The effectiveness of reconstruction of the anterior cruciate ligament with hamstrings and patellar tendon - A cadaveric study comparing anterior tibial and rotational loads
The effectiveness of reconstruction of the anterior cruciate ligament with hamstrings and patellar tendon - A cadaveric study comparing anterior tibial and rotational loads
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DOI：
10.2106/00004623-200206000-00003
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发表时间：
2002-06-01
影响因子：
5.3
通讯作者：
Fu, FH
中科院分区：
文献类型：
--
作者：
Woo, SLY;Kanamori, A;Fu, FH
背景资料：本研究的目的是评估重建前交叉韧带抵抗胫骨前负荷和旋转负荷的有效性。我们假设，目前的重建技术主要用于提供对胫骨前负荷的抵抗力，在限制膝关节对联合旋转负荷的不稳定性方面效果较差。方法：12个新鲜冷冻的年轻人尸体膝盖（来自死亡时平均年龄[和标准差]为37 - 13岁的个体）使用机器人/万能力进行测试-力矩传感器测试系统载荷条件包括：（1）膝关节完全伸展和屈曲15 °、30 °和90 °时的134 N胫骨前向载荷，以及（2）膝关节屈曲15 °和30 °时的外翻扭矩10 N-m和胫骨内扭矩10 N-m的组合旋转载荷。前交叉韧带完整和缺陷的膝关节的运动学，以及在完整的前交叉韧带的原位力，被确定在两个负载的响应。然后，每个膝关节都接受了前交叉韧带重建，使用四重半腱肌-股薄肌腱移植物，并进行了测试。用骨-髌腱-骨移植物进行第二次重建，并再次测试相同的膝关节。重建膝关节的运动学和原位部队在两个grafts.Results：结果表明，这两个重建是成功的限制胫骨前平移下胫骨前负荷。此外，在134 N胫骨前负荷下，移植物中的平均原位力恢复到完整膝关节的78%至100%。然而，在应对组合旋转载荷时，使用两种移植物中的任何一种进行重建在减少胫骨前平移方面都不那么有效。这一不足进一步揭示了较低的原位力的移植物，范围从45%至65%，在完整的kneke.Conclusions：在目前的重建程序，移植物被放置在靠近胫骨和股骨的中心轴线，这使得它不足以抵抗旋转载荷。我们的研究结果表明，可能需要改进重建手术，恢复前交叉韧带的解剖结构。
Background: The objective of this study was to evaluate the effectiveness of reconstructions of the anterior cruciate ligament to resist anterior tibial and rotational loads. We hypothesized that current reconstruction techniques, which are designed mainly to provide resistance to anterior tibial loads, are less effective in limiting knee instability in response to combined rotational loads.Methods: Twelve fresh-frozen young human cadaveric knees (from individuals with a mean age [and standard deviation] of 37 13 years at the time of death) were tested with use of a robotic/universal force-moment sensor testing system. The loading conditions included (1) a 134-N anterior tibial load with the knee at full extension and at 15, 30, and 90degrees of flexion, and (2) a combined rotational load of 10 N-m of valgus torque and 10 N-m of internal tibial torque with the knee at 15 and 30 of flexion. The kinematics of the knees with an intact and a deficient anterior cruciate ligament, as well as the in situ force in the intact anterior cruciate ligament, were determined in response to both loads. Each knee then underwent reconstruction of the anterior cruciate ligament with use of a quadruple semitendinosus-gracilis tendon graft and was tested. A second reconstruction was performed with a bone-patellar tendon-bone graft, and the same knee was tested again. The kinematics of the reconstructed knees and the in situ forces in both grafts were determined.Results: The results demonstrated that both reconstructions were successful in limiting anterior tibial translation under anterior tibial loads. Furthermore, the mean in situ forces in the grafts under a 134-N anterior tibial load were restored to within 78% to 100% of that in the intact knee. However, in response to a combined rotational load, reconstruction with either of the two grafts was not as effective in reducing anterior tibial translation. This insufficiency was further revealed by the lower in situ forces in the grafts, which ranged from 45% to 65% of that in the intact knee.Conclusions: In current reconstruction procedures, the graft is placed close to the central axis of the tibia and femur, which makes it inadequate for resisting rotational loads. Our findings suggest that improved reconstruction procedures that restore the anatomy of the anterior cruciate ligament may be needed.