Petersen Wolf, Tretow Henning, Weimann Andre, Herbort Mirco, Fu Freddie H, Raschke Michael, Zantop Thore
Department of Trauma-, Hand-, and Reconstructive Surgery, Wilhelms University Muenster, Waldeyerstr 1, D-48149, Muenster, Germany.
Am J Sports Med. 2007 Feb;35(2):228-34. doi: 10.1177/0363546506294468. Epub 2006 Nov 12.
This research was undertaken to determine whether there is a need for a second tibial tunnel in anatomic anterior cruciate ligament reconstruction.
Anatomic two-bundle reconstruction with two tibial tunnels restores knee anterior tibial translation in response to 134 N and to 5-N.m internal tibial torque combined with 10-N.m valgus torque more closely to normal than does double-bundle reconstruction with one tibial tunnel.
Controlled laboratory study.
Ten cadaveric knees were subjected to a 134-N anterior tibial load at 0 degrees, 30 degrees, 60 degrees, and 90 degrees and to 5-N.m internal tibial torque and 10-N.m valgus torque at 15 degrees and 30 degrees. Resulting knee kinematics and in situ force in the anterior cruciate ligament or replacement graft were determined by using a robotic/universal force-moment sensor testing system for (1) intact, (2) anterior cruciate ligament-deficient, (3) double-bundle/one tibial tunnel, and (4) double-bundle/two tibial tunnels.
Anterior tibial translation for the reconstruction with two tibial tunnels was significantly closer to that of the intact knee than was the reconstruction with one tibial tunnel at 0 degrees and 30 degrees of flexion (0 degrees = 3.82 vs 6.0 mm, P < .05; 30 degrees = 7.99 vs 11 mm, P < .05). The in situ force normalized to the intact anterior cruciate ligament for the reconstruction with two tibial tunnels was significantly higher than the in situ force of the reconstruction with one tibial tunnel (30 degrees = 89 vs 82 N, P < .05). With a combined rotatory load, the anterior tibial translation of specimens with a tibial two-tunnel technique was significantly lower than that of specimens with one tunnel (0 degrees = 5.7 vs 8.4 mm, P < .05; 30 degrees = 7.5 vs 9.5 mm, P < .05).
Anatomic reconstruction with two tibial tunnels may produce a better biomechanical outcome, especially close to extension.
At the time of initial fixation, there appears to be a small biomechanical advantage to the second tibial tunnel in the setting of two-bundle anterior cruciate ligament reconstruction.
本研究旨在确定在解剖学前交叉韧带重建中是否需要第二个胫骨隧道。
与单胫骨隧道双束重建相比，双胫骨隧道解剖双束重建在134 N前向胫骨负荷以及5 N·m胫骨内扭矩联合10 N·m外翻扭矩作用下，能使膝关节前向胫骨平移更接近正常。
对照实验室研究。
对10具尸体膝关节在0°、30°、60°和90°时施加134 N前向胫骨负荷，并在15°和30°时施加5 N·m胫骨内扭矩和10 N·m外翻扭矩。使用机器人/通用力-力矩传感器测试系统测定（1）完整膝关节、（2）前交叉韧带损伤膝关节、（3）单胫骨隧道双束重建膝关节以及（4）双胫骨隧道双束重建膝关节的膝关节运动学和前交叉韧带或替代移植物的原位力。
在0°和30°屈膝位时，双胫骨隧道重建的前向胫骨平移显著比单胫骨隧道重建更接近完整膝关节（0°时：3.82对6.0 mm，P <.05；30°时：7.99对11 mm，P <.05）。双胫骨隧道重建相对于完整前交叉韧带的原位力显著高于单胫骨隧道重建（30°时：89对82 N，P <.05）。在联合旋转负荷下，双胫骨隧道技术标本的前向胫骨平移显著低于单隧道标本（0°时：5.7对8.4 mm，P <.05；30°时：7.5对9.5 mm，P <.05）。
双胫骨隧道解剖重建可能产生更好的生物力学结果，尤其是在接近伸直位时。
在初次固定时，双束前交叉韧带重建中第二个胫骨隧道似乎具有较小的生物力学优势。
