Yamamoto Yuji, Hsu Wei-Hsiu, Woo Savio L-Y, Van Scyoc Andrew H, Takakura Yoshiyuki, Debski Richard E
Musculoskeletal Research Center, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Am J Sports Med. 2004 Dec;32(8):1825-32. doi: 10.1177/0363546504263947.
Locations of femoral tunnels for anterior cruciate ligament replacement grafts remain a subject of debate.
A lateral femoral tunnel placed at the insertion of the posterolateral bundle of the anterior cruciate ligament can restore knee function comparably to anatomical femoral tunnel placement.
Controlled laboratory study.
Ten cadaveric knees were subjected to the following external loading conditions: (1) a 134-N anterior tibial load and (2) combined rotatory loads of 10-N.m valgus and 5-N.m internal tibial torques. Data on resulting knee kinematics and in situ force of the intact anterior cruciate ligament and anterior cruciate ligament graft were collected using a robotic/universal force-moment sensor testing system for (1) intact, (2) anterior cruciate ligament-deficient, (3) anatomical double-bundle reconstructed, and (4) laterally placed single-bundle reconstructed knees.
In response to anterior tibial load, anterior tibial translation and in situ force in the graft were not significantly different between the 2 reconstructions except at high knee flexion. For example, at 90 degrees of knee flexion, anterior tibial translation was 6.1 +/- 2.3 mm for anatomical double-bundle reconstruction and 7.6 +/- 2.6 mm for laterally placed single-bundle reconstruction (P < .05). In response to rotatory loads, there were no significant differences between the 2 reconstruction procedures (4.8 +/- 2.4 mm vs 4.8 +/- 3.0 mm in anterior tibial translation at 15 degrees of knee flexion, P > .05).
Lateral tunnel placement can restore rotatory and anterior knee stability similarly to an anatomical reconstruction when the knee is near extension. However, the same is not true when the knee is at high flexion angles.
To reproduce the complex function of the anterior cruciate ligament, reproducing both bundles of the anterior cruciate ligament may be necessary.
前交叉韧带重建移植物股骨隧道的位置仍是一个有争议的话题。
在前交叉韧带后外侧束附着处放置外侧股骨隧道，与解剖学股骨隧道放置相比，可同等程度地恢复膝关节功能。
对照实验室研究。
对10个尸体膝关节施加以下外部负荷条件：（1）134N的胫骨前负荷；（2）10N·m外翻和5N·m胫骨内扭矩的联合旋转负荷。使用机器人/通用力-力矩传感器测试系统收集完整前交叉韧带和前交叉韧带移植物在以下情况下的膝关节运动学数据和原位力：（1）完整膝关节；（2）前交叉韧带损伤膝关节；（3）解剖双束重建膝关节；（4）外侧单束重建膝关节。
在胫骨前负荷作用下，除膝关节高度屈曲时外，两种重建方式下的胫骨前移和移植物原位力无显著差异。例如，在膝关节屈曲90度时，解剖双束重建的胫骨前移为6.1±2.3mm，外侧单束重建为7.6±2.6mm（P<.05）。在旋转负荷作用下，两种重建方法之间无显著差异（膝关节屈曲15度时胫骨前移分别为4.8±2.4mm和4.8±3.0mm，P>.05）。
当膝关节接近伸直时，外侧隧道放置与解剖重建一样，可恢复膝关节的旋转和前向稳定性。然而，当膝关节处于高度屈曲角度时则并非如此。
为了重现前交叉韧带的复杂功能，可能需要重建前交叉韧带的两束。
