个体化与非个体化双束前交叉韧带重建术中束间撞击压力：一项尸体研究
Interbundle Impingement Pressure in Individualized and Nonindividualized Double-Bundle Anterior Cruciate Ligament Reconstruction: A Cadaveric Study.
作者信息
Wu Bing, Liang Daqiang, Yang Lei, Li Sheng, Qiu Zhihe, Qin Qihuang, Liang Xinzhi, Liu Haifeng, Ouyang Kan, Xiong Jianyi, Wang Daping, Lu Wei, Zhong Mingjin, Li Ying, Li Hao, Feng Wenzhe, Chen Kang, Peng Liangquan, Zhu Weiming
机构信息
Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China.
Department of Sports Medicine, 1st Affiliated Hospital, Shenzhen University, Shenzhen, China.
出版信息
Orthop J Sports Med. 2021 Feb 2;9(2):2325967120958487. doi: 10.1177/2325967120958487. eCollection 2021 Feb.
BACKGROUND
Graft impingement is one of the main concerns in double-bundle anterior cruciate ligament reconstruction (DB-ACLR). Impingement between the anteromedial (AM) and posterolateral (PL) bundles has been postulated to cause graft deterioration or rerupture, but this has not been thoroughly investigated, and the interbundle impingement pressure (IIP) has not been well researched.
PURPOSE
To determine the IIP between the AM and PL bundles in the native anterior cruciate ligament (ACL) and in DB-ACLR with individualized and nonindividualized double-tunnel placement.
STUDY DESIGN
Controlled laboratory study.
METHODS
A total of 30 fresh-frozen, nonpaired, human cadaveric knees were randomly divided into 3 groups of 10 knees: native intact ACL (NI group), DB-ACLR tunnel placement using the preserved remnant procedure (individualized reconstruction) (PR group), and DB-ACLR tunnel placement using the bony landmark procedure (nonindividualized reconstruction) (BL group). Pressure sensors were inserted between the AM and PL bundles. The knee was moved passively from full extension to full flexion, and the IIP between the 2 ACL bundles was measured every 15°. Similarly, the impingement pressure was measured between the ACL and intercondylar roof and between the ACL and posterior cruciate ligament (PCL).
RESULTS
No significant differences were found in the maximum, mean, or minimum ACL-roof and ACL-PCL impingement pressures among the 3 groups. The IIP significantly increased when the knee joint was flexed >120° in all 3 groups ( < .001). Compared with the other 2 groups, the BL group had significantly higher maximum and mean IIP throughout the range of knee movement ( < .001) and from maximum extension to 120° of flexion ( < .001). The BL group also had significantly higher minimum IIP than the other 2 groups when knee flexion was >120° ( < .001). No significant differences were seen in maximum, minimum, or mean IIP between the NI and PR groups.
CONCLUSION
The PR procedure (individualized DB-ACLR) was more consistent with the interbundle biomechanical conditions of the native ACL, whereas the BL procedure (nonindividualized DB-ACLR) had higher maximum and mean IIP. The IIP was higher than the ACL-intercondylar roof or ACL-PCL pressures, and it increased significantly when knee flexion was >120°.
CLINICAL RELEVANCE
These data suggest that surgeons can perform individualized DB-ACLR using preserved remnants for tunnel placement as impingement-free DB-ACLR.
背景
移植物撞击是双束前交叉韧带重建术（DB - ACLR）中的主要问题之一。据推测，前内侧（AM）束和后外侧（PL）束之间的撞击会导致移植物退变或再断裂，但这尚未得到充分研究，且束间撞击压力（IIP）也未得到深入研究。
目的
确定在天然前交叉韧带（ACL）以及采用个体化和非个体化双隧道置入的DB - ACLR中，AM束和PL束之间的IIP。
研究设计
对照实验室研究。
方法
总共30个新鲜冷冻、不成对的人体尸体膝关节被随机分为3组，每组10个膝关节：天然完整ACL组（NI组）、采用保留残端技术进行DB - ACLR隧道置入（个体化重建）的组（PR组）以及采用骨性标志技术进行DB - ACLR隧道置入（非个体化重建）的组（BL组）。压力传感器插入AM束和PL束之间。膝关节从完全伸直被动移动到完全屈曲，每15°测量一次两条ACL束之间的IIP。同样，测量ACL与髁间顶之间以及ACL与后交叉韧带（PCL）之间的撞击压力。
结果
3组之间在ACL - 髁间顶和ACL - PCL撞击压力的最大值、平均值或最小值方面未发现显著差异。在所有3组中，当膝关节屈曲>120°时，IIP显著增加（P <.001）。与其他两组相比，BL组在整个膝关节活动范围内的最大和平均IIP显著更高（P <.001），在从最大伸直位到屈曲120°时也是如此（P <.001）。当膝关节屈曲>120°时，BL组的最小IIP也显著高于其他两组（P <.001）。NI组和PR组之间在最大、最小或平均IIP方面未发现显著差异。
结论
PR技术（个体化DB - ACLR）与天然ACL的束间生物力学条件更一致，而BL技术（非个体化DB - ACLR）的最大和平均IIP更高。IIP高于ACL - 髁间顶或ACL - PCL压力，并且当膝关节屈曲>120°时显著增加。
临床意义
这些数据表明，外科医生可以使用保留的残端进行个体化DB - ACLR隧道置入，作为无撞击的DB - ACLR。
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