Korea University Ansan Hospital, Anam-dong Seongbuk-Gu, Seoul, Korea.
Arthroscopy. 2009 Sep;25(9):989-95. doi: 10.1016/j.arthro.2009.02.006. Epub 2009 Aug 7.
This article reports the biomechanical demonstration of a technique for transtibial posterior cruciate ligament (PCL) reconstruction using a soft-tissue graft with cross-pin fixation in the tibia and compares this with the biomechanical properties achieved with other methods.
We used 5 paired cadaveric knees and another 10 tibias. Soft-tissue grafts were randomized. The femoral side of the anterior cruciate ligament was fixed with a Bio-TransFix device (Arthrex, Naples, FL) (group I), and the tibial side of the PCL was fixed with a Bio-TransFix device (group II). In another 10 tibias, tibial fixations were performed by use of a bio-interference screw (group III). Biomechanical testing was carried out on a testing machine, and maximal failure load, stiffness, and displacement were analyzed. The lengths of the slots of the TransFix device (Arthrex) from the near cortex were measured to compare the proper length of the device.
Maximal mean failure loads in groups I, II, and III were 549.3 +/- 55.4 N, 570.8 +/- 96.9 N, and 371.3 +/- 106.2 N, respectively, showing a significant difference (P = .0003). Stiffnesses were 47.52 +/- 16.84 N/mm, 59.14 +/- 17.09 N/mm, and 27.60 +/- 16.73 N/mm, respectively, showing a significant difference (P = .01). Mean displacements were 19.99 +/- 5.79 mm, 19.09 +/- 8.51 mm, and 17.58 +/- 7.10 mm, respectively, showing no significant difference (P = .7535). The mean lengths of the slots of the TransFix device of the femurs and tibias were similar at 20.3 +/- 1.25 mm and 20.2 +/- 1.32 mm, respectively, showing no significant difference (P = .8637).
The transtibial technique by use of cross-pin tibial fixation with a Bio-TransFix device in PCL reconstruction provides stable fixation that is comparable to that achieved by use of conventional bio-interference screw fixation and femoral fixation in an anterior cruciate ligament reconstruction, an already well-established technique.
Biomechanically, tibial cross-pin fixation compares favorably with interference screw fixation and is useful when a graft is short. However, safety issues have not yet been resolved.
本文报告了一种使用软组织移植物经胫骨后侧交叉韧带（PCL）重建的技术的生物力学演示，并将其与其他方法获得的生物力学特性进行了比较。
我们使用了 5 对配对的尸体膝关节和另外 10 个胫骨。随机选择软组织移植物。前交叉韧带的股骨侧用 Bio-TransFix 装置（Arthrex，那不勒斯，佛罗里达州）固定（I 组），PCL 的胫骨侧用 Bio-TransFix 装置固定（II 组）。在另外 10 个胫骨中，胫骨固定采用生物干扰螺钉（III 组）。在试验机上进行生物力学测试，分析最大失效载荷、刚度和位移。测量 TransFix 装置（Arthrex）的近皮质槽的长度，以比较装置的适当长度。
I、II 和 III 组的最大平均失效载荷分别为 549.3 ± 55.4 N、570.8 ± 96.9 N 和 371.3 ± 106.2 N，差异有统计学意义（P =.0003）。刚度分别为 47.52 ± 16.84 N/mm、59.14 ± 17.09 N/mm 和 27.60 ± 16.73 N/mm，差异有统计学意义（P =.01）。平均位移分别为 19.99 ± 5.79 mm、19.09 ± 8.51 mm 和 17.58 ± 7.10 mm，差异无统计学意义（P =.7535）。股骨和胫骨 TransFix 装置槽的平均长度相似，分别为 20.3 ± 1.25 mm 和 20.2 ± 1.32 mm，差异无统计学意义（P =.8637）。
PCL 重建中使用胫骨交叉钉固定的经胫骨技术提供了稳定的固定，与传统生物干扰螺钉固定和前交叉韧带重建中已经确立的股骨固定相当。
生物力学上，胫骨交叉钉固定与干扰螺钉固定相比具有优势，在移植物较短时很有用。然而，安全问题尚未解决。
