Hame Sharon L, Markolf Keith L, Gabayan Arash J, Hunter D Monte, Davis Brent, Shapiro Matthew S
Biomechanics Research Section, Department of Orthopaedic Surgery, University of California, Los Angeles, California, USA.
Arthroscopy. 2002 Jan;18(1):55-60. doi: 10.1053/jars.2002.25971.
The purpose of this study was to determine the effects of rotating a bone-patellar tendon- bone allograft during anterior cruciate ligament reconstruction on anteroposterior (AP) knee laxity and forces developed within the graft.
In vitro biomechanical study using human cadaveric knees.
Thirteen fresh-frozen knee specimens received bone-patella tendon-bone allografts that were pretensioned at 30 degrees of flexion to restore AP laxity to that of the intact knee. AP laxity was then measured at 0 degrees, 30 degrees, and 90 degrees of knee flexion with the graft in neutral rotation and in 90 degrees and 180 degrees of internal and external rotation. Five specimens received allografts that were rotated to 90 degrees internally and externally and then tensioned. Two knee specimens were used to measure the effects of graft rotation on graft force at full extension; 1 received 7 separate allografts and the other received 10 allografts. During testing, the potted end of the allograft that was connected to a tibial load cell was rotated.
In specimens tensioned and then rotated, AP laxity at 30 degrees of knee flexion decreased an average of 0.9 mm with 90 degrees of graft rotation in either direction. At 180 degrees of external rotation, the mean decrease in laxity of 1.8 mm was significantly greater than that for 180 degrees of internal rotation (P <.05). When significant, all mean laxity reductions at 0 degrees and 90 degrees of flexion were less than those at 30 degrees of flexion. In specimens where the graft was rotated and then tensioned, rotation had no significant effect on laxity. With the exception of 90 degrees of external rotation, rotation of the graft increased graft tension at full extension; 90 degrees of internal rotation increased mean graft force by 11 N (P <.05). Rotating the graft 180 degrees in either direction increased mean graft force at full extension by 25 N (P <.05).
Although minor, rotating the graft had significant effects on knee laxity and graft tension. In general, AP laxity decreased and graft tension increased with increasing rotation of the graft. The direction of rotation did not seem to be important. As a result, clinicians who choose to rotate their patellar tendon grafts can expect that the biomechanical changes in the graft with rotation will have little clinical importance.
本研究的目的是确定在前交叉韧带重建过程中旋转骨-髌腱-骨同种异体移植物对膝关节前后向（AP）松弛度以及移植物内产生的力的影响。
使用人体尸体膝关节的体外生物力学研究。
13个新鲜冷冻的膝关节标本接受了骨-髌腱-骨同种异体移植物，这些移植物在屈膝30度时进行预张紧，以使AP松弛度恢复到完整膝关节的水平。然后在膝关节屈曲0度、30度和90度时，分别在移植物中立旋转以及内旋和外旋90度和180度的情况下测量AP松弛度。5个标本接受了向内和向外旋转90度然后张紧的同种异体移植物。使用2个膝关节标本测量移植物旋转对完全伸展时移植物力的影响；1个标本接受7个单独的同种异体移植物，另一个接受10个同种异体移植物。在测试过程中，连接到胫骨载荷传感器的移植物的盆栽端进行旋转。
在张紧然后旋转的标本中，屈膝30度时，移植物向任何一个方向旋转90度，AP松弛度平均降低0.9毫米。在180度外旋时，平均松弛度降低1.8毫米，显著大于180度内旋时的降低幅度（P<.05）。当有显著差异时，在屈膝0度和90度时所有平均松弛度的降低均小于屈膝30度时的降低幅度。在移植物旋转然后张紧的标本中，旋转对松弛度没有显著影响。除了90度外旋外，移植物旋转会增加完全伸展时的移植物张力；90度内旋使平均移植物力增加11牛（P<.05）。移植物向任何一个方向旋转180度都会使完全伸展时的平均移植物力增加25牛（P<.05）。
虽然影响较小，但旋转移植物对膝关节松弛度和移植物张力有显著影响。一般来说，随着移植物旋转增加，AP松弛度降低，移植物张力增加。旋转方向似乎并不重要。因此，选择旋转髌腱移植物的临床医生可以预期，移植物旋转引起的生物力学变化在临床上几乎没有重要意义。
