Li Guoan, Papannagari Ramprasad, DeFrate Louis E, Yoo Jae Doo, Park Sang Eun, Gill Thomas J
Bioengineering Laboratory, Department of Orthopedic Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA.
Acta Orthop. 2006 Apr;77(2):267-74. doi: 10.1080/17453670610046019.
Long-term follow-up studies have indicated that there is an increased incidence of arthrosis following anterior cruciate ligament (ACL) reconstruction, suggesting that the reconstruction may not reproduce intact ACL biomechanics. We studied not only the magnitude but also the orientation of the ACL and ACL graft forces.
10 knee specimens were tested on a robotic testing system with the ACL intact, deficient, and reconstructed (using a bone-patella tendon-bone graft). The magnitude and orientation of the ACL and ACL graft forces were determined under an anterior tibial load of 130 N at full extension, and 15, 30, 60, and 90 degrees of flexion. Orientation was described using elevation angle (the angle formed with the tibial plateau in the sagittal plane) and deviation angle (the angle formed with respect to the anteroposterior direction in the transverse plane).
ACL reconstruction restored anterior tibial translation to within 2.6 mm of that of the intact knee under the 130-N anterior load. Average internal tibial rotation was reduced after ACL reconstruction at all flexion angles. The force vector of the ACL graft was significantly different from the ACL force vector. The average values of the elevation and deviation angles of the ACL graft forces were higher than that of the intact ACL at all flexion angles.
Contemporary single bundle ACL reconstruction restores anterior tibial translation under anterior tibial load with different forces (both magnitude and orientation) in the graft compared to the intact ACL. Such graft function might alter knee kinematics in other degrees of freedom and could overly constrain the tibial rotation. An anatomic ACL reconstruction should reproduce the magnitude and orientation of the intact ACL force vector, so that the 6-degrees-of-freedom knee kinematics and joint reaction forces can be restored.
长期随访研究表明，前交叉韧带（ACL）重建术后关节病的发病率有所增加，这表明重建可能无法重现完整ACL的生物力学特性。我们不仅研究了ACL和ACL移植物的力的大小，还研究了其方向。
在机器人测试系统上对10个膝关节标本进行测试，分别测试ACL完整、缺损和重建（使用骨-髌腱-骨移植物）的情况。在伸直位以及屈曲15°、30°、60°和90°时，在130 N的胫骨前负荷下测定ACL和ACL移植物的力的大小和方向。方向用仰角（矢状面与胫骨平台形成的角度）和偏角（横断面相对于前后方向形成的角度）来描述。
在130 N的胫骨前负荷下，ACL重建使胫骨前移恢复到与完整膝关节相差2.6 mm以内。在所有屈曲角度下，ACL重建后胫骨平均内旋减少。ACL移植物的力矢量与ACL力矢量有显著差异。在所有屈曲角度下，ACL移植物力的仰角和偏角的平均值均高于完整ACL。
与完整ACL相比，当代单束ACL重建在胫骨前负荷下可恢复胫骨前移，但移植物中的力（大小和方向）不同。这种移植物功能可能会改变膝关节在其他自由度的运动学，并可能过度限制胫骨旋转。解剖学ACL重建应重现完整ACL力矢量的大小和方向，以便恢复膝关节的六自由度运动学和关节反应力。
