Background:Adjusting the direction of the anterolateral ligament (ALL) femoral tunnel is suggested to avoid tunnel convergence during anterior cruciate ligament (ACL) reconstruction. Yet, there has been no in vivo clinical study reporting the effect of changing the direction of the ALL tunnel on the incidence of convergence with the ACL tunnel.Purpose:To report the incidence of convergence between the ACL femoral tunnel and a distally and anteriorly directed ALL femoral tunnel and to determine a safe distal angle and anterior angle.Study Design:Cross-sectional study; Level of evidence, 3.Methods:A total of 227 patients undergoing concomitant ALL and anatomic single-bundle ACL reconstruction between January 2020 and December 2022 were retrospectively reviewed. The tunnel convergence rate, angular orientation of the tunnels, and distance between tunnels were obtained using postoperative computed tomography. The patients were grouped based on the direction of the ALL tunnel (transverse vs distal anterior) and the presence of tunnel convergence (convergence vs no convergence).Results:The overall tunnel convergence rate was 53.3% (121/227 patients). Tunnel convergence was observed less frequently in the distal anterior group (33.7%) than in the transverse group (65.2%) ( P < .001). The no convergence group showed an ALL tunnel oriented more distally (20.2°± 11.1°) and anteriorly (19.5°± 10.2°) compared with the convergence group (8.7°± 6.5° and 6.9°± 5.3°, respectively) ( P = .005 and P = .008, respectively). There were no cases of tunnel convergence for ALL tunnels >24.3° distally and >25.5° anteriorly. There was no difference in the angle of the ACL femoral tunnel between all groups.Conclusion:A distally and anteriorly directed ALL femoral tunnel reduced the incidence of convergence with the ACL femoral tunnel. A distal angle >24.3° and an anterior angle >25.5° of an ALL tunnel are suggested to safely avoid convergence with the ACL tunnel.

中文翻译：

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ACL 和 ALL 联合重建中远端和前方 ALL 股骨隧道与 ACL 股骨隧道之间的收敛发生率：227 名患者的 3 维计算机断层扫描分析

背景：建议调整前外侧韧带（ALL）股骨隧道的方向，以避免前交叉韧带（ACL）重建过程中隧道汇聚。然而，还没有体内临床研究报告改变 ALL 隧道方向对与 ACL 隧道会聚发生率的影响。 目的：报告 ACL 股骨隧道与远端向前定向的会聚发生率ALL股骨隧道并确定安全的远端角和前角。研究设计：横断面研究；证据级别，3。方法：对 2020 年 1 月至 2022 年 12 月期间同时接受 ALL 和解剖单束 ACL 重建的 227 例患者进行回顾性分析。使用术后计算机断层扫描获得隧道收敛速度、隧道角度方向和隧道之间的距离。根据 ALL 隧道的方向（横向与远端前部）和隧道会聚的存在（会聚与不会聚）对患者进行分组。结果：总体隧道会聚率为 53.3%（121/227 名患者）。远端前组 (33.7%) 中观察到隧道会聚的频率低于横向组 (65.2%) (P < .001)。与会聚组（分别为 8.7°± 6.5° 和 6.9°± 5.3°）相比，无会聚组显示 ALL 隧道朝向更远端（20.2°± 11.1°）和更靠前（19.5°± 10.2°）（ P =分别为 .005 和 P = .008）。所有隧道远端 >24.3° 和前方 >25.5° 均未出现隧道收敛的情况。所有组之间ACL股骨隧道的角度没有差异。结论：远端向前的ALL股骨隧道减少了与ACL股骨隧道会聚的发生率。建议 ALL 隧道的远端角 >24.3° 和前角 >25.5°，以安全地避免与 ACL 隧道汇合。