Ho Jason Y, Gardiner Aaron, Shah Vivek, Steiner Mark E
Department of Orthopedics, The Permanente Medical Group, Kaiser Permanente Walnut Creek Medical Center, Walnut Creek, California 94596, USA.
Arthroscopy. 2009 May;25(5):464-72. doi: 10.1016/j.arthro.2009.02.013.
The purpose of this study was to compare the kinematics of a central anatomic single-bundle anterior cruciate ligament (ACL) reconstruction with a double-bundle ACL reconstruction by use of hamstring grafts and anatomic tunnel placement.
Anterior tibial translation and rotation were measured with a computer navigation system in 8 pairs of fresh-frozen cadaveric knees by use of a 133-N anterior force, an internal and external torque of 10 Nm, and an anterior force (133 N) combined with an internal rotation torque (10 Nm). Tests were performed at 30 degrees and 60 degrees of flexion with the ACL intact, the ACL transected, and after reconstruction of one side of a pair with either a single or a double-bundle construct.
At 30 degrees of flexion, cutting the ACL increased anterior translation under an anterior force (P < .0001), an internal rotation torque (P = .02), and a combined anterior force plus internal rotation torque (P = .01). At 60 degrees of flexion, transecting the ACL led to increased anterior translation only when an anterior force was used (P < .0001). Both single- and double-bundle reconstructions restored normal kinematics at 30 degrees and 60 degrees of knee flexion.
Central anatomic single-bundle ACL reconstruction with tunnels centered within the tibial and femoral insertions and double-bundle ACL reconstruction can restore normal anterior translation to the knee under anterior and rotational loads applied at 30 degrees and 60 degrees of flexion.
The primary kinematic effect of an ACL injury is an increase in anterior tibial translation, but there is no significant change in maximum internal or external rotation. Single- and double-bundle ACL reconstructions are equally effective in restoring normal anterior translation to the knee under both anterior and rotational loads.
本研究旨在比较采用腘绳肌腱移植物和解剖隧道定位的中央解剖单束前交叉韧带（ACL）重建与双束ACL重建的运动学情况。
使用计算机导航系统，对8对新鲜冷冻尸体膝关节施加133 N的前向力、10 N·m的内、外扭矩以及133 N前向力与10 N·m内旋扭矩的组合，测量胫骨前移和旋转情况。在ACL完整、ACL切断以及一对膝关节的一侧用单束或双束结构重建后，分别在30°和60°屈膝位进行测试。
在30°屈膝位，切断ACL会使在前向力作用下的胫骨前移增加（P <.0001）、在内旋扭矩作用下增加（P =.02）以及在前向力加内旋扭矩联合作用下增加（P =.01）。在60°屈膝位，仅在前向力作用时，切断ACL会导致胫骨前移增加（P <.0001）。单束和双束重建在30°和60°屈膝位均能恢复正常运动学情况。
采用位于胫骨和股骨附着点中心的隧道进行中央解剖单束ACL重建以及双束ACL重建，在30°和60°屈膝位施加前向和旋转负荷时，均可使膝关节恢复正常的胫骨前移。
ACL损伤的主要运动学效应是胫骨前移增加，但最大内旋或外旋无明显变化。单束和双束ACL重建在恢复膝关节在前向和旋转负荷下的正常胫骨前移方面同样有效。
