Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
Arthroscopy. 2012 Feb;28(2):264-71. doi: 10.1016/j.arthro.2011.07.020. Epub 2011 Oct 22.
The purpose of this study was to evaluate the effect of the anatomic double-bundle reconstruction (ADBR) of the posterior cruciate ligament (PCL) with 2 femoral tunnels and 2 tibial tunnels.
Eight fresh-frozen human knees were used. Bone tunnels were created based on the PCL anatomic footprints. A 9-mm looped semitendinosus and gracilis tendon for anterolateral bundle reconstruction (ALR), a 7-mm looped semitendinosus tendon for posteromedial bundle reconstruction (PMR), and the same grafts for the ADBR were used. Under a 100-N posterior tibial load and under a 100-N posterior tibial load and 5 Nm of external tibial torque, the posterior tibial translation (PTT) was measured.
Under posterior tibial load, at 0°, the PTT of the ALR was larger than that of the intact knee (P = .04) and the ADBR (P = .03); however, there were no significant differences between the PTT of the PMR and that of the ADBR (P = .28) and intact knee (P = .99). At 30°, the PTT of the ADBR was smaller than that of the ALR (P = .02) and PMR (P = .02). At 60°, the PTT of the PMR was larger than that of the ADBR (P = .02). At 90°, the PTT of the PMR was larger than that of the ADBR (P = .02). Under posterior tibial load and external tibial torque, at 0°, the PTT of the ALR was larger than that of the ADBR (P = .04).
Although the graft size of the ADBR was larger than other reconstructions, the ADBR was better than the ALR at 0° and 30° of knee flexion under the posterior tibial load and at 0° under the combination of posterior tibial load and external tibial torque, as well as better than the PMR at 30°, 60°, and 90° of knee flexion under the posterior tibial load.
The clinical outcome of PCL reconstruction might improve by reducing posterior knee laxity in knee extension with the ADBR.
本研究旨在评估采用 2 个股骨隧道和 2 个胫骨隧道的解剖双束重建（ADBR）对后交叉韧带（PCL）的影响。
使用 8 个新鲜冷冻的人膝关节。根据 PCL 解剖足迹创建骨隧道。使用 9mm 环形半腱肌和股薄肌腱进行前外侧束重建（ALR），7mm 环形半腱肌肌腱进行后内侧束重建（PMR），以及相同的移植物用于 ADBR。在 100N 胫骨后负荷和 100N 胫骨后负荷加 5Nm 胫骨外扭矩下，测量胫骨后平移（PTT）。
在胫骨后负荷下，在 0°时，ALR 的 PTT 大于完整膝关节（P=.04）和 ADBR（P=.03）；然而，PMR 的 PTT 与 ADBR（P=.28）和完整膝关节（P=.99）之间没有显著差异。在 30°时，ADBR 的 PTT 小于 ALR（P=.02）和 PMR（P=.02）。在 60°时，PMR 的 PTT 大于 ADBR（P=.02）。在 90°时，PMR 的 PTT 大于 ADBR（P=.02）。在胫骨后负荷加胫骨外扭矩下，在 0°时，ALR 的 PTT 大于 ADBR（P=.04）。
尽管 ADBR 的移植物尺寸大于其他重建，但在胫骨后负荷下，0°和 30°时，ADBR 优于 ALR，在胫骨后负荷加胫骨外扭矩下，0°时，ADBR 优于 PMR，在胫骨后负荷下，30°、60°和 90°时，PMR 优于 PMR。
通过减少 ADBR 后膝关节伸展时的后膝关节松弛，PCL 重建的临床结果可能会得到改善。
