Bouguennec N, Odri G A, Graveleau N, Colombet P
Clinique chirurgicale traumatologique et orthopédique, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France.
Service de chirurgie orthopédique, CHR Orléans, 1, rue Porte-Madeleine, 45000 Orléans, France.
Orthop Traumatol Surg Res. 2015 May;101(3):301-5. doi: 10.1016/j.otsr.2015.01.007. Epub 2015 Mar 6.
TELOS™ is among the reference tools for the instrumental measurement of anterior tibial translation during the initial work-up and follow-up of patients with injuries to the anterior cruciate ligament (ACL). GRNB(®) is a non-irradiating but recently developed tool for which only limited data are available.
The GRNB(®) offers better reproducibility than TELOS™ for measuring anterior tibial translation without rotation in normal knees.
We retrospectively evaluated instrumental laxity measurements in normal knees. Data were available for 60 TELOS™ measurements (9kg load) and 57 GNRB(®) measurements (89N and 134N loads). For each instrument, we compared the absolute variation in anterior tibial translation between two measurements performed 6 months apart. For each GNRB(®) measurement, patellar pressure was recorded.
No significant differences were found between mean (± SD) variations in translation between the two instruments. A greater than 2.5mm variation between the two measurements was significantly more common with TELOS™ than with GRNB(®) (P<0.05, Chi(2) test). GRNB(®) translation values did not correlate with patellar pressure.
The GNRB(®) device offers greater reproducibility than TELOS™ when used to quantitate anterior tibial translation. The limited sample size may have prevented the detection of a significant difference between mean values. In addition, disadvantages of the TELOS™ include radiation exposure of the patient, operator-dependency of measurements made on the radiographs, and absence of a biofeedback system to limit hamstring contraction. GNRB(®) does have hamstring contraction biofeedback control but uses another parameter, namely, patellar pressure, for which the optimal value is unknown. Quadriceps and hamstring co-contraction induced by excessive patellar pressure may influence anterior tibial translation. The optimal patellar pressure value needs to be determined.
在对前交叉韧带（ACL）损伤患者进行初步检查和随访期间，TELOS™是用于仪器测量胫骨前移的参考工具之一。GRNB(®)是一种非辐射性的最新开发工具，目前仅有有限的数据。
在测量正常膝关节无旋转情况下的胫骨前移时，GRNB(®)比TELOS™具有更好的可重复性。
我们回顾性评估了正常膝关节的仪器松弛度测量。有60次TELOS™测量（9千克负荷）和57次GNRB(®)测量（89牛和134牛负荷）的数据。对于每种仪器，我们比较了相隔6个月进行的两次测量之间胫骨前移的绝对变化。对于每次GNRB(®)测量，记录了髌骨压力。
两种仪器之间平移的平均（±标准差）变化未发现显著差异。两次测量之间变化大于2.5毫米的情况在TELOS™中比在GRNB(®)中更常见（P<0.05，卡方检验）。GRNB(®)的平移值与髌骨压力无关。
当用于量化胫骨前移时，GNRB(®)设备比TELOS™具有更高的可重复性。样本量有限可能妨碍了均值之间显著差异的检测。此外，TELOS™的缺点包括患者接受辐射、X线片测量依赖操作者以及缺乏限制腘绳肌收缩的生物反馈系统。GNRB(®)确实有腘绳肌收缩生物反馈控制，但使用了另一个参数，即髌骨压力，其最佳值未知。过大的髌骨压力引起的股四头肌和腘绳肌共同收缩可能会影响胫骨前移。需要确定最佳的髌骨压力值。
