Department of Orthopedic Surgery, Hallym University Medical Center, Dongtan, South Korea.
Department of Orthopedic Surgery, Hallym University Medical Center, Dongtan, South Korea.
Arthroscopy. 2014 Jun;30(6):739-46. doi: 10.1016/j.arthro.2014.02.024. Epub 2014 Apr 13.
To investigate changes in femoral tunnel diameter, dimension, and volume after anterior cruciate ligament reconstruction with notchplasty.
Porcine knee specimens were divided into 2 groups of 10 specimens each. Group A did not receive notchplasty. A 2-mm notchplasty was conducted in group B. Seven-millimeter-diameter femoral tunnels were drilled and a doubled flexor digitorum profundus tendon was inserted and fixed with an EndoButton (Smith & Nephew, Andover, MA) in each knee specimen. Samples were mounted on a materials testing machine. Each group was preloaded at 10 N and subjected to 20 loading cycles (between 0 and 40 N), followed by 1,000 loading cycles in the elastic region (between 10 and 150 N). High-resolution computed tomography with 1.0-mm slices was conducted with all samples before and after testing. A 3-dimensional model was constructed to evaluate the degree of the tunnel change.
In group B the mean longest diameter and dimension of the femoral tunnel significantly increased after the test (P = .005 and P = .001, respectively). The volumetric loss of bony structure after the test in group B was significantly greater than that in group A (P = .039). Meanwhile, no significant difference was found before and after the test in terms of tunnel diameter, dimension, and volumetric loss around the tunnel in group A.
The intra-articular orifice of the femoral tunnel was enlarged after the uniaxial cyclic loading test after notchplasty. An enlarged tunnel orifice may lead to a discrepancy between the tunnel and the graft at the tunnel aperture.
The data may have an implication that suspensory fixation with a notchplasty has a negative effect on the full graft accommodation at the tunnel aperture. Aperture widening may affect graft positioning, leading to subtle changes in graft biomechanics and laxity.
研究前交叉韧带重建时行切迹成形术对股骨隧道直径、维度和容积的变化。
猪膝关节标本分为两组，每组 10 个标本。A 组不进行切迹成形术，B 组进行 2mm 的切迹成形术。每个膝关节标本均钻 7mm 直径的股骨隧道，插入并固定双股屈趾深肌腱，采用 EndoButton（Smith & Nephew，Andover，MA）。将标本安装在材料试验机上。每组标本在 10N 预加载后，进行 20 次加载循环（0-40N），然后在弹性区域（10-150N）进行 1000 次加载循环。所有标本在测试前后均采用 1.0mm 层厚的高分辨率 CT 进行扫描。构建三维模型以评估隧道变化程度。
B 组测试后股骨隧道最长直径和维度显著增加（P=0.005 和 P=0.001）。B 组测试后骨结构容积丢失明显大于 A 组（P=0.039）。同时，A 组隧道直径、维度和隧道周围容积在测试前后均无显著差异。
切迹成形术后单轴循环加载试验后，股骨隧道关节内口扩大。隧道口增大可能导致隧道和移植物在隧道口处不匹配。
这些数据表明，带有切迹成形术的悬吊固定对完全容纳移植物在隧道口处有负面影响。孔径增宽可能会影响移植物的定位，导致移植物生物力学和松弛度的细微变化。
