Savio L-Y. Woo, DSc (Hon DEng (Hon), Musculoskeletal Research Center, Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, 405 Center for Bioengineering, 300 Technology Drive, Pittsburgh, PA 15219.
Am J Sports Med. 2014 Mar;42(3):723-30. doi: 10.1177/0363546513516603. Epub 2014 Jan 8.
Recently, many surgeons have chosen the quadriceps tendon (QT) as an autograft for anterior cruciate ligament (ACL) reconstruction. However, there have not been biomechanical studies that quantitatively evaluated knee function after reconstruction using a QT autograft.
To measure the 6 degrees of freedom knee kinematics and in situ graft forces after reconstruction with a QT autograft compared with a quadrupled semitendinosus and gracilis (QSTG) tendon autograft.
Controlled laboratory study.
Ten human cadaveric knees (age, 54-64 years) were tested in 3 conditions: (1) intact, (2) ACL deficient, and (3) after ACL reconstruction using a QT or QSTG autograft. With use of a robotic/universal force-moment sensor testing system, knee kinematics and in situ forces in the ACL and autografts were obtained at 5 knee flexion angles under externally applied loads: (1) 134-N anterior tibial load, (2) 134-N anterior tibial load with 200-N axial compression, and (3) 10-N·m valgus and 5-N·m internal tibial torque.
Under the anterior tibial load, both autografts restored anterior tibial translation to within 2.5 mm of the intact knee and in situ forces to within 20 N of the intact ACL at 15°, 30°, and 60°. Adding compression did not change these findings. With the combined rotatory load, the anterior tibial translation and graft in situ forces were again not significantly different from the intact ACL. There were no significant differences between the grafts under any experimental condition.
Reconstruction of the ACL with a QT autograft restored knee function to similar levels as that reconstructed with a QSTG autograft under loads simulating clinical examinations.
The positive biomechanical results of this cadaveric study lend support to the use of a QT autograft for ACL reconstruction, as it could restore knee function immediately after surgery under applied loads that mimic clinical examinations.
最近，许多外科医生选择使用股四头肌肌腱（QT）作为前交叉韧带（ACL）重建的自体移植物。然而，目前还没有生物力学研究定量评估使用 QT 自体移植物重建后的膝关节功能。
与使用四股半腱肌和股薄肌（QSTG）肌腱自体移植物重建相比，测量使用 QT 自体移植物重建后膝关节的 6 自由度运动学和原位移植物力。
对照实验室研究。
对 10 个人体尸体膝关节（年龄 54-64 岁）进行了 3 种情况的测试：（1）完整，（2）ACL 缺失，（3）ACL 重建后使用 QT 或 QSTG 自体移植物。使用机器人/通用力-力矩传感器测试系统，在 5 个膝关节屈曲角度下，在外加负荷下获得 ACL 和自体移植物的膝关节运动学和原位力：（1）134-N 胫骨前负荷，（2）134-N 胫骨前负荷加 200-N 轴向压缩，（3）10-N·m 外翻和 5-N·m 胫骨内扭矩。
在胫骨前负荷下，两种自体移植物均将胫骨前向平移恢复至与完整膝关节相差 2.5mm 以内，并将原位 ACL 力恢复至与完整 ACL 相差 20N 以内，在 15°、30°和 60°时。施加压缩并没有改变这些发现。在联合旋转负荷下，胫骨前向平移和移植物原位力与完整 ACL 相比再次没有明显差异。在任何实验条件下，移植物之间均无显著差异。
使用 QT 自体移植物重建 ACL 可使膝关节功能恢复到与使用 QSTG 自体移植物重建相似的水平，因为在模拟临床检查的负荷下，可在手术后立即恢复膝关节功能。
这项尸体研究的积极生物力学结果支持使用 QT 自体移植物进行 ACL 重建，因为它可以在模拟临床检查的应用负荷下立即恢复手术后的膝关节功能。
