Comparison of the ACL and ACL graft forces before and after ACL reconstruction - An in-vitro robotic investigation
Comparison of the ACL and ACL graft forces before and after ACL reconstruction - An in-vitro robotic investigation
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DOI：
10.1080/17453670610046019
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发表时间：
2006-04-01
影响因子：
3.7
通讯作者：
Gill, Thomas J.
中科院分区：
文献类型：
--
作者：
Li, Guoan;Papannagari, Ramprasad;Gill, Thomas J.
长期随访研究表明，前交叉韧带（ACL）重建后关节关节炎的发生率增加，这表明重建可能无法再现完整的ACL生物力学。我们不仅研究了前交叉韧带和前交叉韧带移植力的大小和方向。方法10个膝关节标本在机器人测试系统上进行了ACL完整、缺失和重建（使用骨-髌骨肌腱-骨移植）的测试。在完全伸展、15度、30度、60度和90度的胫骨前负荷下，确定前交叉韧带和前交叉韧带移植物力的大小和方向。用仰角（矢状面与胫骨平台形成的角）和偏离角（横切面与前后方向形成的角）描述定位。结果前交叉韧带重建后，在130-N前负荷作用下，腓骨前移位恢复到与完整膝关节的2.6 mm范围内。在所有屈曲角度重建前交叉韧带后，平均胫骨内旋减少。ACL移植物的力矢量与ACL的力矢量有显著差异。在所有屈曲角度下，前交叉韧带移植物力的仰角和偏角平均值均高于完整前交叉韧带。与完整的前交叉韧带相比，当代单束前交叉韧带重建可以在胫骨前负荷（包括大小和方向）下恢复前腓骨平移。这种移植物功能可能会改变膝关节在其他自由度上的运动，并可能过度限制胫骨旋转。解剖前交叉韧带重建应再现完整前交叉韧带力矢量的大小和方向，以便恢复6自由度膝关节运动学和关节反作用力。
Background Long-term follow-up studies have indicated that there is an increased incidence of arthrosis following anterior cruciate ligament (ACL) reconstruction, suggesting that the reconstruction may not reproduce intact ACL biomechanics. We studied not only the magnitude but also the orientation of the ACL and ACL graft forces.Methods 10 knee specimens were tested on a robotic testing system with the ACL intact, deficient, and reconstructed (using a bone-patella tendon-bone graft). The magnitude and orientation of the ACL and ACL graft forces were determined under an anterior tibial load of 130 N at full extension, and 15, 30, 60, and 90 degrees of flexion. Orientation was described using elevation angle (the angle formed with the tibial plateau in the sagittal plane) and deviation angle (the angle formed with respect to the anteroposterior direction in the transverse plane).Results ACL reconstruction restored anterior fibial translation to within 2.6 mm of that of the intact knee under the 130-N anterior load. Average internal tibial rotation was reduced after ACL reconstruction at all flexion angles. The force vector of the ACL graft was significantly different from the ACL force vector. The average values of the elevation and deviation angles of the ACL graft forces were higher than that of the intact ACL at all flexion angles.Interpretation Contemporary single bundle ACL reconstruction restores anterior fibial translation under anterior tibial load with different forces (both magnitude and orientation) in the graft compared to the intact ACL. Such graft function might alter knee kinematics in other degrees of freedom and could overly constrain the tibial rotation. An anatomic ACL reconstruction should reproduce the magnitude and orientation of the intact ACL force vector, so that the 6-degrees-of-freedom knee kinematics and joint reaction forces can be restored.