Kleweno Conor P, Jacir Alberto M, Gardner Thomas R, Ahmad Christopher S, Levine William N
Harvard Combined Orthopaedics Residency Program, Boston, Massachusetts, USA.
Am J Sports Med. 2009 Feb;37(2):339-45. doi: 10.1177/0363546508326706. Epub 2008 Dec 17.
A number of different femoral anterior cruciate ligament fixation techniques are currently in use. Slippage of the graft caused by excessive early loading or aggressive rehabilitation may negate benefits of surgery and result in a knee with undesirable laxity.
Anterior cruciate ligament femoral graft slippage varies by fixation technique and amount of cyclic loading.
Controlled laboratory study.
Graft slippage in 5 different soft tissue anterior cruciate ligament femoral fixation techniques (Bio-TransFix cross-pin technique, Stratis ST cross-pin technique, Bilok ST transverse femoral screw, Delta tapered bio-interference screw, and single-loop TensionLok) was compared by cyclic loading of double-bundle grafts in porcine femurs. Graft slippage was measured using a differential variable reluctance transducer.
The Bio-TransFix had significantly less (P = .002) total graft slippage (1.14 +/- 0.43 mm) compared to the Delta (3.74 +/- 3.25 mm), Bilok ST (3.92 +/- 2.28 mm), and TensionLok (5.09 +/- 1.12 mm) but not the Stratis ST (1.92 +/- 1.55 mm). All techniques showed the greatest amount of dynamic excursion (P < .001), slippage (P < .001), and percentage of total slippage (mean 68%, P < .001) during the first 100 cycles of loading. The TensionLok had the greatest amount of dynamic excursion during the first 100 cycles (4.15 +/- 1.00 mm) followed by the Bilok ST (3.37 +/- 2.07 mm), Delta (1.76 +/- 0.93 mm), and Stratis ST (1.75 +/- 0.96 mm); the Bio-TransFix demonstrated the least (1.26 +/- 0.48 mm). There was no statistical difference in failure load between repair techniques (P = .103).
Graft slippage was statistically different between anterior cruciate ligament femoral fixation techniques for static and dynamic loading. All techniques exhibited the greatest amount of slippage during the first 100 cycles of loading. The differential variable reluctance transducer permitted evaluation of dynamic graft-construct-bone displacement during experimental loading, simulating the loading experienced during early rehabilitation.
The optimal method of graft fixation for anterior cruciate ligament reconstruction remains unknown. In the current study, cross-pin constructs appeared to be superior to certain other available fixation systems.
目前有多种不同的股骨前交叉韧带固定技术在使用。早期过度负荷或激进康复导致的移植物滑移可能会抵消手术的益处，并导致膝关节出现不理想的松弛。
前交叉韧带股骨移植物的滑移因固定技术和循环负荷量而异。
对照实验室研究。
通过对猪股骨双束移植物进行循环加载，比较5种不同的软组织前交叉韧带股骨固定技术（Bio-TransFix交叉针技术、Stratis ST交叉针技术、Bilok ST股骨横向螺钉、Delta锥形生物干扰螺钉和单环TensionLok）中的移植物滑移情况。使用差动可变磁阻传感器测量移植物滑移。
与Delta（3.74±3.25mm）、Bilok ST（3.92±2.28mm）和TensionLok（5.09±1.12mm）相比，Bio-TransFix的总移植物滑移显著更少（P = 0.002）（1.14±0.43mm），但与Stratis ST（1.92±1.55mm）相比无显著差异。所有技术在加载的前100个周期内均表现出最大量的动态偏移（P < 0.001）、滑移（P < 0.001）和总滑移百分比（平均68%，P < 0.001）。TensionLok在最初100个周期内的动态偏移量最大（4.15±1.00mm），其次是Bilok ST（3.37±2.07mm）、Delta（1.76±0.93mm）和Stratis ST（1.75±0.96mm）；Bio-TransFix表现出的动态偏移量最小（1.26±0.48mm）。修复技术之间的失效负荷无统计学差异（P = 0.103）。
在前交叉韧带股骨固定技术中，静态和动态负荷下的移植物滑移在统计学上存在差异。所有技术在加载的前100个周期内均表现出最大量的滑移。差动可变磁阻传感器允许在实验加载过程中评估移植物-结构-骨的动态位移，模拟早期康复过程中所经历的负荷。
前交叉韧带重建的最佳移植物固定方法仍然未知。在当前研究中，交叉针结构似乎优于某些其他可用的固定系统。
