Clarkstown Orthopedics, West Nyack, New York 10994, USA.
Arthroscopy. 2010 Feb;26(2):202-13. doi: 10.1016/j.arthro.2009.07.014. Epub 2010 Jan 12.
The purpose of this study was to compare the bundle tension curves and resultant knee kinematics between 2 tensioning protocols in anatomic double-bundle anterior cruciate ligament (ACL) reconstruction.
Anatomic double-bundle ACL reconstruction was performed in 7 male cadaveric knees. Each graft was tensioned to 22 N under 2 conditions: (1) both bundles tensioned at 20 degrees of knee flexion (20/20 protocol) or (2) posterolateral (PL) bundle tensioned at 15 degrees and anteromedial (AM) bundle at 45 degrees (45/15 protocol). Knee kinematics were recorded in response to anterior and combined rotatory loads in the intact, ACL-deficient, and reconstructed states. Bundle tension was recorded dynamically with knee motion and during each loading test.
Tensioning both bundles at 20 degrees of knee flexion resulted in a reciprocal bundle tension pattern that was not statistically different; the PL bundle tension was greater than the AM bundle tension in full extension, and the AM bundle tension was greater than the PL bundle tension from 25 degrees to 120 degrees. In the second tensioning protocol, the AM bundle tension was significantly greater than the PL bundle tension at all flexion angles. Both tensioning protocols restored normal knee kinematics.
Bundle-tensioning protocol is a variable that has a significant effect on the bundle-loading patterns in double-bundle ACL reconstruction. The 20/20 protocol resulted in AM and PL bundle-loading patterns that were equivalent during dynamic testing, whereas the 45/15 protocol led to excessive tension in the AM bundle in full extension. We recommend equal tensioning of both bundles with the knee at 20 degrees of flexion to restore relatively normal tension curves in each bundle and to avoid excessive stress on the AM bundle.
In double-bundle ACL reconstruction, there is no consensus regarding bundle-tensioning protocols. This study provides data on the individual bundle tension curves that result from 2 commonly used tensioning protocols. These data will assist clinicians as the technique and application of double-bundle ACL reconstruction move forward.
本研究旨在比较解剖学双束前交叉韧带（ACL）重建中两种张力方案的束带张力曲线和膝关节运动学结果。
对 7 个男性尸体膝关节进行解剖学双束 ACL 重建。每个移植物在 2 种条件下分别以 22N 的张力进行紧张：（1）在 20°膝关节屈曲下同时紧张两个束带（20/20 方案）或（2）后外侧（PL）束在 15°紧张，前内侧（AM）束在 45°紧张（45/15 方案）。在完整、ACL 缺失和重建状态下，记录膝关节对前向和联合旋转负荷的运动学。在膝关节运动过程中以及在每次加载试验时动态记录束带张力。
在 20°膝关节屈曲下同时紧张两个束带导致的束带张力模式具有相似性，无统计学差异；在完全伸展时，PL 束的张力大于 AM 束，在 25°至 120°时 AM 束的张力大于 PL 束。在第二种张力方案中，在所有屈曲角度下 AM 束的张力均显著大于 PL 束。两种张力方案均恢复了正常的膝关节运动学。
束带紧张方案是一个重要的变量，对双束 ACL 重建中的束带加载模式有显著影响。在动态测试中，20/20 方案导致 AM 和 PL 束的加载模式等效，而 45/15 方案导致 AM 束在完全伸展时张力过大。我们建议在膝关节屈曲 20°时同时紧张两个束带，以恢复每个束带相对正常的张力曲线，并避免 AM 束过度受力。
在双束 ACL 重建中，束带紧张方案尚未达成共识。本研究提供了两种常用紧张方案所导致的单个束带张力曲线的数据。这些数据将帮助临床医生在双束 ACL 重建技术和应用向前推进时提供参考。
