Loss of knee extension after anterior cruciate ligament reconstruction: Effects of knee position and graft tensioning
Loss of knee extension after anterior cruciate ligament reconstruction: Effects of knee position and graft tensioning
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DOI：
10.2106/jbjs.f.00370
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发表时间：
2007-07-01
影响因子：
5.3
通讯作者：
Wojtys, Edward M.
中科院分区：
文献类型：
--
作者：
Austin, John C.;Phornphutkul, Chanakarn;Wojtys, Edward M.
背景：许多作者报道了前交叉韧带重建后最常见的并发症是膝关节伸展丧失。本体外研究的目的是确定在重建前交叉韧带的植骨固定过程中，膝关节屈曲角度和骨-髌腱-骨移植物张力对膝关节伸展丧失的影响。方法：采用胫骨和股骨隧道在原交叉韧带的足迹上重建10具尸体的前交叉韧带。植骨固定的初始张力为44 N （10 lb）或89 N (20 lb)，膝关节屈曲为0度或30度。在移植物固定后使用数字图像测量膝关节屈曲角度。结果：在该尸体模型中，膝关节屈曲30度时移植物的张力与膝关节伸展的丧失有关。在测试条件下，移植物张力不影响膝关节伸展。结论：结果表明，当胫骨和股骨隧道放置在原前交叉韧带的足迹上时，如果移植物被固定在膝关节完全伸展处，则可以减少导致膝关节完全伸展丧失的常见原因之一。更重要的是，即使将股骨和胫骨隧道放置在原前交叉韧带的股骨和胫骨足底，在膝关节屈曲时固定移植物也会导致膝关节伸展能力的丧失。
Background: Loss of knee extension has been reported by many authors to be the most common complication following anterior cruciate ligament reconstruction. The objective of this in vitro study was to determine the effect, on loss of knee extension, of the knee flexion angle and the tension of the bone-patellar tendon-bone graft during graft fixation in a reconstruction of an anterior cruciate ligament.Methods: The anterior cruciate ligament was reconstructed with use of tibial and femoral bone tunnels placed in the footprint of the native anterior cruciate ligament in ten cadavers. The graft was secured with an initial tension of either 44 N (10 lb) or 89 N (20 lb) applied with the knee at 0 degrees or 30 degrees of flexion. The knee flexion angle was measured with use of digital images following graft fixation.Results: Tensioning of the graft at 30 degrees of knee flexion was associated with loss of knee extension in this cadaver model. Graft tension did not affect knee extension under the conditions tested.Conclusions: The results suggest that one of the common causes of the loss of full knee extension may be diminished if the graft is secured in full knee extension when the tibial and femoral tunnels are placed in the footprint of the native anterior cruciate ligament. More importantly, even when the femoral and tibial tunnels are placed in the femoral and tibial footprints of the native anterior cruciate ligament, fixing a graft in knee flexion can result in the loss of knee extension.