Biomechanical evaluation of knee joint laxities and graft forces after anterior cruciate ligament reconstruction by anteromedial portal, outside-in, and transtibial techniques.
Biomechanical evaluation of knee joint laxities and graft forces after anterior cruciate ligament reconstruction by anteromedial portal, outside-in, and transtibial techniques.
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DOI：
10.1177/0363546511420810
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发表时间：
2011-12
期刊：
影响因子：
--
通讯作者：
Gill TJ
中科院分区：
文献类型：
--
作者：
Sim JA;Gadikota HR;Li JS;Li G;Gill TJ
最近，强调解剖前交叉韧带（ACL）重建，以改善关节松弛，并可能避免软骨退变的开始。目前缺乏关于通过目前实践的隧道创建技术重建ACL在恢复正常关节松弛方面的有效性的信息。对照实验室研究。前内侧入路技术、由外向内技术和改良经胫骨技术重建前交叉韧带均能恢复正常膝关节松弛度和ACL力。使用机器人测试系统在0°、30°、60°和90°屈曲时的胫骨前载荷（134 N）和0°和30°屈曲时的组合扭矩（10 N·m外翻和5 N·m胫骨内扭矩）下对8个新鲜冷冻的人类尸体膝关节样本进行测试。在5种不同条件下（ACL完整膝关节、ACL缺陷膝关节、通过AM入路技术重建ACL膝关节、通过OI技术重建ACL膝关节和通过TT技术重建ACL膝关节），测量每个膝关节标本的膝关节运动学、ACL和ACL移植物力。在胫骨前负荷下，3种重建方法在恢复胫骨前平移方面无显著差异（P > 0.05）。然而，3种ACL重建技术均不能完全恢复正常的胫骨前平移（P <.05）。在胫骨扭矩联合作用下，AM入路和OI技术在屈曲0°时均能接近地恢复正常膝关节胫骨前平移（P > .05），但在屈曲30°时则不能（P <.05）。在胫骨扭矩联合作用下，采用TT技术重建ACL在屈曲0°和30°时均无法恢复正常的胫骨前平移（P <.05）。在两种载荷条件下，3种重建技术中ACL移植物所经受的力均低于正常ACL所经受的力。AM入路、OI和改良TT技术重建前交叉韧带在恢复正常膝关节松弛和原位ACL力方面具有生物力学可比性。AM入路、OI和改良TT技术重建前交叉韧带的膝关节松弛度相似。在选择隧道创建技术之前，应该仔细考虑技术风险和珍珠。
Recently, anatomic anterior cruciate ligament (ACL) reconstruction is emphasized to improve joint laxity and to potentially avert initiation of cartilage degeneration. There is a paucity of information on the efficacy of ACL reconstructions by currently practiced tunnel creation techniques in restoring normal joint laxity. Controlled laboratory study. Anterior cruciate ligament reconstruction by the anteromedial (AM) portal technique, outside-in (OI) technique, and modified transtibial (TT) technique can equally restore the normal knee joint laxity and ACL forces. Eight fresh-frozen human cadaveric knee specimens were tested using a robotic testing system under an anterior tibial load (134 N) at 0°, 30°, 60°, and 90° of flexion and combined torques (10-N·m valgus and 5-N·m internal tibial torques) at 0° and 30° of flexion. Knee joint kinematics, ACL, and ACL graft forces were measured in each knee specimen under 5 different conditions (ACL-intact knee, ACL-deficient knee, ACL-reconstructed knee by AM portal technique, ACL-reconstructed knee by OI technique, and ACL-reconstructed knee by TT technique). Under anterior tibial load, no significant difference was observed between the 3 reconstructions in terms of restoring anterior tibial translation (P > .05). However, none of the 3 ACL reconstruction techniques could completely restore the normal anterior tibial translations (P <.05). Under combined tibial torques, both AM portal and OI techniques closely restored the normal knee anterior tibial translation (P > .05) at 0° of flexion but could not do so at 30° of flexion (P <.05). The ACL reconstruction by the TT technique was unable to restore normal anterior tibial translations at both 0° and 30° of flexion under combined tibial torques (P <.05). Forces experienced by the ACL grafts in the 3 reconstruction techniques were lower than those experienced by normal ACL under both the loading conditions. Anterior cruciate ligament reconstructions by AM portal, OI, and modified TT techniques are biomechanically comparable with each other in restoring normal knee joint laxity and in situ ACL forces. Anterior cruciate ligament reconstructions by AM portal, OI, and modified TT techniques result in similar knee joint laxities. Technical perils and pearls should be carefully considered before choosing a tunnel creating technique.
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影响因子：
4.8
作者：
Abebe, Ermias S.;Moorman, C. T., III;DeFrate, Louis E.
通讯作者：
DeFrate, Louis E.
影响因子：
2.8
作者：
Li, G;Gill, TJ;Zarins, B
通讯作者：
Zarins, B
影响因子：
4.7
作者：
HARNER, CD;MARKS, PH;MENGATO, R
通讯作者：
MENGATO, R
DOI：
10.1016/j.arthro.2007.06.013
发表时间：
2007-11-01
影响因子：
4.7
作者：
Golish, S. Raymond;Baumfeld, Joshua A.;Miller, Mark D.
通讯作者：
Miller, Mark D.
影响因子：
4.8
作者：
Heming, James F.;Rand, Jason;Steiner, Mark E.
通讯作者：
Steiner, Mark E.