Weimann Andre, Wolfert Alexandra, Zantop Thore, Eggers Anne-Kathleen, Raschke Michael, Petersen Wolf
Department of Trauma, Hand, and Reconstructive Surgery, Westfalian Wilhelms University, Muenster, Germany.
Arthroscopy. 2007 Oct;23(10):1104-11. doi: 10.1016/j.arthro.2007.04.014.
The aim of this study was to evaluate the influence of the operative technique on reducing the so called "killer turn" at the tibial bone tunnel exit in posterior cruciate ligament (PCL) reconstruction.
We investigated the benefit of reducing the sharp edge of the tibial bone tunnel exit using a custom made rasp in combination with extracortical and aperture (interference screw) graft fixation. Grafts were fixed in a porcine tibia model. Ten reconstructions each (sharp and rounded edge) were cyclically loaded (2,000 times) between 50 and 150 N, and another 10 each were subjected to 2,000 cycles between 50 and 300 N force. The surviving PCL reconstructions were loaded to failure using a material testing machine.
Being subjected to the sharp edge of the posterior tibia, 5 of 10 extracortical and 8 of 10 aperture fixed grafts survived cyclic loading between 50 and 150 N. All extracortical fixed and 8 of 10 aperture fixed grafts failed before 2,000 cycles when loaded between 50 and 300 N. Structural properties of grafts fixed with interference screw were statistically significant higher when compared to extracortical fixation. After rounding the sharp edge of the tunnel, all grafts survived cycles between 50 and 150 N and 6 out of 10 extracortical and 8 of 10 aperture fixed grafts survived 2,000 cycles between 50 and 300 N.
The results of this study suggest that a rounded posterior aspect of the tunnel exit at the tibial tunnel exit leads to significant less graft damage when compared to the typical sharp edge of the bone tunnel exit ("killer turn"). Additionally, the results show that aperture fixation of soft tissue grafts in PCL reconstruction is superior when compared to an extracortical fixation site.
Aperture fixation and a rounded tibial bone tunnel exit seem to be a reasonable alternative in PCL reconstruction.
本研究旨在评估手术技术对在后交叉韧带（PCL）重建中减少胫骨骨隧道出口处所谓“致命转折”的影响。
我们研究了使用定制锉刀结合皮质外和骨隧道内（挤压螺钉）移植物固定来减少胫骨骨隧道出口尖锐边缘的益处。移植物被固定在猪胫骨模型中。每组10例重建（尖锐边缘和圆形边缘）在50至150 N之间循环加载（2000次），另外每组10例在50至300 N力之间进行2000次循环。使用材料试验机对存活的PCL重建进行加载直至失效。
暴露于胫骨后缘的尖锐边缘时，10例皮质外固定移植物中有5例以及10例骨隧道内固定移植物中有8例在50至150 N之间的循环加载中存活。当在50至300 N之间加载时，所有皮质外固定移植物以及10例骨隧道内固定移植物中有8例在2000次循环之前失效。与皮质外固定相比，挤压螺钉固定的移植物的结构性能在统计学上显著更高。在将隧道尖锐边缘倒圆后，所有移植物在50至150 N之间的循环中存活，10例皮质外固定移植物中有6例以及10例骨隧道内固定移植物中有8例在50至300 N之间存活2000次循环。
本研究结果表明，与骨隧道出口处典型的尖锐边缘（“致命转折”）相比，胫骨隧道出口处隧道后缘倒圆可显著减少移植物损伤。此外，结果表明在PCL重建中软组织移植物的骨隧道内固定优于皮质外固定。
骨隧道内固定和圆形胫骨骨隧道出口似乎是PCL重建中的合理选择。
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