Seo Young-Jin, Song Si Young, Kim In Sung, Seo Myeong Jae, Kim Yoon Sang, Yoo Yon-Sik
Department of Orthopedic Surgery, Hallym University Medical Center, Dongtan, Gyunggido, Korea.
Knee Surg Sports Traumatol Arthrosc. 2014 Sep;22(9):2057-63. doi: 10.1007/s00167-013-2609-6. Epub 2013 Jul 14.
The aim of the study was to analyse the change in length and tension of the reconstructed single-bundle posterior cruciate ligament (PCL) with three different femoral tunnels at different knee flexion angles by use of three-dimensional finite element method.
The right knees of 12 male subjects were scanned with a high-resolution computed tomography scanner at four different knee flexion angles (0°, 45°, 90° and 135°). Three types of single-bundle PCL reconstruction were then conducted in a 90° flexion model: femoral tunnels were created in anterolateral (AL), central and posteromedial (PM) regions of the footprint. Length versus flexion curves and tension versus flexion curves were generated.
Between 0° and 90° of knee flexion, changes in length and tension in the PM grafts were not significant. Whereas the lengths and tension of the AL and central grafts significantly increased in the same flexion range. The length and tension of the PM grafts at 135° of knee flexion were significantly higher than those at 90° of knee flexion, whereas the AL and the central grafts showed only slight length changes beyond 90° of flexion. However, the tension of the AL graft increased significantly beyond 90° of flexion.
Changes in the graft length, and tension were generally affected by different femoral tunnels and knee flexion angles. In groups with the AL and PM single-bundle reconstruction, the graft tension increased beyond 90° of knee flexion when the graft is tensioned at 90° of flexion. These data suggest that final fixation angle at 90° for the AL or PM graft would induce graft overtension in high knee flexion of 135°. Whereas central graft which is fixed in 90° of flexion is desirable in terms of prevention of graft overtension. Because the graft tension within it was relatively constant beyond 90° of flexion.
本研究旨在通过三维有限元方法分析在不同膝关节屈曲角度下，三种不同股骨隧道的重建单束后交叉韧带（PCL）的长度和张力变化。
对12名男性受试者的右膝在四个不同膝关节屈曲角度（0°、45°、90°和135°）用高分辨率计算机断层扫描仪进行扫描。然后在90°屈曲模型中进行三种类型的单束PCL重建：在足迹的前外侧（AL）、中央和后内侧（PM）区域创建股骨隧道。生成长度与屈曲曲线以及张力与屈曲曲线。
在膝关节屈曲0°至90°之间，PM移植物的长度和张力变化不显著。而在相同的屈曲范围内，AL和中央移植物的长度和张力显著增加。膝关节屈曲135°时PM移植物的长度和张力显著高于屈曲90°时，而AL和中央移植物在屈曲超过90°后仅显示轻微的长度变化。然而，AL移植物的张力在屈曲超过90°后显著增加。
移植物长度和张力的变化通常受不同股骨隧道和膝关节屈曲角度的影响。在AL和PM单束重建组中，当移植物在90°屈曲时张紧，在膝关节屈曲超过90°时移植物张力会增加。这些数据表明，AL或PM移植物在90°的最终固定角度会在135°的高膝关节屈曲中导致移植物过度张紧。而就防止移植物过度张紧而言，在90°屈曲时固定的中央移植物是理想的。因为在屈曲超过90°后其内部的移植物张力相对恒定。
