PURPOSE To 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. METHODS Eight 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. RESULTS Posteromedial 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. CONCLUSION The 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.

中文翻译：

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保留躯体的后内侧门入路减少了导针和神经血管结构之间的距离。

目的比较在解剖隧道的位置和与重要神经血管结构的接近性方面，采用后内侧门户的股骨干保留的前十字韧带（ACL）重建技术与传统的经干移植技术的比较。方法获得8个尸体膝盖进行研究。使用四种不同的技术放置股骨隧道引导针：副前内侧门，后内侧门，经胫骨和图4方法。然后解剖膝盖，并进行以下测量：每个针到隐神经和腓神经的距离，pop肌腱，神经血管束，股ACL足印和关节软骨，以及导针进入股外侧con的角度。进行荧光镜检查以确定脉络膜瘢痕的破坏。结果与其他三种技术相比，后内侧门静脉引导针明显更靠近神经血管束，pop肌腱和隐神经，但距离腓骨神经较远。它与ACL的解剖足迹之间的距离也最小，与股外侧lateral之间的夹角也最大。后内侧门引导销距关节软骨的距离与前内侧副门和图4引导销相近，而跨胫骨引导销最远。后内侧门引导针未能破坏所有标本中的骨scar，而其他三种技术始终侵犯骨scar。结论后内侧门户技术为解剖性ACL重建提供了一种合适的方法，同时保护了远端股骨物理免受损伤。由于该技术靠近一些重要的神经血管结构，因此需要格外小心。这项研究表明，后内侧门户技术是保留植骨的ACL修复的技术挑战较少的方法，需要特别注意保护神经血管束免受潜在损伤。