Acute anterior cruciate ligament reconstruction with an augmented remnant repair: a comparative macroscopic and biomechanical study in an animal model.
Acute anterior cruciate ligament reconstruction with an augmented remnant repair: a comparative macroscopic and biomechanical study in an animal model.
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DOI：
10.1016/j.arthro.2013.11.030
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发表时间：
2014-03
期刊：
影响因子：
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通讯作者：
Guan-yang Song;Jin Zhang;Xu Li;Xing-zuo Chen;Yue Li;H. Feng
中科院分区：
文献类型：
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作者：
Guan-yang Song;Jin Zhang;Xu Li;Xing-zuo Chen;Yue Li;H. Feng
目的比较急性修复前交叉韧带（ACL）残端的结构完整性和愈合能力，以及急性残端修复前交叉韧带重建术（ACLR）术后短期生物力学结果是否上级传统ACLR。随机分为残端修复ACLR组（1组，n = 25）和常规ACLR组（2组，n = 25）。两组中的每只动物均接受单侧ACLR和半腱肌肌腱自体移植物。在ACLR期间，第1组中的ACL残留物采用股骨张紧技术进行了急性修复，而第2组中的ACL残留物进行了清创。第1组对剩余部分的结局进行了宏观评价。根据2个不同的标准，将残端的结构完整性和残端-移植物愈合能力分为3类（A级，良好; B级，一般;或C级，差）。比较两组患者膝关节屈曲30°和90°时胫骨前平移试验和拉伸试验的生物力学差异。术后12周进行大体观察和生物力学测试。结果第1组（n = 25）ACL残余物大体观察显示，残余物结构完整性为A级10个样本（40%）中（连续性保持良好，探测时有足够的组织和张力），B级5例（20%），C级10例（40%）。残留物存活的标本（结构完整性为A级和B级，n = 15）的残留物-移植物愈合能力均被归类为C级（整个移植物长度上明显的残留物-移植物间隔）。对于生物力学测试，两组之间没有显著差异（每组25只），相对于30°时的胫骨前平移试验（P= 0.15）和90°（P= .91）膝关节屈曲和僵硬（P= .66），极限失效载荷（P= 0.11）和断裂伸长率（P= .92）.结论在我们的兔ACL股骨脱离模型中，急性修复后的ACL残余物表现出高吸收率、低愈合能力和差的生物力学特性。急性残余修复ACLR没有明显的优越性超过传统ACLR在rabbits.Clinical RelevanceThe研究结果并不支持的论点，残余修复ACLR，即使在急性设置，可以产生更好的术后膝关节稳定性的结果比传统ACLR。
PurposeOur purpose was (1) to compare the structural integrity and healing capacity of the acutely repaired anterior cruciate ligament (ACL) remnants and (2) to determine whether the short-term postoperative biomechanical results of the acute remnant-repairing anterior cruciate ligament reconstruction (ACLR) were superior to the conventional ACLR.MethodsAn acute complete ACL femoral detachment model was created in 50 rabbits. The rabbits were immediately randomly allocated into the remnant-repairing ACLR group (group 1, n = 25) and the conventional ACLR group (group 2, n = 25). Each animal in both groups was subjected to unilateral ACLR with semitendinosus tendon autografts. During ACLR, the ACL remnants were acutely repaired with the femoral-tensioning technique in group 1, whereas the ACL remnants were debrided in group 2. The outcomes of the remnant were macroscopically evaluated in group 1. The remnant's structural integrity and remnant-to-graft healing capacity were divided into 3 categories (grade A, good; grade B, fair; or grade C, poor) according to 2 distinct criteria. Biomechanical tests including the anterior tibial translation test at 30° and 90° of knee flexion and tensile tests were compared between groups. All the macroscopic evaluations and biomechanical tests were performed postoperatively at week 12.ResultsThe macroscopic evaluations of the ACL remnants in group 1 (n = 25) showed that the remnants' structural integrity was grade A (well-maintained continuity with an adequate amount of tissue and tension on probing) in 10 specimens (40%), grade B (fairly maintained continuity with thin and slack fibers detected) in 5 (20%), and grade C (resorption with no remnant left in situ) in 10 (40%). The remnant-to-graft healing capacities among the specimens with surviving remnants (grades A and B for structural integrity, n = 15) were all classified as grade C (an obvious remnant-to-graft interval through the entire length of the graft). For the biomechanical tests, there were no significant differences between the groups (25 in each group) with respect to the anterior tibial translation test at 30° (P= .15) and 90° (P= .91) of knee flexion and stiffness (P= .66), ultimate failure load (P= .11), and elongation at failure (P= .92).ConclusionsIn our rabbit model of ACL femoral detachment, the acutely repaired ACL remnants showed a high resorption rate, low healing capacity, and poor biomechanical properties. The acute remnant-repairing ACLR had no evident superiority over the conventional ACLR in rabbits.Clinical RelevanceThe findings did not support the contention that the remnant-repairing ACLR, even performed in the acute setting, could produce better postoperative knee joint stability outcomes than the conventional ACLR.