Mae Tatsuo, Shino Konsei, Iuchi Ryo, Kinugasa Kazutaka, Uchida Ryohei, Nakagawa Shigeto, Yoshikawa Hideki, Nakata Ken
Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita-city, Osaka, 565-0871, Japan.
Center of Sports Orthopaedic Surgery, Yukioka Hospital, 2-2-3, Ukita, Kita-ku, Osaka, 530-0021, Japan.
J Orthop Sci. 2017 Sep;22(5):886-891. doi: 10.1016/j.jos.2017.05.006. Epub 2017 May 27.
To clarify 1) the force sharing between two portions of BTB graft in anatomic rectangular tunnel (ART) reconstruction and 2) the knee stability in ART technique under anterior tibial load.
Eleven fresh cadaveric knees were used. First, anterior-posterior (A-P) laxity was measured with Knee Laxity Tester in response to 134 N of A-P tibial load at 20° on the normal knees. Then ART ACL reconstruction was performed with a BTB graft. For graft, the patellar bone plug and tendon portion was longitudinally cut into half as AM and PL portions. After the tibial bone plug was fixed at femoral aperture, AM/PL portions were connected to the tension-adjustable force gauges at tibial tubercle, and were fixed with 10 N to each portion at 20°. Then the tension was measured 1) under anterior tibial load of 134 N at 0, 30, 60, and 90°, and 2) during passive knee extension from 120 to 0°. Next the graft tension was set at 0, 10, 20, 30, or 40 N at 20°, and the A-P laxity was measured by applying A-P load of 134 N. By comparing the laxity for the normal knee, the tension to restore the normal A-P laxity (LMP) was estimated.
The AM force was significantly smaller at 0° and larger at 90° than the PL force under anterior load, while the force sharing showed a reciprocal pattern. During knee extension motion, the tension of both portions gradually increased from around 5 N to 20-30 N with knee extended. And the LMP was 1.6 ± 1.0 N with a range from 0.3 to 3.5 N.
The pattern of force sharing was similar to that in the normal ACL in response to anterior tibial load and during passive knee extension motion. LMP in this procedure was close to the tension in the normal ACL.
Level IV, a controlled-laboratory study.
阐明1）在解剖学矩形隧道（ART）重建中双束骨-髌腱-骨（BTB）移植物两部分之间的力分配，以及2）在前交叉韧带（ACL）负荷下ART技术中的膝关节稳定性。
使用11个新鲜尸体膝关节。首先，在正常膝关节上，使用膝关节松弛度测试仪在20°时对134 N的前后（A-P）胫骨负荷测量前后（A-P）松弛度。然后用BTB移植物进行ART ACL重建。对于移植物，将髌骨骨块和肌腱部分纵向切成两半，即前内侧（AM）部分和后外侧（PL）部分。在胫骨骨块固定于股骨隧道后，将AM/PL部分在胫骨结节处连接到张力可调测力计，并在20°时对每部分施加10 N的固定力。然后在以下情况下测量张力：1）在0°、30°、60°和90°时134 N的前交叉韧带负荷下；2）在膝关节从120°被动伸展至0°的过程中。接下来，在20°时将移植物张力设置为0、10、20、30或40 N，并通过施加134 N的A-P负荷测量A-P松弛度。通过比较正常膝关节的松弛度，估算恢复正常A-P松弛度（LMP）所需的张力。
在前交叉韧带负荷下，0°时AM力明显小于PL力，90°时则大于PL力，而力分配呈现相反模式。在膝关节伸展运动过程中，随着膝关节伸展，两部分的张力从约5 N逐渐增加至20 - 30 N。LMP为1.6 ± 1.0 N，范围为0.3至3.5 N。
在前交叉韧带负荷和膝关节被动伸展运动过程中，力分配模式与正常ACL相似。该手术中的LMP接近正常ACL中的张力。
IV级，对照实验室研究。
