Beynnon B D, Uh B S, Johnson R J, Fleming B C, Renström P A, Nichols C E
Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington 05450, USA.
Am J Sports Med. 2001 Mar-Apr;29(2):161-6. doi: 10.1177/03635465010290020801.
The relationship between the elongation values of an autogenous bone-patellar tendon-bone graft immediately after fixation and the anterior-posterior laxity of the knee 5 years later was studied in vivo. Immediately after fixation, the change in the graft midsubstance length during passive knee flexion-extension was measured using a Hall-effect transducer, and anterior-posterior knee laxity was measured with the KT-1000 arthrometer. Subjects were divided into group 1 (N = 6), with graft elongation values bounded by the 95% confidence intervals of the normal anterior cruciate ligament elongation values, and group 2 (N = 7), subjects with values outside these intervals. Immediately after reconstruction, the side-to-side difference in anterior-posterior laxity between the reconstructed and uninjured knees was not different between group 1 (-2.6 +/- 0.7 mm, mean +/- SEM) and group 2 (-1.7 +/- 1.0 mm) (P = 0.49). At 5-year follow-up, the difference was 1.2 +/- 0.7 mm for group 1, while for group 2 it was significantly greater at 4.7 +/- 0.6 mm (P = 0.004). At surgery, graft elongation values produced by flexion of the knee that are outside the limits of the anterior cruciate ligament result in significant increases in anterior knee laxity at long-term follow-up, while grafts with elongation values similar to the normal anterior cruciate ligament do not. Not only is restoration of anterior-posterior laxity values to within normal limits important, but the biomechanical behavior of the graft produced by flexion-extension of the knee should be appreciated.
在体内研究了自体骨-髌腱-骨移植物固定后即刻的伸长值与5年后膝关节前后松弛度之间的关系。固定后即刻，使用霍尔效应传感器测量被动膝关节屈伸过程中移植物中间段长度的变化，并用KT-1000关节测量仪测量膝关节前后松弛度。受试者分为第1组（N = 6），其移植物伸长值在正常前交叉韧带伸长值的95%置信区间内，以及第2组（N = 7），其值在这些区间之外。重建后即刻，第1组（-2.6 +/- 0.7 mm，平均值 +/- 标准误）和第2组（-1.7 +/- 1.0 mm）重建膝关节与未受伤膝关节之间的前后松弛度的左右差异无统计学意义（P = 0.49）。在5年随访时，第1组的差异为1.2 +/- 0.7 mm，而第2组明显更大，为4.7 +/- 0.6 mm（P = 0.004）。在手术时，膝关节屈曲产生的移植物伸长值超出前交叉韧带的限度会导致长期随访时膝关节前侧松弛度显著增加，而伸长值与正常前交叉韧带相似的移植物则不会。不仅将前后松弛度值恢复到正常范围内很重要，而且还应了解膝关节屈伸产生的移植物的生物力学行为。
