Optimization of graft fixation at the time of anterior cruciate ligament reconstruction - Part II: Effect of knee flexion angle
Optimization of graft fixation at the time of anterior cruciate ligament reconstruction - Part II: Effect of knee flexion angle
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DOI：
10.1177/0363546508317412
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发表时间：
2008-06-01
影响因子：
4.8
通讯作者：
Fujie, Hiromichi
中科院分区：
文献类型：
--
作者：
Mae, Tatsuo;Shino, Konsei;Fujie, Hiromichi
背景资料：关于前交叉韧带重建术中移植物固定时膝关节屈曲角度尚无共识。目的：评价最终移植物固定时屈曲角度对股骨和胫骨之间位置关系以及载荷的影响。研究设计：对照实验室研究。方法：利用自行研制的机器人系统，对6个完整尸体膝关节进行6个自由度的被动屈伸运动，并记录其三维运动轨迹。前交叉韧带重建采用单髁技术，使用自体四股腘绳肌腱，移植物固定在0 °（A组）、200 °（B组）或900 °（C组），初始张力恒定为44 N。然后，膝关节重复与之前相同的运动，同时记录股骨和胫骨之间的相对位置。结果：B组在所有屈曲角度下胫骨相对于正常膝关节的后移最小，而B组胫骨与股骨之间的载荷也最小，最接近正常膝关节。由于B组股骨与胫骨的位置关系和载荷最接近正常膝关节，在前交叉韧带重建术中，200 °屈曲是移植物张紧和固定最理想的测试位置。在前交叉韧带重建中，当移植物固定在屈曲20 °时，胫骨-股骨位置保持良好。
Background: There is no consensus about flexion angle of the knee at the time of graft fixation in anterior cruciate ligament reconstruction.Purpose: To evaluate the effect of flexion angle at the final graft fixation on the positional relationship as well as the load between femur and tibia.Study Design: Controlled laboratory study.Methods: Six intact cadaveric knees were passively flexed and extended under 6 degrees of freedom with the robotic system developed in our laboratory, while their 3-climensional paths were recorded. Anterior cruciate ligament reconstruction was performed with a single-socket technique using autogenous quadrupled hamstring tendons, while the graft was fixed at 0 degrees (group A), 200 (group B), or 900 (group C) with a constant initial tension of 44 N. The knees then repeated the same movement as before while the relative position between femur and tibia was recorded. The load in the femorotibial joint was also calculated based on the principle of superposition.Results: Posterior displacement of the tibia compared with the normal knee was the smallest in group B at all flexion angles, while the load between tibia and femur in group B was also the smallest and the closest to the normal knee.Conclusion: As the positional relationship as well as the load between femur and tibia in group B was the closest to that in the normal knee, 200 of flexion is the most desirable of the positions tested for graft tensioning and fixation at the time of anterior cruciate ligament reconstruction.Clinical Relevance: The tibia-femur position is well retained when the graft was fixed at 20 degrees of flexion in anterior cruciate ligament reconstruction.