Effect of Dynamic Changes in Anterior Cruciate Ligament In Situ Graft Force on the Biological Healing Response of the Graft-Tunnel Interface
Effect of Dynamic Changes in Anterior Cruciate Ligament In Situ Graft Force on the Biological Healing Response of the Graft-Tunnel Interface
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DOI：
10.1177/0363546517745624
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发表时间：
2018-03-01
影响因子：
4.8
通讯作者：
Rodeo, Scott A.
中科院分区：
文献类型：
--
作者：
Ma, Richard;Schar, Michael;Rodeo, Scott A.
背景：用于重建的前交叉韧带 (ACL) 移植物会受到复杂的力的作用。目前的“解剖”ACL 重建技术可能会导致更大的原位移植物力。改变 ACL 移植物力大小对移植物隧道骨整合的生物学效应尚不清楚。目的：研究目的是确定膝关节运动期间 ACL 移植物上的机械力如何影响隧道中的肌腱愈合。研究设计：对照实验室研究。方法：雄性大鼠（N = 120）接受软组织屈肌腱的单侧 ACL 重建在手术时通过不同的股骨隧道位置调节 ACL 移植物力，以通过膝关节运动产生不同的移植物力模式，使用定制的膝关节弯曲装置通过控制日常膝关节运动来传递移植物负载，然后通过生物力学、微计算机断层扫描和组织学分析来评估移植物隧道愈合。结果：ACL 移植物隧道愈合对术后膝关节运动的移植物力的动态变化敏感。与具有低力 ACL 移植物和关节运动的膝关节以及固定的膝关节相比，伴随关节运动的 ACL 移植物力导致早期下 ACL 移植物负载失效（平均值 +/- SD：分别为 5.50 +/- 2.30 N 与 9.91 +/- 3.54 N [P = .013] 和 10.90 +/- 2.8 N [P = .001]，股骨体积分数更大）。与高力 ACL 移植物相比，在第 3 周和第 6 周时，在固定膝盖和采用低力 ACL 移植物的膝盖中观察到了这种情况。结论：作者能够证明 ACL 移植物隧道合并对 ACL 移植物力随关节运动的动态变化敏感，早期对 ACL 移植物施加的高力似乎会损害移植物隧道骨整合。
Background: Anterior cruciate ligament (ACL) grafts that are placed for reconstruction are subject to complex forces. Current "anatomic'' ACL reconstruction techniques may result in greater in situ graft forces. The biological effect of changing magnitudes of ACL graft force on graft-tunnel osseointegration is not well understood.Purpose: The research objective is to determine how mechanical force on the ACL graft during knee motion affects tendon healing in the tunnel.Study Design: Controlled laboratory study.Methods: Male rats (N = 120) underwent unilateral ACL reconstruction with a soft tissue flexor tendon autograft. ACL graft force was modulated by different femoral tunnel positions at the time of surgery to create different graft force patterns with knee motion. External fixators were used to eliminate graft load during cage activity. A custom knee flexion device was used to deliver graft load through controlled daily knee motion. Graft-tunnel healing was then assessed via biomechanical, micro-computed tomography, and histological analyses.Results: ACL graft-tunnel healing was sensitive to dynamic changes in graft forces with postoperative knee motion. High ACL graft force with joint motion resulted in early inferior ACL graft load to failure as compared with knees that had low-force ACL grafts and joint motion and knees that were immobilized (mean +/- SD: 5.50 +/- 2.30 N vs 9.91 +/- 3.54 N [P = .013] and 10.90 +/- 2.8 N [P = .001], respectively). Greater femoral bone volume fraction was seen in immobilized knees and knees with low-force ACL grafts when compared with high-force ACL grafts at 3 and 6 weeks.Conclusion: The authors were able to demonstrate that ACL graft-tunnel incorporation is sensitive to dynamic changes in ACL graft force with joint motion. Early high forces on the ACL graft appear to impair graft-tunnel osseointegration.