Min Byoung-Hyun, Song Hyung Keun, Park Ki Hoon, Kim Tae Hun, Park Do Young, Chung Jun Young
Department of Orthopedic Surgery, Ajou University School of Medicine, 164 Worldcup-ro, Yongtong-gu, Suwon, 16499 Korea.
Indian J Orthop. 2022 Jan 31;56(5):812-820. doi: 10.1007/s43465-021-00597-x. eCollection 2022 May.
Modified ACL reconstruction with over-the-top augmentation technique (OA-ACLR) was designed to allow one-stage revision regardless of tunnel conditions as well as to offer firm stability by hybrid double-fixation. Thus, the purpose of the study is to biomechanically evaluate its effect on knee stability by comparing it with single-bundle ACL reconstruction (SB-ACLR).
Ten porcine knees were sequentially tested using a custom testing system for intact ACL, ACL deficiency, SB-ACLR and OA-ACLR. First, 134-N anterior tibial load was applied, and anterior tibial translation was measured at 30°, 60°, and 90°. Then, anterior tibial translation and relative tibial rotation were measured in a combined rotatory load of 5-Nm of internal tibial torque and 10-Nm of valgus torque.
Under anterior tibial load or combined anterior and rotatory loads, SB-ACLR and OA-ACLR resulted in no significant increase in anterior tibial translation at all flexion angles compared with an intact ACL group, and no significant difference was noted in anterior tibial translation between the two ACL reconstruction groups. In combined rotatory load, OA-ACLR resulted in enhanced rotational stability compared with SB-ACLR, and it more closely restored relative tibial internal rotation to the intact ACL group.
Our study showed that modified ACL reconstruction with over-the-top augmentation technique resulted in enhanced rotational stability compared to the conventional single-bundle ACL reconstruction, especially at lower flexion angle in a porcine model. Therefore, with several potential advantages as well as biomechanical superiority, our new technique could be clinically applicable in primary and revision ACL reconstruction.
Experimental.
采用后交叉韧带附着点上方增强技术的改良前交叉韧带重建术（OA - ACLR）旨在无论隧道情况如何均可进行一期翻修，并通过混合双固定提供牢固的稳定性。因此，本研究的目的是通过与单束前交叉韧带重建术（SB - ACLR）比较，对其对膝关节稳定性的影响进行生物力学评估。
使用定制测试系统对10个猪膝关节依次进行完整前交叉韧带、前交叉韧带缺损、单束前交叉韧带重建和后交叉韧带附着点上方增强技术的改良前交叉韧带重建测试。首先，施加134 N的胫骨前移负荷，并在30°、60°和90°测量胫骨前移。然后，在5 N·m的胫骨内旋扭矩和10 N·m的外翻扭矩的联合旋转负荷下测量胫骨前移和相对胫骨旋转。
在胫骨前移负荷或联合前向和旋转负荷下，与完整前交叉韧带组相比，单束前交叉韧带重建和后交叉韧带附着点上方增强技术的改良前交叉韧带重建在所有屈曲角度下胫骨前移均无显著增加，且两个前交叉韧带重建组之间的胫骨前移无显著差异。在联合旋转负荷下，与单束前交叉韧带重建相比，后交叉韧带附着点上方增强技术的改良前交叉韧带重建的旋转稳定性增强，并且其相对胫骨内旋更接近完整前交叉韧带组。
我们的研究表明，与传统的单束前交叉韧带重建相比，采用后交叉韧带附着点上方增强技术的改良前交叉韧带重建可增强旋转稳定性，尤其是在猪模型的较低屈曲角度下。因此，鉴于其具有多种潜在优势以及生物力学优势，我们的新技术可在临床应用于初次和翻修前交叉韧带重建。
实验性研究。
