Kitamura Nobuto, Yasuda Kazunori, Tohyama Harukazu, Yamanaka Masanori, Tanabe Yoshie
Department of Sports Medicine and Joint Reconstruction Surgery, Hokkaido University School of Medicine, Sapporo, Japan.
Arthroscopy. 2005 Aug;21(8):970-8. doi: 10.1016/j.arthro.2005.05.025.
Posterior cruciate ligament (PCL) reconstruction procedures have not been thoroughly evaluated under cyclic loading conditions. We tested the hypothesis that PCL reconstruction with a quadrupled flexor-tendon graft and fixation using tapes and staples is biomechanically superior to that fixed with sutures, a button, and a post-screw, and is comparable to reconstruction with a bone--patellar tendon--bone (BPTB) graft.
In vitro biomechanical study.
A total of 45 porcine knees were used. The quadrupled flexor-tendon graft was fixed using the suture/button/post-screw procedure in 15 knees, and with the tape/staples procedure in another 15 knees. The remaining 15 knees underwent reconstruction with a BPTB graft secured with screws as the standard control. In each group of 15 knees, 5 underwent tensile testing without cyclic loading, and 10 underwent the same tensile test after 5,000 cycles of load-controlled or displacement-controlled loading.
Each type of cyclic loading produced larger biomechanical changes in the knees fixed with the suture/button/post-screw procedure than in the knees secured using the other 2 procedures.
In PCL reconstruction, the tape/staples procedure is biomechanically superior to the suture/button/post-screw procedure, and is comparable to the BPTB/screws procedure with regard to the ultimate failure load. Neither of the procedures using the quadrupled flexor-tendon graft was comparable to the BPTB graft in linear stiffness and the initial displacement after load-controlled cyclic testing.
The biomechanical behaviors of PCL-reconstructed knees are significantly different, depending on surgical techniques.
后交叉韧带（PCL）重建手术在循环加载条件下尚未得到充分评估。我们测试了以下假设：使用四倍股四头肌肌腱移植并采用带袢钢板和钉固定的PCL重建在生物力学上优于使用缝线、纽扣和后交叉螺钉固定的方法，并且与使用骨-髌腱-骨（BPTB）移植重建相当。
体外生物力学研究。
总共使用了45个猪膝关节。15个膝关节采用缝线/纽扣/后交叉螺钉方法固定四倍股四头肌肌腱移植，另外15个膝关节采用带袢钢板/钉方法固定。其余15个膝关节采用螺钉固定BPTB移植作为标准对照进行重建。在每组15个膝关节中，5个在无循环加载的情况下进行拉伸测试，10个在进行5000次载荷控制或位移控制的加载循环后进行相同的拉伸测试。
与使用其他两种方法固定的膝关节相比，每种类型的循环加载在采用缝线/纽扣/后交叉螺钉方法固定的膝关节中产生了更大的生物力学变化。
在PCL重建中，带袢钢板/钉方法在生物力学上优于缝线/纽扣/后交叉螺钉方法，并且在极限破坏载荷方面与BPTB/螺钉方法相当。使用四倍股四头肌肌腱移植的两种方法在载荷控制循环测试后的线性刚度和初始位移方面均无法与BPTB移植相媲美。
根据手术技术的不同，PCL重建膝关节的生物力学行为存在显著差异。
