Biomechanical comparison of three anatomic ACL reconstructions in a porcine model
Biomechanical comparison of three anatomic ACL reconstructions in a porcine model
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DOI：
10.1007/s00167-010-1338-3
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发表时间：
2011-05-01
影响因子：
3.8
通讯作者：
Fu, Freddie H.
中科院分区：
文献类型：
--
作者：
Debandi, Anibal;Maeyama, Akira;Fu, Freddie H.
不同的隧道配置已用于双束（DB）前交叉韧带（ACL）重建。然而，关于双股骨隧道和单胫骨隧道（2F-1 T）或单股骨隧道和双胫骨隧道（1F-2 T）的三隧道DB是否比单束（SB）ACL重建更好地恢复完整的膝关节生物力学，仍然存在争议。目的是比较SB和两种三隧道DB ACL重建的膝关节运动学和移植物中的原位力。（模拟KT-1000测试）在30 A度，60 A度，和90 A屈曲度，以及在30 A屈曲度和60 A屈曲度下的4 Nm胫骨内扭矩和7 Nm外翻扭矩（模拟平移测试）。使用机器人系统测量了（1）ACL完整、（2）ACL缺陷和（3）三种ACL重建膝关节（SB、DB 2F-1 T和DB 1F-2 T）的膝关节运动学和ACL或置换移植物中的原位力。在模拟膝关节移位试验中，在低屈曲角下，DB移植物比SB移植物更接近于恢复完整ACL中的原位力。SB和DB ACL重建之间的膝关节运动学无显著差异。与DB 1F-2 T技术相比，DB 2F-1 T重建在膝关节运动学或原位力方面没有显示出显著差异。与解剖SB重建相比，解剖三隧道DB重建在低屈曲角下模拟膝关节移位试验中更好地恢复了ACL的原位力。以解剖方式进行的两种三隧道DB ACL重建具有相似的生物力学行为。只要符合解剖结构，无论采用2F-1 T还是1F-2 T三隧道手术，DB ACL重建术均优于SB ACL重建术。
Different tunnel configurations have been used for double-bundle (DB) anterior cruciate ligament (ACL) reconstruction. However, controversy still exists as to whether three-tunnel DB with double-femoral tunnels and single-tibial tunnel (2F-1T) or with single-femoral tunnel and double-tibial tunnels (1F-2T) better restores intact knee biomechanics than single-bundle (SB) ACL reconstruction. The purpose was to compare the knee kinematics and in situ force in the grafts among SB and two types of three-tunnel DB ACL reconstructions performed in an anatomic fashion.Twenty-four porcine knees were subjected to an 89-N anterior tibial load (simulated KT-1000 test) at 30A degrees, 60A degrees, and 90A degrees of flexion and to a 4-Nm internal tibial torque and 7-Nm valgus torque (simulated pivot-shift test) at 30A degrees and 60A degrees of flexion. The resulting knee kinematics and in situ force in the ACL or replacement grafts were measured using a robotic system for (1) ACL-intact, (2) ACL-deficient, and (3) three ACL reconstructed knees: SB; DB 2F-1T; and DB 1F-2T.During the simulated pivot-shift test, the DB grafts more closely restored the in situ force in the intact ACL at low flexion angle than the SB graft. There were no significant differences in knee kinematics between SB and DB ACL reconstruction. The DB 2F-1T reconstruction did not show a significant difference in knee kinematics or in situ force when compared to the DB 1F-2T technique.The in situ force in the ACL is better restored with an anatomic three-tunnel DB reconstruction in response to the simulated pivot-shift test at low flexion angle when compared to an anatomic SB reconstruction. Both three-tunnel DB ACL reconstructions performed in an anatomic fashion had similar biomechanical behavior. As long as it is performed anatomically, DB ACL reconstruction could be better alternative than SB ACL reconstruction, no matter which three-tunnel procedure, 2F-1T or 1F-2T, is used.