Knee stability and graft function following anterior cruciate ligament reconstruction: Comparison between 11 o'clock and 10 o'clock femoral tunnel placement
Knee stability and graft function following anterior cruciate ligament reconstruction: Comparison between 11 o'clock and 10 o'clock femoral tunnel placement
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DOI：
10.1053/jars.2003.50084
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发表时间：
2003-03-01
影响因子：
4.7
通讯作者：
Woo, SLY
中科院分区：
文献类型：
--
作者：
Loh, JC;Fukuda, Y;Woo, SLY
目的：通过比较固定在10点和11点位置的前交叉韧带(前交叉韧带)移植物在胫骨前外力和联合旋转载荷作用下的生物力学结果以及与完整膝关节的生物力学结果，研究前交叉韧带移植物恢复膝关节功能的效果。研究类型：采用人体身体标本进行生物力学实验。方法：10例(41~13岁)人身体膝关节，按随机顺序在10点和11点位置放置骨-髌腱-骨移植重建膝关节，然后使用机器人/万能力矩传感器测试系统进行测试。施加两种外载荷：(1)膝关节完全伸展、屈曲15度、30度、60度和90度的134N胫骨前向载荷；(2)膝关节屈曲15度和30度时外翻10N-m和胫骨内侧扭矩5N-m的联合旋转载荷。重建膝关节的运动学结果和前交叉韧带移植物中的原位作用力被确定为每个股骨隧道位置。结果：在134N胫骨前向载荷作用下，两个股骨隧道位置的胫骨前移(ATT)与正常膝关节相比，除膝关节屈曲90时和10点钟位膝关节屈曲60时外，其余均无显著差异。除屈膝90度外，10点位和11点位的ATT差异无统计学意义。然而，在复合旋转载荷下，11点位置的耦合ATT约为完整膝关节屈曲15度和30度时的130%。对于10点钟位置，双膝ATT在屈曲15度时与完整膝关节无显著差异，在屈曲30度时约为完整膝关节的120%。在屈曲15度和30度时，10点钟位置的耦合ATT显著小于11点钟位置。在相同的载荷条件下(分别为70+/-18N和60+/-15N)，前交叉韧带移植物在10点位置的原位张力也显著高于11点位置在屈曲30度时的原位压力。结论：与11点位相比，10点位更有效地抵抗旋转负荷，因为移植物的ATT较小，原位受力较高。尽管在胫骨前部负荷下，放置在10点或11点位置的前交叉韧带移植物同样有效，但两种股骨隧道位置都不能将膝关节的稳定性完全恢复到完整膝关节的水平。
Purpose: To study how well an anterior cruciate ligament (ACL) graft fixed at the 10 and 11 o'clock positions can restore knee function in response to both externally applied anterior tibial and combined rotatory loads by comparing the biomechanical results with each other and with the intact knee. Type of Study: Biomechanical experiment using human cadaveric specimens. Methods: Ten human cadaveric knees (age, 41 13 years) were reconstructed by placing a bone-patellar tendon-bone graft at the 10 and 11 o'clock positions, in a randomized order, and then tested using a robotic/universal force-moment sensor testing system. Two external loading conditions were applied: (1) 134 N anterior tibial load with the knee at full extension, 15degrees, 30degrees, 60degrees, and 90degrees of flexion, and (2) a combined rotatory load of 10 N-m valgus and 5 N-m internal tibial torque with the knee at 15 and 30 of flexion. The resulting kinematics of the reconstructed knee and in situ forces in the ACL graft were determined for each femoral tunnel position. Results: In response to a 134-N anterior tibial load, anterior tibial translation (ATT) for both femoral tunnel positions was not significantly different from the intact knee except at 90 of knee flexion as well as at 60 of knee flexion for the 10 o'clock position. There was no significant difference in the ATT between the 10 and 11 o'clock positions, except at 90 of knee flexion. Under a combined rotatory load, however, the coupled ATT for the 11 o'clock position was approximately 130% of that for the intact knee at 15degrees and 30degrees of flexion. For the 10 o'clock position, the coupled ATT was not significantly different from the intact knee at 15degrees of flexion and approximately 120% of that for the intact knee at 30degrees of flexion. Coupled ATT for the 10 o'clock position was significantly smaller than for the 11 o'clock position at 15degrees and 30degrees of flexion. The in situ force in the ACL graft was also significantly higher for the 10 o'clock position than the 11 o'clock position at 30degrees of flexion in response to the same loading condition (70 +/- 18 N v 60 +/- 15 N, respectively). Conclusions: The 10 o'clock position more effectively resists rotatory loads when compared with the 11 o'clock position as evidenced by smaller ATT and higher in situ force in the graft. Despite the fact that ACL grafts placed at the 10 or 11 o'clock positions are equally effective under an anterior tibial load, neither femoral tunnel position was able to fully restore knee stability to the level of the intact knee.