Miller R Matthew, Rahnemai-Azar Amir Ata, Sürer Levent, Arilla Fabio V, Fu Freddie H, Debski Richard E, Musahl Volker
Orthopaedic Robotics Laboratory, University of Pittsburgh, 408 Center for Bioengineering, 300 Technology Drive, 306 CNBIO, Pittsburgh, PA, 15219, USA.
Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, 300 Technology Drive, 306 CNBIO, Pittsburgh, PA, 15219, USA.
Knee Surg Sports Traumatol Arthrosc. 2017 Apr;25(4):1249-1254. doi: 10.1007/s00167-016-4019-z. Epub 2016 Feb 11.
Anatomic double-bundle ACL reconstruction can be performed using different grafts, such as quadriceps tendon. Grafts can be split in either coronal or sagittal planes to approximate the two bundles of the native ACL, but it is unknown whether a difference exists in the graft tensile properties depending on splitting plane. The purpose of this study was to evaluate the tensile properties of split human quadriceps tendon-bone grafts.
Twenty full-thickness quadriceps tendon-bone grafts were prepared to mimic grafts for double-bundle ACL reconstruction. Ten grafts were split in the sagittal plane, and ten were split in the coronal plane. Each graft underwent cyclic creep testing and load-to-failure testing to compare creep, ultimate load, ultimate elongation, stiffness, and tangent modulus between splitting planes. All parameters were compared between splitting groups (significance p < 0.05).
Lateral halves of grafts split in the sagittal plane exhibited a percent creep of 42.5 ± 12.4 %, ultimate load of 445 ± 210 N, ultimate elongation of 7.3 ± 1.9 mm, stiffness of 75.7 ± 19.9 N/mm, and tangent modulus of 174.0 ± 99.8 MPa. No differences were found between halves within split tendons or between splitting planes (n.s.).
Overall, splitting quadriceps tendon grafts for anatomic double-bundle ACL reconstruction results in similar tensile properties regardless of splitting plane. Surgeons can split quadriceps tendon in either splitting plane, but should take care to preserve fibres as much as possible. This study provides data that support the use of both coronal and sagittal splits of quadriceps tendons for anatomic double-bundle ACL reconstruction.
解剖双束前交叉韧带重建可使用不同的移植物，如股四头肌肌腱。移植物可在冠状面或矢状面劈开以近似天然前交叉韧带的两束，但尚不清楚根据劈开平面不同移植物的拉伸特性是否存在差异。本研究的目的是评估劈开的人股四头肌肌腱-骨移植物的拉伸特性。
制备20个全层股四头肌肌腱-骨移植物以模拟用于双束前交叉韧带重建的移植物。10个移植物在矢状面劈开，10个在冠状面劈开。每个移植物都进行循环蠕变测试和破坏载荷测试，以比较劈开平面之间的蠕变、极限载荷、极限伸长、刚度和切线模量。比较劈开组之间的所有参数（显著性p<0.05）。
在矢状面劈开的移植物外侧半部分表现出42.5±12.4%的蠕变百分比、445±210N的极限载荷、7.3±1.9mm的极限伸长、75.7±19.9N/mm的刚度和174.0±99.8MPa的切线模量。在劈开的肌腱内两半之间或劈开平面之间未发现差异（无显著性）。
总体而言，用于解剖双束前交叉韧带重建而劈开股四头肌肌腱移植物，无论劈开平面如何，其拉伸特性相似。外科医生可在任一劈开平面劈开股四头肌肌腱，但应注意尽可能保留纤维。本研究提供的数据支持在解剖双束前交叉韧带重建中使用冠状面和矢状面劈开的股四头肌肌腱。
