Dargel Jens, Schmidt-Wiethoff Rüdiger, Heck Marco, Brüggemann Gert-Peter, Koebke Jürgen
Department for Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Germany.
Arthroscopy. 2008 Jan;24(1):96-105. doi: 10.1016/j.arthro.2007.07.031. Epub 2007 Nov 8.
To determine whether or not suturing a soft tissue graft in a whipstitch fashion is an essential procedure in order to ensure sufficient initial fixation strength of the cross-pin fixation technique in anterior cruciate ligament reconstruction.
Porcine digital extensor tendons were used as 4-stranded soft tissue grafts. Specimens were fixated within 52 porcine femoral bone tunnels using a cross-pin fixation technique (RigidFix; Ethicon, Norderstedt, Germany). In group I (n = 28), the looped-over part of the grafts was sutured using a whipstitch technique; in group II (n = 28) the grafts were not sutured. Initial fixation properties were determined using either a single cycle load to failure protocol or a dynamic loading protocol, submitting the graft to 1,000 cycles of flexion-extension loading between 0 degrees and 90 degrees , followed by ultimate loading to failure. The graft-pin interaction and the graft-tunnel interface was histomorphologically visualized in unloaded and dynamically loaded grafts.
After dynamic loading, the residual displacement in sutured grafts was lower when compared to nonsutured grafts. The ultimate failure loads were significantly lower in nonsutured grafts when compared to sutured grafts after dynamic loading. The histomorphologic analysis demonstrated intratunnel displacement of nonsutured grafts after dynamic loading, while sutured grafts remained in situ. In cases where the cross-pins had not threaded the tendon loops, sutured grafts provided higher fixation strength and less graft displacement.
The results of the present study suggest that suturing the looped-over portion of a quadruple tendon graft provides superior biomechanical graft fixation properties when compared to nonsutured grafts when using the femoral cross-pin fixation technique.
Suturing the hamstring tendon graft in a whipstitch fashion is recommended for the femoral cross-pin fixation of an anterior cruciate ligament graft.
确定在前交叉韧带重建中，采用锁边缝合法缝合软组织移植物是否是确保交叉针固定技术获得足够初始固定强度的必要步骤。
采用猪趾伸肌腱作为四股软组织移植物。使用交叉针固定技术（RigidFix；Ethicon，德国诺德施泰特）将标本固定在52个猪股骨骨隧道内。在第一组（n = 28）中，采用锁边缝合法缝合移植物的套叠部分；在第二组（n = 28）中，移植物不进行缝合。使用单周期加载至失效方案或动态加载方案确定初始固定特性，使移植物在0度至90度之间进行1000次屈伸加载循环，然后进行最终加载至失效。在未加载和动态加载的移植物中，通过组织形态学观察移植物与针的相互作用以及移植物与隧道界面。
动态加载后，缝合移植物的残余位移比未缝合移植物低。动态加载后，未缝合移植物的最终破坏载荷显著低于缝合移植物。组织形态学分析表明，动态加载后未缝合移植物在隧道内发生位移，而缝合移植物仍处于原位。在交叉针未穿过肌腱环的情况下，缝合移植物提供了更高的固定强度和更小的移植物位移。
本研究结果表明，在使用股骨交叉针固定技术时，与未缝合的移植物相比，缝合四股肌腱移植物的套叠部分可提供更好的生物力学移植物固定特性。
对于前交叉韧带移植物的股骨交叉针固定，建议采用锁边缝合法缝合腘绳肌腱移植物。
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