School of Medical Imaging, Xuzhou Medical University, Xuzhou, Jiangsu, China.
Department of Mechanical Engineering, University of Utah, Salt Lake, UT, USA.
J Healthc Eng. 2022 Feb 26;2022:7596995. doi: 10.1155/2022/7596995. eCollection 2022.
The purpose of this study was to investigate the effect of tibial insertion site (TIS) of the anterior cruciate ligament (ACL) in single-bundle ACL reconstruction on ligament force during gait. A musculoskeletal model with an ACL ligament was created, and gait data were collected based on the motion capture system from seven female patients with single-bundle ACL reconstruction. The TIS was simulated in OpenSim and systematically changed in 2.5 mm intervals (2.5 mm, 5.0 mm, and 7.5 mm) in the anteroposterior and mediolateral directions from the center. The changes of the ACL force overtime and peak force were compared using the Pearson correlation and paired -test separately for all simulated TISs. The results indicated that anterior movement of the TIS would significantly increase the loading of reconstructed ACL and the risk of secondary injury, but the posterior TIS would keep the ACL loose during gait. The mediolateral change of the TIS also affected the ligament force during gait, which increased in the medial direction and decreased in lateral direction, but the magnitude of the change is relatively small compared with those measured in the anteroposterior direction. Therefore, during preoperative surgery planning, defining the outline of the ACL attachment site during surgery can help to guide the decision for the TIS and can significantly affect the reconstructed ACL force during gait, especially if the TIS is moved in the anteroposterior direction.
本研究旨在探讨前交叉韧带（ACL）单束重建时胫骨止点（TIS）位置对步态中韧带力的影响。建立了包含 ACL 韧带的肌肉骨骼模型，并基于运动捕捉系统从 7 名接受单束 ACL 重建的女性患者中收集了步态数据。在 OpenSim 中模拟 TIS，并在前后和内外方向上以 2.5mm 的间隔（2.5mm、5.0mm 和 7.5mm）从中心系统地改变 TIS。使用 Pearson 相关系数和配对 t 检验分别比较了所有模拟 TIS 的 ACL 力随时间变化和峰值力的变化。结果表明，TIS 的前向运动将显著增加重建 ACL 的负荷和二次损伤的风险，但后向 TIS 在步态中会使 ACL 保持松弛。TIS 的内外变化也会影响步态中的韧带力，内侧方向增加，外侧方向减少，但与前后方向测量的变化幅度相比，变化幅度相对较小。因此，在术前手术规划中，确定 ACL 附着点的轮廓可以帮助指导 TIS 的决策，并显著影响步态中重建 ACL 的力，特别是 TIS 在前后方向上移动时。
