Woo Savio L-Y, Kanamori Akihiro, Zeminski Jennifer, Yagi Masayoshi, Papageorgiou Christos, Fu Freddie H
Department of Orthopaedic Surgery, Musculoskeletal Research Center, University of Pittsburh, Pennsylvania 15213, USA.
J Bone Joint Surg Am. 2002 Jun;84(6):907-14. doi: 10.2106/00004623-200206000-00003.
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.
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 degrees, 30 degrees, and 90 degrees 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 degrees and 30 degrees 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.
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.
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.
本研究的目的是评估前交叉韧带重建对抵抗胫骨前移和旋转负荷的有效性。我们假设，目前主要旨在提供对胫骨前负荷抵抗的重建技术，在限制膝关节对联合旋转负荷的不稳定性方面效果较差。
使用机器人/通用力-力矩传感器测试系统对12个新鲜冷冻的年轻人体尸体膝关节（死亡时平均年龄[及标准差]为37±13岁）进行测试。加载条件包括：（1）膝关节完全伸展以及屈曲15度、30度和90度时施加134 N的胫骨前负荷；（2）膝关节屈曲15度和30度时施加10 N·m的外翻扭矩和10 N·m的胫骨内扭矩的联合旋转负荷。测定完整和前交叉韧带损伤膝关节的运动学，以及完整前交叉韧带的原位力，以响应两种负荷。然后，每个膝关节使用四股半腱肌-股薄肌腱移植物进行前交叉韧带重建并进行测试。使用骨-髌腱-骨移植物进行第二次重建，并再次对同一膝关节进行测试。测定重建膝关节的运动学和两种移植物中的原位力。
结果表明，两种重建在限制胫骨前负荷下的胫骨前移方面均成功。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，对于联合旋转负荷，两种移植物中的任何一种重建在减少胫骨前移方面都不那么有效。移植物中较低的原位力进一步揭示了这种不足，其范围为完整膝关节的45%至65%。
在目前的重建手术中，移植物放置在靠近胫骨和股骨中心轴的位置，这使得它在抵抗旋转负荷方面不足。我们的研究结果表明，可能需要改进的重建手术来恢复前交叉韧带的解剖结构。
