单束与双束前交叉韧带重建在恢复膝关节运动学和前交叉韧带力方面的比较。
Comparison of single- and double-bundle anterior cruciate ligament reconstructions in restoration of knee kinematics and anterior cruciate ligament forces.
作者信息
Seon Jong Keun, Gadikota Hemanth R, Wu Jia-Lin, Sutton Karen, Gill Thomas J, Li Guoan
机构信息
Bioengineering Laboratory, Massachusetts General Hospital / Harvard Medical School, 55 Fruit Street, GRJ 1215, Boston, MA 02114, USA.
出版信息
Am J Sports Med. 2010 Jul;38(7):1359-67. doi: 10.1177/0363546510361494. Epub 2010 Apr 14.
BACKGROUND
Anterior cruciate ligament (ACL) deficiency alters 6 degrees of freedom knee kinematics, yet only anterior translation and internal rotation have been the primary measures in previous studies.
PURPOSE
To compare the 6 degrees of freedom knee kinematics and the graft forces after single- and double-bundle ACL reconstructions under various external loading conditions.
STUDY DESIGN
Controlled laboratory study.
METHODS
Ten human cadaveric knees were tested with a robotic testing system under 4 conditions: intact, ACL deficient, single-bundle reconstructed with a quadrupled hamstring tendon graft, and double-bundle reconstructed with 2 looped hamstring tendon grafts. Knee kinematics and forces of the ACL or ACL graft in each knee were measured under 3 loading conditions: an anterior tibial load of 134 N, a simulated quadriceps muscle load of 400 N, and combined tibial torques (10 N.m valgus and 5 N.m internal tibial torques) at 0 degrees , 15 degrees , 30 degrees , 60 degrees , and 90 degrees of knee flexion.
RESULTS
The double-bundle reconstruction restored the anterior and medial laxities closer to the intact knee than the single-bundle reconstruction. However, the internal rotation of the tibia under the simulated quadriceps muscle load was significantly decreased when compared with the intact knee after both reconstructions, more so after double-bundle reconstruction (P < .05). The entire graft force of the double-bundle reconstruction was more similar to that of the intact ACL than that of the single-bundle reconstruction. However, the posterolateral bundle graft in the double-bundle reconstructed knee was overloaded as compared with the intact posterolateral bundle.
CONCLUSION
The double-bundle reconstruction can better restore the normal anterior-posterior and medial-lateral laxities than the single-bundle reconstruction can, but an overloading of the posterolateral bundle graft can occur in a double-bundle reconstructed knee.
CLINICAL RELEVANCE
Both single-bundle and double-bundle techniques cannot restore the rotational laxities and the ACL force distributions of the intact knee.
背景
前交叉韧带（ACL）损伤会改变膝关节的六个自由度的运动学，但在以往研究中，仅将前向平移和内旋作为主要测量指标。
目的
比较单束和双束ACL重建术后在各种外部负荷条件下膝关节的六个自由度的运动学及移植物受力情况。
研究设计
对照实验室研究。
方法
使用机器人测试系统对10具人类尸体膝关节在4种情况下进行测试：完整状态、ACL损伤状态、用四股绳肌腱移植物进行单束重建、用2个环行绳肌腱移植物进行双束重建。在3种负荷条件下测量每个膝关节的ACL或ACL移植物的运动学和受力情况：134 N的胫骨前负荷、400 N的模拟股四头肌负荷，以及在膝关节屈曲0°、15°、30°、60°和90°时的联合胫骨扭矩（10 N·m外翻和5 N·m胫骨内扭矩）。
结果
与单束重建相比，双束重建能使膝关节的前后和内外侧松弛度更接近完整膝关节。然而，与完整膝关节相比，两种重建术后在模拟股四头肌负荷下胫骨的内旋均显著降低，双束重建后更为明显（P < 0.05）。双束重建的整个移植物受力比单束重建更接近完整ACL的受力。然而，与完整的后外侧束相比，双束重建膝关节中的后外侧束移植物负荷过重。
结论
与单束重建相比，双束重建能更好地恢复膝关节正常的前后和内外侧松弛度，但双束重建膝关节中后外侧束移植物可能会出现负荷过重的情况。
临床意义
单束和双束技术均无法恢复完整膝关节的旋转松弛度和ACL力分布。
Zotero 插件