Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, 1010 Kaufmann Building, Pittsburgh, PA 15213, USA.
Knee Surg Sports Traumatol Arthrosc. 2011 May;19(5):728-35. doi: 10.1007/s00167-010-1338-3. Epub 2010 Dec 11.
Different tunnel configurations have been used for double-bundle (DB) anterior cruciate ligament (ACL) reconstruction. However, controversy still exists as to whether three-tunnel DB with double-femoral tunnels and single-tibial tunnel (2F-1T) or with single-femoral tunnel and double-tibial tunnels (1F-2T) better restores intact knee biomechanics than single-bundle (SB) ACL reconstruction. The purpose was to compare the knee kinematics and in situ force in the grafts among SB and two types of three-tunnel DB ACL reconstructions performed in an anatomic fashion.
Twenty-four porcine knees were subjected to an 89-N anterior tibial load (simulated KT-1000 test) at 30°, 60°, and 90° of flexion and to a 4-Nm internal tibial torque and 7-Nm valgus torque (simulated pivot-shift test) at 30° and 60° of flexion. The resulting knee kinematics and in situ force in the ACL or replacement grafts were measured using a robotic system for (1) ACL-intact, (2) ACL-deficient, and (3) three ACL reconstructed knees: SB; DB 2F-1T; and DB 1F-2T.
During the simulated pivot-shift test, the DB grafts more closely restored the in situ force in the intact ACL at low flexion angle than the SB graft. There were no significant differences in knee kinematics between SB and DB ACL reconstruction. The DB 2F-1T reconstruction did not show a significant difference in knee kinematics or in situ force when compared to the DB 1F-2T technique.
The in situ force in the ACL is better restored with an anatomic three-tunnel DB reconstruction in response to the simulated pivot-shift test at low flexion angle when compared to an anatomic SB reconstruction. Both three-tunnel DB ACL reconstructions performed in an anatomic fashion had similar biomechanical behavior. As long as it is performed anatomically, DB ACL reconstruction could be better alternative than SB ACL reconstruction, no matter which three-tunnel procedure, 2F-1T or 1F-2T, is used.
双束（DB）前交叉韧带（ACL）重建采用了不同的隧道构型。然而，对于三隧道 DB 是否优于单束（SB）ACL 重建，即三隧道 DB 采用双股骨隧道和单胫骨隧道（2F-1T）或单股骨隧道和双胫骨隧道（1F-2T）来更好地恢复完整的膝关节生物力学，仍存在争议。本研究旨在比较解剖式 SB 和两种三隧道 DB ACL 重建的膝关节运动学和移植物内的原位力。
24 个猪膝关节在 30°、60°和 90°的屈曲位分别接受 89-N 的胫骨前负荷（模拟 KT-1000 测试）和 4-Nm 的胫骨内旋扭矩和 7-Nm 的外翻扭矩（模拟髌股关节脱位测试）。使用机器人系统测量 ACL 或替代移植物的膝关节运动学和原位力，包括（1）ACL 完整，（2）ACL 缺失和（3）三种 ACL 重建膝关节：SB；DB 2F-1T；和 DB 1F-2T。
在模拟髌股关节脱位测试中，与 SB 移植物相比，DB 移植物在低屈曲角度时更能恢复 ACL 的原位力。SB 和 DB ACL 重建之间的膝关节运动学没有显著差异。与 DB 1F-2T 技术相比，DB 2F-1T 重建在膝关节运动学或原位力方面没有显著差异。
与解剖式 SB 重建相比，在低屈曲角度模拟髌股关节脱位测试时，解剖式三隧道 DB 重建更能恢复 ACL 的原位力。两种解剖式三隧道 DB ACL 重建具有相似的生物力学行为。只要它是解剖式的，DB ACL 重建可能是优于 SB ACL 重建的更好选择，无论使用哪种三隧道技术，2F-1T 还是 1F-2T。
