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Abstract：
OBJECTIVE: To introduce a novel transverse tunnel (TT) in anterior talofibular ligament (ATFL) reconstruction, and assess whether it was superior to the tunnels currently used.
METHODS: Thirteen fresh cadaveric lower extremities were perfused with lead-based contrast. Talar tunnels were drilled from the ATFL insertion in the following directions: transversely towards the medial side (TT), towards the talar neck (TNT), and towards the anterior, distal, and posterior points of the medial malleolus (AMMT, DMMT, and PMMT, respectively). MicroCT was used to reconstruct the tali, and virtual transosseous and 20-mm blind-ended tunnels were generated. The graft bending angle, vascular compromise caused by the tunnels, and the minimum distances from the tunnels to the chondral surfaces were evaluated.
RESULTS: The bending angles between the ATFL and the TT, TNT, AMMT, DMMT, and PMMT were 47.3±7.9°, 41.5±7.7°, 57.0±6.0°, 63.9±11.7°, and 87.9±6.2°, respectively. The proportion of damaged intraosseous vessels was significantly less for the TT (7.8±2.7%) compared with the AMMT (10.0±5.2%), DMMT (15.5±6.5%), and PMMT (16.9±3.9%). Both the TNT and the AMMT carried a high risk of joint penetration, with respective minimum distances of 2.2±1.7 mm and 1.4±1.0 mm from the tunnel to the cartilage; in contrast, the TT, DMMT, and PMMT had larger safety margins, with minimum distances of 5.4±0.8 mm, 8.9+2.7 mm, and 6.0±1.2 mm. The blind-ended tunnels caused less vascular compromise and had larger minimum distances to the cartilage (better drilling safety) than the transosseous tunnels for all tunnel directions.
CONCLUSIONS: The TT achieves a superior graft bending angle and intraosseous blood supply protection than the AMMT, DMMT, and PMMT, and is less likely to result in cartilage damage than the TNT. The 20-mm blind-ended tunnels achieve less vessel damage and better drilling safety than transosseous tunnels.
METHODS: Thirteen fresh cadaveric lower extremities were perfused with lead-based contrast. Talar tunnels were drilled from the ATFL insertion in the following directions: transversely towards the medial side (TT), towards the talar neck (TNT), and towards the anterior, distal, and posterior points of the medial malleolus (AMMT, DMMT, and PMMT, respectively). MicroCT was used to reconstruct the tali, and virtual transosseous and 20-mm blind-ended tunnels were generated. The graft bending angle, vascular compromise caused by the tunnels, and the minimum distances from the tunnels to the chondral surfaces were evaluated.
RESULTS: The bending angles between the ATFL and the TT, TNT, AMMT, DMMT, and PMMT were 47.3±7.9°, 41.5±7.7°, 57.0±6.0°, 63.9±11.7°, and 87.9±6.2°, respectively. The proportion of damaged intraosseous vessels was significantly less for the TT (7.8±2.7%) compared with the AMMT (10.0±5.2%), DMMT (15.5±6.5%), and PMMT (16.9±3.9%). Both the TNT and the AMMT carried a high risk of joint penetration, with respective minimum distances of 2.2±1.7 mm and 1.4±1.0 mm from the tunnel to the cartilage; in contrast, the TT, DMMT, and PMMT had larger safety margins, with minimum distances of 5.4±0.8 mm, 8.9+2.7 mm, and 6.0±1.2 mm. The blind-ended tunnels caused less vascular compromise and had larger minimum distances to the cartilage (better drilling safety) than the transosseous tunnels for all tunnel directions.
CONCLUSIONS: The TT achieves a superior graft bending angle and intraosseous blood supply protection than the AMMT, DMMT, and PMMT, and is less likely to result in cartilage damage than the TNT. The 20-mm blind-ended tunnels achieve less vessel damage and better drilling safety than transosseous tunnels.
摘要：
目的：介绍一种新型的横隧道（TT）重建前腓骨韧带（ATFL），并评估它是否优于目前使用的隧道。
方法：用铅基对比剂灌注13例新鲜尸体下肢。从ATFL插入沿以下方向钻出的Talar隧道：横向朝向内侧（TT），朝向距骨颈部（TNT），朝向前方，远端,和内踝的后点(AMMT，DMMT,而PMMT,分别)。MicroCT被用来重建塔利，并产生了虚拟的跨骨隧道和20毫米的盲端隧道。移植物弯曲角度，由隧道引起的血管受损，并评估了从隧道到软骨表面的最小距离。
结果：ATFL和TT之间的弯曲角度，TNT,AMMT,DMMT,PMMT为47.3±7.9°，41.5±7.7°,57.0±6.0°,63.9±11.7°,87.9±6.2°，分别。与AMMT（10.0±5.2％）相比，TT（7.8±2.7％）的骨内血管受损比例明显较少，DMMT(15.5±6.5%),和PMMT（16.9±3.9%）。TNT和AMMT都有很高的联合渗透风险，隧道到软骨的最小距离分别为2.2±1.7mm和1.4±1.0mm；相反，TT,DMMT,PMMT有更大的安全裕度，最小距离为5.4±0.8mm，8.9+2.7mm,和6.0±1.2毫米。对于所有隧道方向，盲端隧道导致的血管损害较少，并且到软骨的最小距离更大（钻孔安全性更好）。
结论：TT比AMMT具有更好的移植物弯曲角度和骨内供血保护，DMMT,而PMMT,与TNT相比，软骨损伤的可能性较小。与跨海隧道相比，20毫米的盲端隧道实现了更少的船舶损坏和更好的钻井安全性。
方法：用铅基对比剂灌注13例新鲜尸体下肢。从ATFL插入沿以下方向钻出的Talar隧道：横向朝向内侧（TT），朝向距骨颈部（TNT），朝向前方，远端,和内踝的后点(AMMT，DMMT,而PMMT,分别)。MicroCT被用来重建塔利，并产生了虚拟的跨骨隧道和20毫米的盲端隧道。移植物弯曲角度，由隧道引起的血管受损，并评估了从隧道到软骨表面的最小距离。
结果：ATFL和TT之间的弯曲角度，TNT,AMMT,DMMT,PMMT为47.3±7.9°，41.5±7.7°,57.0±6.0°,63.9±11.7°,87.9±6.2°，分别。与AMMT（10.0±5.2％）相比，TT（7.8±2.7％）的骨内血管受损比例明显较少，DMMT(15.5±6.5%),和PMMT（16.9±3.9%）。TNT和AMMT都有很高的联合渗透风险，隧道到软骨的最小距离分别为2.2±1.7mm和1.4±1.0mm；相反，TT,DMMT,PMMT有更大的安全裕度，最小距离为5.4±0.8mm，8.9+2.7mm,和6.0±1.2毫米。对于所有隧道方向，盲端隧道导致的血管损害较少，并且到软骨的最小距离更大（钻孔安全性更好）。
结论：TT比AMMT具有更好的移植物弯曲角度和骨内供血保护，DMMT,而PMMT,与TNT相比，软骨损伤的可能性较小。与跨海隧道相比，20毫米的盲端隧道实现了更少的船舶损坏和更好的钻井安全性。
