Ristanis Stavros, Stergiou Nicholas, Siarava Eleftheria, Ntoulia Aikaterini, Mitsionis Grigorios, Georgoulis Anastasios D
Orthopaedic Sports Medicine Center, Ioannina, Greece.
J Bone Joint Surg Am. 2009 Sep;91(9):2151-8. doi: 10.2106/JBJS.H.00940.
Rotational knee movement after reconstruction of the anterior cruciate ligament has been difficult to quantify. The purpose of this study was to identify in vivo whether a more horizontal placement of the femoral tunnel (in the ten o'clock position rather than in the eleven o'clock position) can restore rotational kinematics, during highly demanding dynamic activities, in a knee in which a bone-patellar tendon-bone graft had been used to reconstruct the anterior cruciate ligament.
We evaluated ten patients in whom a bone-patellar tendon-bone graft had been used to reconstruct the anterior cruciate ligament with the femoral tunnel in the eleven o'clock position, ten patients who had had the same procedure with the femoral tunnel in the ten o'clock position, and ten healthy controls. Kinematic data were collected while the subjects (1) descended from a stairway, made foot contact, and then pivoted 90 degrees on the landing lower limb and (2) jumped from a platform, landed with both feet on the ground, and pivoted 90 degrees on the right or left lower limb. The dependent variable that we examined was tibial rotation during pivoting.
The results demonstrated that reconstruction of the anterior cruciate ligament with the femoral tunnel in either the ten or the eleven o'clock position successfully restored anterior tibial translation. However, both techniques resulted in tibial rotation values, during the dynamic activities evaluated, that were significantly larger than those in the intact contralateral lower limbs and those in the healthy controls. Tibial rotation did not differ significantly between the two reconstruction groups or between the healthy controls and the intact contralateral lower limbs. However, we noticed that positioning the tunnel at ten o'clock resulted in slightly decreased rotation values that may have clinical relevance but not statistical significance.
Regardless of which of the two tested positions was utilized to fix the graft to the femur, reconstruction of the anterior cruciate ligament did not restore normal tibial rotation during dynamic activities.
前交叉韧带重建术后膝关节的旋转运动难以量化。本研究的目的是在体内确定，对于使用骨-髌腱-骨移植物重建前交叉韧带的膝关节，将股骨隧道放置得更水平（在十点位置而非十一点位置）是否能在高要求的动态活动中恢复旋转运动学。
我们评估了10例使用骨-髌腱-骨移植物重建前交叉韧带且股骨隧道位于十一点位置的患者、10例进行相同手术但股骨隧道位于十点位置的患者以及10名健康对照者。在受试者（1）从楼梯上下来、接触地面，然后以落地的下肢为轴旋转90度以及（2）从平台上跳下、双脚落地，然后以右下肢或左下肢为轴旋转90度时收集运动学数据。我们检查的因变量是旋转过程中的胫骨旋转。
结果表明，股骨隧道位于十点或十一点位置重建前交叉韧带均成功恢复了胫骨前移。然而，在评估的动态活动中，两种技术导致的胫骨旋转值均显著大于对侧完整下肢和健康对照者的胫骨旋转值。两个重建组之间以及健康对照者与对侧完整下肢之间的胫骨旋转无显著差异。然而，我们注意到将隧道置于十点位置会使旋转值略有降低，这可能具有临床相关性，但无统计学意义。
无论采用两个测试位置中的哪一个将移植物固定到股骨上，前交叉韧带重建在动态活动中均未恢复正常的胫骨旋转。
