Engebretsen L, Lew W D, Lewis J L, Hunter R E
Department of Orthopedics, University of Minnesota, Minneapolis.
Acta Orthop Scand. 1989 Dec;60(6):703-9. doi: 10.3109/17453678909149609.
An experimental knee-testing system was used to investigate the immediate postoperative mechanical state in knees with nonaugmented and augmented repairs of the anterior cruciate ligament. Ligament, repair tissue, and augmentation forces were measured using buckle transducers, and joint motion was measured using an instrumented spatial linkage during the application of 90 N anteriorly-directed tibial loads to seven fresh knee specimens at 0-90 degrees of flexion. Force and motion data were collected from each knee with an intact and excised anterior cruciate ligament, and after performing (1) a nonaugmented repair and an augmented repair using the Ligament Augmentation Device (3M Company) placed either (2) anatomically through the lateral femoral condyle or (3) in the over-the-top position. The forces in the nonaugmented repair and the repair with the augmentation in the two positions were greater than the forces in the intact anterior cruciate ligament with the knee under the same anterior loads; this difference from normal was not significant with the over-the-top augmentation. With the augmentation anatomically placed, the load sharing did not reduce the force in the repair tissue as compared with the nonaugmented case. The over-the-top augmentation, on the other hand, lowered the repair tissue forces at extension while avoiding high repair tissue forces in flexion. The tibia was consistently in an externally rotated configuration compared with normal in both the unloaded and anterior load states with all three repair procedures.
使用一个实验性膝关节测试系统来研究前交叉韧带非增强修复和增强修复的膝关节术后即刻的力学状态。在对七个新鲜膝关节标本施加90N向前的胫骨负荷、膝关节处于0至90度屈曲状态时，使用扣式传感器测量韧带、修复组织和增强装置的力，使用仪器化空间连杆测量关节运动。从每个具有完整和切除前交叉韧带的膝关节收集力和运动数据，并在进行以下操作后收集：(1) 非增强修复以及使用韧带增强装置（3M公司）进行增强修复，该装置放置在 (2) 通过外侧股骨髁的解剖位置或 (3) 过顶位置。在相同的前负荷下，非增强修复以及在两个位置进行增强修复时膝关节的力大于完整前交叉韧带膝关节的力；过顶增强时与正常情况的这种差异不显著。与非增强情况相比，解剖位置放置增强装置时，负荷分担并没有降低修复组织中的力。另一方面，过顶增强在伸展时降低了修复组织的力，同时避免了屈曲时修复组织承受高力。在所有三种修复手术的无负荷和前负荷状态下，与正常情况相比，胫骨始终处于外旋状态。
