Grotting John A, Nelson Trevor J, Banffy Michael B, Yalamanchili Dheeraj, Eberlein Sam A, Chahla Jorge, Metzger Melodie F
Kerlan-Jobe Orthopedic Clinic, Los Angeles, CA, United States of America.
Cedars-Sinai Orthopaedic Biomechanics Laboratory, Los Angeles, CA, United States of America.
Knee. 2020 Mar;27(2):375-383. doi: 10.1016/j.knee.2020.01.004. Epub 2020 Feb 1.
The purpose of this study was to compare kinematics and patellofemoral contact pressures of all inside and transtibial single bundle PCL reconstructions and determine if suture augmentation further improves the biomechanics of either technique.
Cadaveric knees were tested with a posterior drawer force, and varus, valgus, internal and external moments at 30, 60, 90, and 120° of flexion. Displacement, rotation, and patellofemoral contact pressures were compared between: Intact, PCL-deficient, All-Inside PCL reconstruction with (AI-SA) and without (AI) suture augmentation, and transtibial PCL reconstruction with (TT-SA) and without (TT) suture augmentation.
Sectioning the PCL increased posterior tibial translation (PTT) from intact at 60° to 120° of flexion, p < 0.001. AI PCL reconstruction improved stability from the deficient-state but had greater PTT than intact at 90° of flexion, p < 0.05. Adding suture augmentation to the AI reconstruction further reduced PTT to levels that were not statistically different from intact at all flexion angles. TT reconstructed knees had greater PTT than intact knees at 60, 90, and 120° of flexion, p < 0.01. Adding suture augmentation (TT-SA) improved posterior stability to PTT levels that were not statistically different from intact knees at 30, 60, and 120° of flexion. Patellofemoral pressures were highest in PCL-deficient knees at increased angles of flexion and were reduced after reconstruction, but this was not significant.
In this time-zero study, both the all-inside and transtibial single bundle PCL reconstructions effectively reduce posterior translation from the deficient-PCL state. In addition, suture augmentation of both techniques provided further anterior-posterior stability.
本研究旨在比较全内和经胫骨单束后交叉韧带（PCL）重建的运动学和髌股关节接触压力，并确定缝线增强是否能进一步改善这两种技术的生物力学性能。
对尸体膝关节施加后抽屉力，并在屈膝30°、60°、90°和120°时施加内翻、外翻、内旋和外旋力矩。比较完整膝关节、PCL损伤膝关节、采用（AI-SA）和未采用（AI）缝线增强的全内PCL重建膝关节以及采用（TT-SA）和未采用（TT）缝线增强的经胫骨PCL重建膝关节之间的位移、旋转和髌股关节接触压力。
切断PCL后，屈膝60°至120°时胫骨后移（PTT）增加，p < 0.001。全内PCL重建可改善PCL损伤状态下的稳定性，但在屈膝90°时PTT大于完整膝关节，p < 0.05。在全内重建中增加缝线增强可进一步将PTT降低至在所有屈膝角度下与完整膝关节无统计学差异的水平。经胫骨重建膝关节在屈膝60°、90°和120°时PTT大于完整膝关节，p < 0.01。增加缝线增强（TT-SA）可将后稳定性提高至在屈膝30°、60°和120°时与完整膝关节无统计学差异的PTT水平。髌股关节压力在PCL损伤膝关节中随着屈膝角度增加而最高，重建后降低，但差异不显著。
在本即时研究中，全内和经胫骨单束PCL重建均能有效减少PCL损伤状态下的胫骨后移。此外，两种技术的缝线增强均提供了进一步的前后稳定性。
