双束前交叉韧带重建联合外侧关节外腱固定术在慢性复杂前交叉韧带损伤膝关节模型中有效恢复膝关节稳定性：一项尸体生物力学研究。
Double-Bundle Anterior Cruciate Ligament Reconstruction With Lateral Extra-Articular Tenodesis Is Effective in Restoring Knee Stability in a Chronic, Complex Anterior Cruciate Ligament-Injured Knee Model: A Cadaveric Biomechanical Study.
机构信息
Department of Orthopaedic Surgery, Kangbuk Samsung Hospital, School of Medicine, Sungkyunkwan University, Seoul, Republic of Korea.
Department of Orthopaedic Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
出版信息
Arthroscopy. 2021 Jul;37(7):2220-2234. doi: 10.1016/j.arthro.2021.02.041. Epub 2021 Mar 9.
PURPOSE
To compare knee stability after intra-articular isolated double-bundle (DB) anterior cruciate ligament reconstruction (ACLR) and single-bundle (SB) and DB ACLR combined with lateral extra-articular tenodesis (LET) in a chronic, complex anterior cruciate ligament (ACL)-injured knee model.
METHODS
In 10 fresh-frozen cadaveric knees, we measured knee laxity in the following order: (1) intact knee; (2) ACL-sectioned knee; (3) complex ACL-injured knee model with additional sectioning of the anterolateral complex and the posterior horns of the medial and lateral menisci; (4) SB ACLR plus LET; (5) DB ACLR; and (6) DB ACLR plus LET.
RESULTS
In comparison with the intact knee, significantly increased internal rotation (IR) laxity persisted at 60° and 90° after DB ACLR (P = .002 and P = .003, respectively). SB ACLR plus LET and DB ACLR plus LET resulted in significant reductions in IR laxity at 90° (P = .003 and P = .037, respectively), representing overconstraint in IR. SB ACLR plus LET resulted in persistently increased external rotation (ER) laxity at 30°, 60°, and 90° (P = .001, P < .001, and P < .001, respectively). The DB ACLR condition persistently showed significant increases in anterior tibial translation laxity at 60° and 90° (P = .037 and P = .024, respectively). A greater increase in ER laxity was seen after SB ACLR plus LET versus DB ACLR plus LET at 30°, 60°, and 90° (P < .001, P < .001, and P < .001, respectively).
CONCLUSIONS
DB ACLR plus LET restored intact knee stability in IR, ER, and anterior tibial translation laxity at 0°, 30°, 60°, and 90° of knee flexion except for overconstraint in IR at 90° in a chronic, complex ACL-injured knee model.
CLINICAL RELEVANCE
This cadaveric study provides some biomechanical evidence to support performing DB ACLR combined with LET to restore knee stability after a complex, chronic knee injury involving an ACL tear combined with anterolateral complex injury and irreparable tears of the posterior horns of the medial and lateral menisci.
目的
比较关节内单纯双束（DB）前交叉韧带重建（ACLR）和单束（SB）以及 DB ACLR 联合外侧关节外 Tenodesis（LET）在慢性复杂前交叉韧带（ACL）损伤膝关节模型中的膝关节稳定性。
方法
在 10 个新鲜冷冻的尸体膝关节中，我们按以下顺序测量膝关节松弛度：（1）完整膝关节；（2）ACL 切断膝关节；（3）ACL 损伤模型合并前外侧复合体和内侧和外侧半月板后角的附加部分切断；（4）SB ACLR 加 LET；（5）DB ACLR；和（6）DB ACLR 加 LET。
结果
与完整膝关节相比，DB ACLR 后 60°和 90°时内旋（IR）松弛度显著增加（P=0.002 和 P=0.003）。SB ACLR 加 LET 和 DB ACLR 加 LET 导致 90°时 IR 松弛度显著降低（P=0.003 和 P=0.037），代表 IR 过度约束。SB ACLR 加 LET 导致 30°、60°和 90°时外旋（ER）松弛度持续增加（P=0.001、P<0.001 和 P<0.001）。DB ACLR 状态在 60°和 90°时始终显示出明显增加的前胫骨平移松弛度（P=0.037 和 P=0.024）。SB ACLR 加 LET 后 ER 松弛度的增加明显大于 DB ACLR 加 LET，分别为 30°、60°和 90°（P<0.001、P<0.001 和 P<0.001）。
结论
在慢性复杂 ACL 损伤膝关节模型中，DB ACLR 加 LET 恢复了 IR、ER 和前胫骨平移松弛度的完整膝关节稳定性，除了 90°时的 IR 过度约束外，膝关节在 0°、30°、60°和 90°的膝关节屈曲角度。
临床相关性
这项尸体研究提供了一些生物力学证据，支持在复杂慢性膝关节损伤（包括 ACL 撕裂合并前外侧复合体损伤和内侧和外侧半月板后角不可修复撕裂）后进行 DB ACLR 联合 LET 以恢复膝关节稳定性。
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