Wang Huizhi, Zhang Min, Cheng Cheng-Kung
School of Biological Science and Medical Engineering, Beihang University, Beijing, China.
Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, China.
Front Bioeng Biotechnol. 2020 Dec 31;8:173. doi: 10.3389/fbioe.2020.00173. eCollection 2020.
The clinical implications of changing the shape of the bone tunnel for Anterior cruciate ligament reconstruction (ACLR) is controversial and few studies have reported on the long-term prevalence for osteoarthritis. As such, this study aims to evaluate the effect of tunnel shape on joint biomechanics. Finite element models of an ACLR were constructed with different shapes (circular, oval, rounded rectangular, rectangular, and gourd-shaped) and diameters (7.5, 8.5, and 9.5 mm) for the bone tunnel. A combined loading of 103 N anterior tibial load, 7.5 Nm internal tibial moment and 6.9 Nm valgus tibial moment was applied at a joint flexion angle of 20°. Joint kinematics and the strain energy density (SED) on the articular cartilage were compared among the different groups. The results showed that conventional ACLR (circular tunnel) lead to an increase in joint kinematics over the intact joint, a lower ligament force and a higher SED on the lateral tibial cartilage. ACLR using the other tunnel shapes resulted in even greater joint kinematics, lower graft force and greater SED on the lateral tibial cartilage. Increasing the tunnel diameter better restored joint kinematics, graft force and articular SED, bringing these values closer to those from the intact knee. In conclusion, increasing the tunnel diameter may be more effective than changing the tunnel shape for restoring joint functionality after ACLR.
改变前交叉韧带重建（ACLR）中骨隧道形状的临床意义存在争议，很少有研究报道骨关节炎的长期患病率。因此，本研究旨在评估隧道形状对关节生物力学的影响。构建了具有不同形状（圆形、椭圆形、圆角矩形、矩形和葫芦形）和直径（7.5、8.5和9.5毫米）的骨隧道的ACLR有限元模型。在20°的关节屈曲角度下施加103 N的胫骨前负荷、7.5 Nm的胫骨内力矩和6.9 Nm的胫骨外翻力矩的联合负荷。比较了不同组之间的关节运动学和关节软骨上的应变能密度（SED）。结果表明，传统的ACLR（圆形隧道）导致关节运动学相对于完整关节增加，韧带力降低，胫骨外侧软骨上的SED更高。使用其他隧道形状的ACLR导致更大的关节运动学、更低的移植物力和胫骨外侧软骨上更大的SED。增加隧道直径能更好地恢复关节运动学、移植物力和关节SED，使这些值更接近完整膝关节的值。总之，在ACLR后恢复关节功能方面，增加隧道直径可能比改变隧道形状更有效。
