Department of Orthopaedic Surgery, Stony Brook University Hospital, Stony Brook, New York, U.S.A..
School of Medicine, Stony Brook University Hospital, Stony Brook, New York, U.S.A.
Arthroscopy. 2019 May;35(5):1547-1554. doi: 10.1016/j.arthro.2018.11.065. Epub 2019 Apr 12.
To biomechanically compare alternative graft constructs for all-inside anterior cruciate ligament (ACL) reconstruction in the event that the semitendinosus harvested is too narrow or too short to make a graft larger than 8 mm.
Bovine extensor tendons were used to make 6 different 9-mm-diameter grafts: traditional 4-strand, anastomosis 4-strand, 6-strand, 3-strand, button-fixation 4-strand, and loop-and-tack 4-strand grafts. The grafts were then subjected to cyclic biomechanical testing followed by failure loading. Force at 3 and 5 mm of displacement and ultimate force were recorded for all grafts.
Compared with the traditional 4-strand graft, the only graft that showed significant biomechanical differences during the cyclic phase of testing was the button-fixation 4-strand graft, which was characterized by lower force at 3 mm of displacement (74 ± 34 N vs 122 ± 13 N, P = .004) and 5 mm of displacement (122 ± 35 N vs 172 ± 3 N, P = .006). During failure loading, ultimate force was significantly lower for both the 6-strand graft (491 ± 186 N, P = .041) and button-fixation 4-strand graft (326 ± 27 N, P < .001) than for the traditional 4-strand graft (778 ± 176 N). All other grafts were equivalent for the parameters tested.
The anastomosis 4-strand, 3-strand, and loop-and-tack 4-strand grafts do not biomechanically differ in cyclic loading and ultimate force from traditional 4-strand grafts. This study supports the use of anastomosis 4-strand, 3-strand, or loop-and-tack 4-strand grafts in the event that a traditional all-inside 4-strand graft cannot be prepared from a harvested semitendinosus tendon in ACL reconstruction.
This study tests and describes alternatives to the traditional 4-strand semitendinosus autograft for all-inside ACL reconstruction in the event that the harvested tendon is not adequate.
为了比较替代的移植物结构，用于全内视前交叉韧带（ACL）重建，以防半腱肌腱采集的太窄或太短而无法制成大于 8 毫米的移植物。
使用牛伸肌腱制造 6 种不同直径为 9 毫米的移植物：传统的 4 股、吻合 4 股、6 股、3 股、纽扣固定 4 股和环扎固定 4 股移植物。然后对移植物进行循环生物力学测试，再进行失效负载。记录所有移植物在 3 和 5 毫米位移时的力和最终力。
与传统的 4 股移植物相比，只有纽扣固定 4 股移植物在测试的循环阶段表现出显著的生物力学差异，其特点是在 3 毫米位移时的力较低（74 ± 34 N 与 122 ± 13 N，P =.004）和 5 毫米位移时的力较低（122 ± 35 N 与 172 ± 3 N，P =.006）。在失效负载下，6 股移植物（491 ± 186 N，P =.041）和纽扣固定 4 股移植物（326 ± 27 N，P <.001）的最终力明显低于传统 4 股移植物（778 ± 176 N）。所有其他移植物在测试参数上都是等效的。
吻合 4 股、3 股和环扎固定 4 股移植物在循环加载和最终力方面与传统的 4 股移植物没有生物力学差异。本研究支持在 ACL 重建中，如果无法从采集的半腱肌腱中制备传统的全内视 4 股移植物时，使用吻合 4 股、3 股或环扎固定 4 股移植物。
本研究测试并描述了替代传统的 4 股半腱肌腱自体移植物的方法，用于全内视 ACL 重建，以防采集的肌腱不足。
