцового канала - 20° (интерквартильный размах 17-25°), наиболее часто встречался угол 19°. На прямой проекции средняя ширина плато большеберцовой кости составила 90,2±1,1 мм, центр большеберцового канала проецировался на 48.55% плато большеберцовой кости от медиального края. На боковой проекции средняя длина плато большеберцовой кости составила 53,8±0,6 мм, центр большеберцового канала проецировался на 43,95% плато большеберцовой кости от вентрального края. На боковой проекции медиана угла дорзального наклона плато большеберцовой кости составила 8° (интерквартильный размах 6-9°). Заключение. Расположение костных каналов при артроскопической пластике ПКС сложно стандартизировать. Даже в руках одного хирурга формирование каналов по одним и тем же анатомическим ориентирам может приводить к их разным положениям в зависимости от антропометрических характеристик пациента, что влияет на оценку послеоперационных результатов

CORRELATION BETWEEN TUNEL POSITION ACCORDING TO RADIOLOGICAL DATA AFTER ARTERIOR CRUCIATE LIGAMENT RECONSTRUCTION, SURGEON'S TUNEL ESTIMATION DURING SURGERY AND ANTROPOMETRIC CHARACTERISTICS OF THE PATIENT

Purpose - to assess the correlation between tunnel position according to radiological data after ACL reconstruction and surgeon's estimation during surgery. Material and methods. The study included 86 patients who underwent primary ACL reconstruction with the same surgeon and surgical technique in European Clinic of Sports Traumatology and Orthopedics between 2013 and 2015. In all cases hamstring autograft was used and patients received coronal and sagittal radiographs on the first day after surgery. Surgical data on tunnel position were obtained directly from the OR as dictated by the performing surgeon and fixed in the special registry. Radiological data were exported to eFilm, Merge Healthcare software for graphical analysis. Results. The study group included 54 male and 32 female patients, mean age 35.2 +/- 1.13, range from 17 to 56 years. Analysis of surgical data showed the median femoral tunnel angle on coronal plane to be 45 degrees (IQR 45-60 degrees), angle which occurred most often was 45 degrees, median tibial tunnel angle on coronal plane appeared to be 30 degrees (IQR 30-35 degrees), angle which occurred most often was 30 degrees. According to radiological coronal plane data median femoral tunnel angle accounted 32 degrees (IQR 28-36 degrees), angle which occurred most often was 35 degrees, while median tibial tunnel angle accounted 20 degrees (IQR 17-25 degrees) angle which occurred most often was 19 degrees. Coronal plane mean tibial plateau width was 90.2 +/- 1.1 mm with tibial tunnel center located on the 48.55% from the medial side. Sagittal plane mean tibial plateau depth was 53.8 +/- 0.6 mm with tibial tunnel center located on the 43.95% from the ventral side. Median tibial plateau posterior slope on the sagittal plane accounted 8 degrees (IQR 6-9 degrees). Conclusion. Tunnel placement during arthroscopic ACL reconstruction could hardly be standardized. Anthropometric differences between patients can lead to different bone tunnel positions even if the procedure is performed by the same surgeon and surgical technique

CORRELATION BETWEEN TUNEL POSITION ACCORDING TO RADIOLOGICAL DATA AFTER ARTERIOR CRUCIATE LIGAMENT RECONSTRUCTION, SURGEON'S TUNEL ESTIMATION DURING SURGERY AND ANTROPOMETRIC CHARACTERISTICS OF THE PATIENT

Purpose - to assess the correlation between tunnel position according to radiological data after ACL reconstruction and surgeon's estimation during surgery. Material and methods. The study included 86 patients who underwent primary ACL reconstruction with the same surgeon and surgical technique in European Clinic of Sports Traumatology and Orthopedics between 2013 and 2015. In all cases hamstring autograft was used and patients received coronal and sagittal radiographs on the first day after surgery. Surgical data on tunnel position were obtained directly from the OR as dictated by the performing surgeon and fixed in the special registry. Radiological data were exported to eFilm, Merge Healthcare software for graphical analysis. Results. The study group included 54 male and 32 female patients, mean age 35.2 +/- 1.13, range from 17 to 56 years. Analysis of surgical data showed the median femoral tunnel angle on coronal plane to be 45 degrees (IQR 45-60 degrees), angle which occurred most often was 45 degrees, median tibial tunnel angle on coronal plane appeared to be 30 degrees (IQR 30-35 degrees), angle which occurred most often was 30 degrees. According to radiological coronal plane data median femoral tunnel angle accounted 32 degrees (IQR 28-36 degrees), angle which occurred most often was 35 degrees, while median tibial tunnel angle accounted 20 degrees (IQR 17-25 degrees) angle which occurred most often was 19 degrees. Coronal plane mean tibial plateau width was 90.2 +/- 1.1 mm with tibial tunnel center located on the 48.55% from the medial side. Sagittal plane mean tibial plateau depth was 53.8 +/- 0.6 mm with tibial tunnel center located on the 43.95% from the ventral side. Median tibial plateau posterior slope on the sagittal plane accounted 8 degrees (IQR 6-9 degrees). Conclusion. Tunnel placement during arthroscopic ACL reconstruction could hardly be standardized. Anthropometric differences between patients can lead to different bone tunnel positions even if the procedure is performed by the same surgeon and surgical technique