Physeal-sparing posteromedial portal approach reduced distance between guide pin and neurovascular structures

Abstract

PurposeTo compare a femoral physeal sparing anterior cruciate ligament (ACL) reconstruction technique utilizing a posteromedial portal to traditional transphyseal techniques with regards to anatomic tunnel positioning and proximity to important neurovascular structures. MethodsEight cadaveric knees were obtained for the study. Femoral tunnel guide pins were placed utilizing four different techniques: accessory anterior medial portal, posteromedial portal, trans‐tibial, and figure‐4 methods. The knees were then dissected and the following measurements taken: distance of each pin to the saphenous and peroneal nerve, popliteus tendon, neurovascular bundle, femoral ACL footprint and articular cartilage, and the angle of the guide pin entering the lateral femoral condyle. Fluoroscopic imaging was taken to determine the disruption of the physeal scar. ResultsPosteromedial portal guide pin was significantly closer to the neurovascular bundle, popliteal tendon and saphenous nerve when compared to the other 3 techniques, but was further from the peroneal nerve. It also had the smallest distance from the anatomic footprint of the ACL, and the largest angle to the lateral femoral condyle. The posteromedial portal guide pin had similar distance from the articular cartilage as the accessory anterior medial portal and figure‐4 guide pin, with the trans‐tibial guide pin being the farthest. The posteromedial portal guide pin failed to disrupt the physeal scar in all specimens, while the other three techniques consistently violated the physeal scar. ConclusionThe posteromedial portal technique offers an appropriate method for anatomic ACL reconstruction while protecting the distal femoral physis from injury. Care needs to be taken with this technique as it comes in closer proximity to some of the important neurovascular structures. This study indicates that posteromedial portal technique is a less technically challenging approach for physeal‐sparing ACL repair with special attention required for the protection of neurovascular bundle from potential injury.

Evaluation of Educational Advancement following a Sports Medicine Rotation

“…Fellows are also requested to initiate a project for the incoming fellow for the following year to ensured that all fellows participated in 2 research projects during their fellowship. Research curriculum included clinical studies [19][20][21][22][23] traditional biomechanical studies [24][25][26] and emerging machine learning Artificial Intelligence (AI) techniques in clinical translational research [27][28][29].…”

Safe femoral tunnel drilling angles avoid injury to the medial and posteromedial femoral anatomic structures during single-bundle posterior cruciate ligament reconstruction with the inside-out technique

“…In the process of PCLR, precise positioning of the tunnel is crucial for successful surgical outcomes. In recent years, the issue of the security of bone tunnel drilling during ligament reconstruction has received signiicant attention [7][8][9][10][11]. In terms of femoral tunnel positioning for PCLR, most studies have focused on tunnel length, graft ixation angles, and knee kinematics [12][13][14][15], whereas the security of the tunnel has not been frequently raised.…”