Mae Tatsuo, Shino Konsei, Matsumoto Norinao, Hamada Masayuki, Yoneda Minoru, Nakata Ken
Department of Sports Medicine, Osaka Kousei-Nenkin Hospital, 4-2-78, Fukushima-ku, Fukushima, Osaka, 553-003, Japan.
Knee Surg Sports Traumatol Arthrosc. 2007 Apr;15(4):328-34. doi: 10.1007/s00167-006-0172-0. Epub 2006 Nov 10.
It is not well known how much tension should be applied to ACL graft at the time of graft fixation. As a step to determine the optimal initial tension, it is indispensable to know the graft tension to restore normal anterior-posterior (A-P) laxity (laxity match pretension, LMP). The objective was to determine the LMP in ACL reconstruction for the anatomical two-bundle technique and for the Rosenberg's isometric bi-socket one, and to compare these two techniques in LMP. Twenty-four patients with unilateral chronic ACL insufficiency were divided into the following two groups. The anatomical two-bundle technique was performed on 12 patients via two femoral tunnels at 9 and 10 o'clock or 2 and 3 o'clock on the posterior margin of the notch and two tibial tunnels (Group A), while the Rosenberg's isometric bi-socket reconstruction was performed on the remaining 12 patients through two femoral tunnels at 10 and 11 o'clock or 1 and 2 o'clock and one wider tibial tunnel (Group B). After two doubled semitendinosus grafts were fixed with two EndoButton-CL s on the femur, they were temporarily fixed to the tension-adjustable force gauge on the tibia, respectively. The total tension applied to grafts was set at 10, 20, 30, 40, or 50 N at 20 degrees of knee flexion, and the A-P laxity was measured by applying A-P drawer load of 134 N at 20 degrees of flexion. By comparing the measured laxity with that for the opposite healthy knee, the tension to restore the normal A-P laxity (LMP) was estimated. The mean LMP of 7.3 N in Group A was significantly smaller than that of 25.8 N in Group B. The anatomical two-bundle technique makes it possible to more effectively restore A-P stability with lower initial tension than the isometric Rosenberg's bi-socket reconstruction.
在移植物固定时，应向 ACL 移植物施加多大张力尚不为人所知。作为确定最佳初始张力的一个步骤，了解恢复正常前后（A-P）松弛度的移植物张力（松弛度匹配预张力，LMP）是必不可少的。目的是确定解剖双束技术和 Rosenberg 等距双套接技术在 ACL 重建中的 LMP，并比较这两种技术在 LMP 方面的差异。24 名单侧慢性 ACL 功能不全患者被分为以下两组。12 例患者采用解剖双束技术，通过在髁间窝后缘 9 点和 10 点或 2 点和 3 点的两个股骨隧道以及两个胫骨隧道进行手术（A 组），而其余 12 例患者采用 Rosenberg 等距双套接重建术，通过在 10 点和 11 点或 1 点和 2 点的两个股骨隧道以及一个更宽的胫骨隧道进行手术（B 组）。在用两个 EndoButton-CL 将两条双股半腱肌移植物固定在股骨上后，分别将它们临时固定在胫骨上的张力可调测力计上。在膝关节屈曲 20 度时，施加在移植物上的总张力设定为 10、20、30、40 或 50 N，并在屈曲 20 度时通过施加 134 N 的 A-P 抽屉负荷来测量 A-P 松弛度。通过将测量的松弛度与对侧健康膝关节的松弛度进行比较，估计恢复正常 A-P 松弛度（LMP）所需的张力。A 组的平均 LMP 为 7.3 N，明显低于 B 组的 25.8 N。与等距的 Rosenberg 双套接重建术相比，解剖双束技术能够以更低的初始张力更有效地恢复 A-P 稳定性。
