Wehrhahn T, Ettinger M, Petri M, Liodakis E, Hurschler C, Albrecht U-V, Krettek C, Jagodzinski M
Unfallchirurgische Klinik, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover, Deutschland.
Unfallchirurg. 2013 Jul;116(7):589-95. doi: 10.1007/s00113-012-2167-2.
A secure tibial press fit technique in posterior cruciate ligament reconstructions may be a relevant alternative to common techniques because no hardware is necessary. Up to the present point in time no biomechanical data exist for a tibial press fit posterior cruciate ligament (PCL) reconstruction. This study compares the biomechanical properties of hamstring and quadriceps tendon grafts using a press fit technique with those of an interference screw fixation.
Quadriceps and hamstring tendons of 20 human cadavers (age 49.2±18.5 years) were used. A press fit fixation with a knot in the semitendinosus tendon (K) and a quadriceps tendon bone block graft (Q) were compared to an interference screw fixation (I) in 27 porcine tibiae. In each group, nine constructs were cyclically stretched and then loaded until failure. Maximum load to failure, stiffness and elongation during failure testing and cyclical loading were investigated.
The maximum load to failure was 518±157 N (387-650 N) for the K group, 558±119 N (466-650 N) for the I group and 620±102 N (541-699 N) for the Q group. The stiffness was 55±27 N/mm (18-89 N/mm) for the K group, 117±62 N/mm (69-165 N/mm) for the I group and 65±21 N/mm (49-82 N/mm) for the Q group. The stiffness of the I group was significantly larger (ANOVA on ranks, P=0.01). The elongation during cyclical loading was significantly larger for all groups from the 1st to the 5th cycle compared to the elongation in between the 5th and the 20th cycle (P<0.03).
All techniques exhibited larger elongation during initial loading. Load to failure and stiffness were significantly different between the fixations. The Q fixation showed equal biomechanical properties compared to a pure tendon fixation (I) with an interference screw. The results of group K were inferior. All three investigated fixation techniques exhibit comparable biomechanical properties. Preconditioning of the constructs is critical. Future randomized, clinical trials have to investigate the biological effectiveness of these fixation techniques.
在交叉韧带重建术中，一种可靠的胫骨压配技术可能是常用技术的一种相关替代方法，因为无需使用硬件。截至目前，尚无关于胫骨压配后交叉韧带（PCL）重建的生物力学数据。本研究比较了使用压配技术的绳肌腱和股四头肌腱移植物与采用干涉螺钉固定的生物力学特性。
使用20具人类尸体（年龄49.2±18.5岁）的股四头肌和绳肌腱。将半腱肌腱打结的压配固定（K）和股四头肌肌腱骨块移植物（Q）与27个猪胫骨中的干涉螺钉固定（I）进行比较。在每组中，九个结构进行循环拉伸，然后加载直至失效。研究了失效测试和循环加载期间的最大失效载荷、刚度和伸长率。
K组的最大失效载荷为518±157 N（387 - 650 N），I组为558±119 N（466 - 650 N），Q组为620±102 N（541 - 699 N）。K组的刚度为55±27 N/mm（18 - 89 N/mm），I组为117±62 N/mm（69 - 165 N/mm），Q组为65±21 N/mm（49 - 82 N/mm）。I组的刚度明显更大（秩和方差分析，P = 0.01）。与第5至20个循环之间的伸长率相比，所有组在第1至第5个循环期间的循环加载伸长率明显更大（P < 0.03）。
所有技术在初始加载期间均表现出更大的伸长率。固定方式之间的失效载荷和刚度存在显著差异。与采用干涉螺钉的纯肌腱固定（I）相比，Q固定显示出同等的生物力学特性。K组的结果较差。所有三种研究的固定技术均表现出可比的生物力学特性。结构的预处理至关重要。未来的随机临床试验必须研究这些固定技术的生物学有效性。
