Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, 1010 Kaufmann Building, Pittsburgh, PA 15213, USA.
Knee Surg Sports Traumatol Arthrosc. 2010 Jan;18(1):2-10. doi: 10.1007/s00167-009-0916-8.
Attention has been focused on the importance of anatomical tunnel placement in anterior cruciate ligament (ACL) reconstruction. The purpose of this study was to compare the effect of different tunnel positions for single-bundle (SB) ACL reconstruction on knee kinematics. Ten porcine knees were used for the following reconstruction techniques: three different anatomic SB [AM-AM (antero-medial), PL-PL (postero-lateral), and MID-MID] (n = 5 for each group), conventional SB (PL-high AM) (n = 5), and anatomic double-bundle (DB) (n = 5). Using a robotic/universal force-moment sensor testing system, an 89 N anterior load (simulated KT1000 test) at 30, 60, and 90 degrees of knee flexion and a combined internal rotation (4 N m) and valgus (7 N m) moment (simulated pivot-shift test) at 30 and 60 degrees were applied. Anterior tibial translation (ATT) (mm) and in situ forces (N) of reconstructed grafts were calculated. During simulated KT1000 test at 60 degrees of knee flexion, the PL-PL had significantly lower in situ force than the intact ACL (P < 0.01). In situ force of the MID-MID was higher than other SB reconstructions (at 30 degrees : 94.8 +/- 2.5 N; at 60 degrees : 85.2 +/- 5.3 N; and 90 degrees: 66.0 +/- 8.7 N). At 30 degrees of knee flexion, the PL-high AM had the lowest in situ values (67.1 +/- 19.3 N). At 60 and 90 degrees of knee flexion the PL-PL had the lowest in situ values (at 60 degrees : 60.8 +/- 19.9 N; 90 degrees : 38.4 +/- 19.2 N). The MID-MID and DB had no significant in situ force differences at 30 and 60 degrees of knee flexion. During simulated pivot-shift test at 60 degrees of knee flexion, the PL-PL and PL-high AM reconstructions had a significant lower in situ force than the intact ACL (P < 0.01). During simulated KT1000 test at 30, 60, and 90 degrees of knee flexion, the PL-PL and PL-high AM had significantly lower ATT than the intact ACL (P < 0.01). During simulated KT1000 test at 60 and 90 degrees, the MID-MID, AM-AM, and DB had significantly lower ATT than the ACL deficient knee (P < 0.01). During simulated KT1000 test at 90 degrees, every reconstructed knee had significantly higher ATT than the intact knee (P < 0.01). In conclusion, the MID-MID position provided the best stability among all anatomic SB reconstructions and more closely restored normal knee kinematics.
人们一直关注前交叉韧带（ACL）重建中解剖学隧道位置的重要性。本研究旨在比较单束（SB）ACL 重建中不同隧道位置对膝关节运动学的影响。使用机器人/通用力-力矩传感器测试系统，在 30、60 和 90 度膝关节屈曲以及 30 和 60 度时施加 89 N 的前向负荷（模拟 KT1000 测试）和联合内旋（4 Nm）和外翻（7 Nm）力矩（模拟前抽屉测试）。计算重建移植物的胫骨前向平移（ATT）（mm）和原位力（N）。在 60 度膝关节屈曲的模拟 KT1000 测试中，PL-PL 的原位力明显低于完整 ACL（P < 0.01）。MID-MID 的原位力高于其他 SB 重建（30 度：94.8 +/- 2.5 N；60 度：85.2 +/- 5.3 N；90 度：66.0 +/- 8.7 N）。在 30 度膝关节屈曲时，PL-high AM 的原位值最低（67.1 +/- 19.3 N）。在 60 和 90 度膝关节屈曲时，PL-PL 的原位值最低（60 度：60.8 +/- 19.9 N；90 度：38.4 +/- 19.2 N）。MID-MID 和 DB 在 30 和 60 度膝关节屈曲时没有明显的原位力差异。在 60 度膝关节屈曲的模拟前抽屉测试中，PL-PL 和 PL-high AM 重建的原位力明显低于完整 ACL（P < 0.01）。在 30、60 和 90 度膝关节屈曲的模拟 KT1000 测试中，PL-PL 和 PL-high AM 的 ATT 明显低于完整 ACL（P < 0.01）。在 60 和 90 度膝关节屈曲的模拟 KT1000 测试中，MID-MID、AM-AM 和 DB 的 ATT 明显低于 ACL 缺失膝关节（P < 0.01）。在 90 度膝关节屈曲的模拟 KT1000 测试中，每个重建的膝关节的 ATT 均明显高于完整膝关节（P < 0.01）。总之，MID-MID 位置在所有解剖学 SB 重建中提供了最佳的稳定性，并更接近地恢复了正常的膝关节运动学。
