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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >Avoidance of Reamer Breakage During ACL Reconstruction With Flexible Reamer System
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Avoidance of Reamer Breakage During ACL Reconstruction With Flexible Reamer System

机译：灵活的铰刀系统避免在ACL重建过程中铰刀损坏

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Dear Editor: I read with great attentiveness the article titled “Anterior Cruciate Ligament Reconstruction Using a Flexible Reamer System: Technique and Pitfalls” by Fitzgerald et al,~( 1 )published in July 2015. It is a perfectly timed article, as surgeons are actually looking to PubMed to know the tips, tricks, and results of the “flexible drilling system for anatomical ACL reconstruction” owing to recent promotion of the Clancy System by Smith & Nephew and the VersiTomic System by Stryker. The authors have rightly described the need to flex the knee to 110°. The article also precisely highlights the potential pitfall of the system: reamer breakage. However, I differ with this view of the authors: “Using an initial 4.5-mm reamer is often advantageous as it allows for button fixation passage out over the lateral wall of the femur and for accurately measuring the femoral tunnel length. Using a 4.5-mm reamer also allows mobility of the nitinol guide wire and can position the final reamer slightly superior or more toward the [posterolateral] bundle footprint; this is useful if the nitinol guide wire is initially positioned slightly inferior or too close to the [anteromedial] bundle footprint.”~( 1 )~((p4)) The 4.5-mm reamer must not be used before the reaming of the proposed femoral tunnel to the desired dimension and desired length, usually by an 8- or 9-mm reamer. To elaborate, the flexible guide wire remains in the femoral tunnel, binded by the cortex of the lateral femoral condyle and by lateral femoral condylar bone. The initial reamer that we use is determined by the diameter of the graft, usually 8 or 9 mm. This reamer is not blown through and through the lateral femoral condyle, and we usually leave 5 to 10 mm of lateral wall so that the guide wire does not leave its purchase in the bone and does not move with the reamers. This, in turn, allows a reasonable length of flexible guide wire coming out of the medial portal. As well, this leads to a long contact between the flexible guide wire and flexible reamer, thereby decreasing the possibility of reamer breakage. After this step, the 4.5-mm reamer is used so as to allow flipping of the suspensory fixation system that we intend to use. Additionally, I also differ with the authors’ view of using a fixed 55° tibial guide. The entry point of the tibial guide wire on the anteromedial tibial surface must be the determinant to the tibial guide angle and not vice versa. Ashish Jaiman, MBBS, MS New Delhi, India.
机译：亲爱的编辑：Fitzgerald等人（1）于2015年7月发表了一篇题为《使用灵活的铰刀系统重建前交叉韧带：技术和陷阱》的文章，引起了我的关注。实际上，由于Smith＆Nephew最近开发了Clancy系统和Stryker开发了VersiTomic系统，实际上希望PubMed了解“用于解剖ACL重建的灵活钻孔系统”的技巧，窍门和结果。作者正确地描述了将膝盖弯曲至110°的必要性。文章还恰好突出了该系统的潜在陷阱：铰刀损坏。但是，我与作者的观点不同：“使用最初的4.5毫米铰刀通常是有利的，因为它可以使纽扣固定穿过股骨的侧壁并准确地测量股骨隧道的长度。使用4.5毫米铰刀还可以使镍钛合金导丝活动性强，并且可以将最终铰刀朝着[后外侧]束足迹稍稍或更高一些定位。如果最初将镍钛合金导丝放置在稍稍低于或太靠近[内侧]束足迹的位置，这将很有用。”〜（1）〜（（p4））在建议的铰孔之前，不得使用4.5毫米铰刀股骨隧道通常使用8毫米或9毫米铰刀达到所需尺寸和所需长度。详细地说，柔性导丝保留在股骨隧道中，并由外侧股骨con皮质和外侧股骨fe骨束缚。我们使用的初始铰刀取决于移植物的直径，通常为8或9 mm。该铰刀不会吹过并穿过股骨外侧con，我们通常会留下5至10 mm的侧壁，以使导丝不会留在骨头中，也不会随铰刀移动。继而，这允许合理长度的柔性导丝从内侧门出来。同样，这导致柔性导丝和柔性铰刀之间的长时间接触，从而减小了铰刀破裂的可能性。在此步骤之后，使用4.5毫米铰刀，以便翻转我们打算使用的悬吊固定系统。此外，作者对于使用固定的55°胫骨导管的观点也与我不同。胫骨导线在胫骨前表面的进入点必须决定胫骨导向角，反之亦然。 Ashish Jaiman，MBBS，MS新德里，印度。

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