Department of Orthopedic Surgery, School of Medicine, Sapporo Medical University, Sapporo, Japan.
Sports Orthopaedic Center, Yukioka Hospital, Osaka, Japan.
Arthroscopy. 2019 Mar;35(3):896-905. doi: 10.1016/j.arthro.2018.10.124. Epub 2019 Feb 4.
The first objective of our cadaveric study was to perform a biomechanical comparison of single-bundle (SB), double-bundle (DB), and triple-bundle (TB) anterior cruciate ligament (ACL) reconstructions using a hamstring tendon graft to determine the laxity match pre-tension (LMP) value, which is the tension within the graft required to re-create the same anterior laxity as the ACL-intact knee. The second objective was to determine the anterior laxity and force distribution during the application of both an anterior force and a simulated pivot-shift test.
Eleven fresh-frozen cadaveric knees were tested using a robotic/universal force-moment sensor system in the intact state, TB-reconstructed knee, DB-reconstructed knee, and SB-reconstructed knee. The LMP in each reconstruction was recorded. Each reconstructed knee was tested with an external load of 100-N anterior drawer and combined rotatory loads of 10-Nm valgus moment and 5-Nm internal rotation. The anterior tibial translation and tensile forces of each graft bundle were measured.
The LMP values for the TB reconstruction were 1.7 N for the anteromedial-medial graft, 1.7 N for the anteromedial-lateral graft, and 3.4 N for the posterolateral graft (PLG). The LMP value was 5.6 N for the anteromedial graft and PLG in the DB reconstruction. The LMP value was 26.3 N for the whole graft in the SB reconstruction. No statistically significant difference in stability was found between TB and DB reconstructions during the anterior load and the combined rotatory load test. For force distribution, the PLG tension in the TB reconstruction was statistically lower than that in the DB reconstruction.
Anatomic TB ACL reconstruction with the lowest initial tension on the graft stabilized the knee equally to DB or SB reconstruction, which required greater initial tension.
Although SB, DB, and TB ACL reconstructions through the anatomic tunnel position could equally restore stability, the initial tension on the graft required to restore stability was less in the latter 2 multi-tunnel reconstructions.
我们的这项尸体研究的首要目标是，使用腘绳肌腱移植物对单束（SB）、双束（DB）和三束（TB）前交叉韧带（ACL）重建进行生物力学比较，以确定预张紧（LMP）值，即重建 ACL 完整膝关节相同前松弛度所需的移植物张力。第二个目标是确定在前向力和模拟枢轴转移试验施加过程中，前侧松弛度和力分布。
使用机器人/通用力-力矩传感器系统在完整状态、TB 重建膝关节、DB 重建膝关节和 SB 重建膝关节中对 11 个新鲜冷冻尸体膝关节进行测试。记录每个重建的 LMP。在每个重建膝关节上施加 100-N 的前抽屉外力和 10-Nm 的外翻矩和 5-Nm 的内旋组合旋转负荷。测量每个移植物束的胫骨前移位和拉伸力。
TB 重建的 LMP 值为前内侧-内侧移植物 1.7N，前内侧-外侧移植物 1.7N，后外侧移植物（PLG）3.4N。DB 重建的 LMP 值为前内侧移植物和 PLG 为 5.6N。SB 重建的 LMP 值为整个移植物 26.3N。在前负荷和联合旋转负荷试验中，TB 和 DB 重建之间的稳定性没有统计学上的显著差异。对于力分布，TB 重建中的 PLG 张力明显低于 DB 重建。
解剖学 TB ACL 重建的初始移植物张力最低，可与 DB 或 SB 重建一样稳定膝关节，而后者需要更大的初始张力。
尽管通过解剖学隧道位置进行的 SB、DB 和 TB ACL 重建均可同等恢复稳定性，但恢复稳定性所需的移植物初始张力在后两种多隧道重建中较小。
