Cheng Rongshan, Wang Huizhi, Jiang Ziang, Dimitriou Dimitris, Cheng Cheng-Kung, Tsai Tsung-Yuan
School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China.
Shanghai Key Laboratory of Orthopaedic Implants & Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Front Bioeng Biotechnol. 2021 Nov 26;9:797389. doi: 10.3389/fbioe.2021.797389. eCollection 2021.
The aims of this study were to 1) investigate the effects of femoral drilling angle in coronal and sagittal planes on the stress and strain distribution around the femoral and tibial tunnel entrance and the stress distribution on the graft, following anterior cruciate ligament reconstruction (ACLR), 2) identify the optimal femoral drilling angle to reduce the risk of the tunnel enlargement and graft failure. A validated three-dimensional (3D) finite element model of a healthy right cadaveric knee was used to simulate an anatomic ACLR with the anteromedial (AM) portal technique. Combined loading of 103.0 N anterior tibial load, 7.5 Nm internal rotation moment, and 6.9 Nm valgus moment during normal human walking at joint flexion of 20° was applied to the ACLR knee models using different tunnel angles (30°/45°/60° and 45°/60° in the coronal and sagittal planes, respectively). The distribution of von Mises stress and strain around the tunnel entrances and the graft was calculated and compared among the different finite element ACLR models with varying femoral drilling angles. With an increasing coronal obliquity drilling angle (30° to 60°), the peak stress and maximum strain on the femoral and tibial tunnel decreased from 30° to 45° and increased from 45° to 60°, respectively. With an increasing sagittal obliquity drilling angle (45° to 60°), the peak stress and the maximum strain on the bone tunnels increased. The lowest peak stress and maximum strain at the ACL tunnels were observed at 45° coronal/45° sagittal drilling angle (7.5 MPa and 7,568.3 μ-strain at the femoral tunnel entrance, and 4.0 MPa and 4,128.7 μ-strain at the tibial tunnel entrance). The lowest peak stress on the ACL graft occurred at 45° coronal/45° sagittal (27.8 MPa) drilling angle. The femoral tunnel drilling angle could affect both the stress and strain distribution on the femoral tunnel, tibial tunnel, and graft. A femoral tunnel drilling angle of 45° coronal/ 45° sagittal demonstrated the lowest peak stress, maximum strain on the femoral and tibial tunnel entrance, and the lowest peak stress on the ACL graft.
1）在前交叉韧带重建（ACLR）后，研究股骨在冠状面和矢状面的钻孔角度对股骨和胫骨隧道入口周围应力和应变分布以及移植物上应力分布的影响；2）确定最佳股骨钻孔角度，以降低隧道扩大和移植物失败的风险。使用经过验证的健康右尸体膝关节三维（3D）有限元模型，采用前内侧（AM）入路技术模拟解剖学ACLR。在膝关节屈曲20°的正常人体行走过程中，对ACLR膝关节模型施加103.0 N的胫骨前向负荷、7.5 Nm的内旋力矩和6.9 Nm的外翻力矩的联合负荷，使用不同的隧道角度（冠状面和矢状面分别为30°/45°/60°和45°/60°）。计算并比较不同股骨钻孔角度的有限元ACLR模型中隧道入口和移植物周围的von Mises应力和应变分布。随着冠状面倾斜钻孔角度增加（从30°到60°），股骨和胫骨隧道上的峰值应力和最大应变分别从30°到45°降低，从45°到60°增加。随着矢状面倾斜钻孔角度增加（从45°到60°），骨隧道上的峰值应力和最大应变增加。在冠状面45°/矢状面45°钻孔角度时，观察到ACLR隧道处的峰值应力和最大应变最低（股骨隧道入口处为7.5 MPa和7568.3 μ应变，胫骨隧道入口处为4.0 MPa和4128.7 μ应变）。ACLR移植物上的最低峰值应力出现在冠状面45°/矢状面45°（27.8 MPa）钻孔角度。股骨隧道钻孔角度会影响股骨隧道、胫骨隧道和移植物上的应力和应变分布。冠状面45°/矢状面45°的股骨隧道钻孔角度显示出最低的峰值应力、股骨和胫骨隧道入口处的最大应变以及ACLR移植物上的最低峰值应力。
