Nuelle Clayton W, Milles Jeffrey L, Pfeiffer Ferris M, Stannard James P, Smith Patrick A, Kfuri Mauricio, Cook James L
Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri.
Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri.
J Knee Surg. 2017 Jul;30(6):523-531. doi: 10.1055/s-0036-1593625. Epub 2016 Oct 25.
No surgical technique recreates native posterior cruciate ligament (PCL) biomechanics. We compared the biomechanics of five different PCL reconstruction techniques versus the native PCL. Cadaveric knees ( = 20) were randomly assigned to one of five reconstruction techniques: Single bundle all-inside arthroscopic inlay, single bundle all-inside suspensory fixation, single bundle arthroscopic-assisted open onlay (SB-ONL), double bundle arthroscopic-assisted open inlay (DB-INL), and double bundle all-inside suspensory fixation (DB-SUSP). Each specimen was potted and connected to a servo-hydraulic load frame for testing in three conditions: PCL intact, PCL deficient, and PCL reconstructed. Testing consisted of a posterior force up to 100 N at a rate of 1 N/s at four knee flexion angles: 10, 30, 60, and 90 degrees. Three material properties were measured under each condition: load to 5 mm displacement, maximal displacement, and stiffness. Data were normalized to the native PCL, compared across techniques, compared with all PCL-intact knees and to all PCL-deficient knees using one-way analysis of variance. For load to 5 mm displacement, intact knees required significantly ( < 0.03) more load at 30 degrees of flexion than all reconstructions except the DB-SUSP. At 60 degrees of flexion, intact required significantly ( < 0.01) more load than all others except the SB-ONL. At 90 degrees, intact, SB-ONL, DB-INL, and DB-SUSP required significantly more load ( < 0.05). Maximal displacement testing showed the intact to have significantly ( < 0.02) less laxity than all others except the DB-INL and DB-SUSP at 60 degrees. At 90 degrees the intact showed significantly ( < 0.01) less laxity than all others except the DB-SUSP. The intact was significantly stiffer than all others at 30 degrees ( < 0.03) and 60 degrees ( < 0.01). Finally, the intact was significantly ( < 0.05) stiffer than all others except the DB-SUSP at 90 degrees. No technique matched the exact properties of the native PCL, but the double bundle reconstructions more closely recreated the native biomechanics immediately after implantation, with the DB-SUSP coming closest to the native ligament. This study contributes new data for consideration in PCL reconstruction technique choice.
没有一种手术技术能够重现天然后交叉韧带（PCL）的生物力学特性。我们比较了五种不同PCL重建技术与天然PCL的生物力学特性。将20具尸体膝关节随机分配至五种重建技术之一：单束全关节镜下嵌入法、单束全关节镜下悬吊固定法、单束关节镜辅助切开覆盖法（SB-ONL）、双束关节镜辅助切开嵌入法（DB-INL）以及双束全关节镜下悬吊固定法（DB-SUSP）。每个标本被固定并连接到一个伺服液压加载框架上，在三种状态下进行测试：PCL完整、PCL缺损以及PCL重建。测试包括在四个膝关节屈曲角度（10°、30°、60°和90°）以1N/s的速率施加高达100N的后向力。在每种状态下测量三种材料特性：5mm位移时的载荷、最大位移以及刚度。数据以天然PCL为参照进行标准化，在不同技术之间进行比较，并使用单因素方差分析与所有PCL完整的膝关节以及所有PCL缺损的膝关节进行比较。对于5mm位移时的载荷，在30°屈曲时，完整膝关节所需的载荷显著（P<0.03）高于除DB-SUSP之外的所有重建方法。在60°屈曲时，完整膝关节所需的载荷显著（P<0.01）高于除SB-ONL之外的所有其他方法。在90°时，完整膝关节、SB-ONL、DB-INL和DB-SUSP所需的载荷显著更高（P<0.05）。最大位移测试显示，在60°时，完整膝关节的松弛度显著（P<0.02）低于除DB-INL和DB-SUSP之外的所有其他方法。在90°时，完整膝关节的松弛度显著（P<0.01）低于除DB-SUSP之外的所有其他方法。在30°（P<0.03）和60°（P<0.01）时，完整膝关节的刚度显著高于所有其他方法。最后，在90°时，完整膝关节的刚度显著（P<0.05）高于除DB-SUSP之外的所有其他方法。没有一种技术能够完全匹配天然PCL的特性，但双束重建技术在植入后能更接近地重现天然生物力学特性，其中DB-SUSP最接近天然韧带。本研究为PCL重建技术的选择提供了新的数据以供参考。
