Yoshiya S, Andrish J T, Manley M T, Bauer T W
Department of Musculoskeletal Research, Cleveland Clinic Foundation, Ohio 44106.
Am J Sports Med. 1987 Sep-Oct;15(5):464-70. doi: 10.1177/036354658701500506.
The purpose of this study was to examine the effect of initial tensioning on the outcome of reconstruction of the ACL. The ACLs of 15 adult mongrel dogs were excised and reconstructed. In the first five dogs, the ACLs of both knees were reconstructed using the medial one-third of the patellar tendon. The graft was fixed under a tension of 1 N (0.22 pounds) in one knee and 39 N (8.8 pounds) in the opposite knee. In the remainder of the dogs, the reconstructions were augmented with Dacron prostheses. Tensioning of both graft components in the augmented reconstructions was either with 1 N in one knee and 39 N in the contralateral knee or disproportionate tensions of 1 N and 39 N applied to the autogenous material and to the prosthesis. Sacrifice was 3 months postsurgery and results were examined with microangiography/history and mechanical testing. In the reconstructions with the patellar tendon alone, the biologic study showed poor vascularity and focal myxoid degeneration within the graft pretensioned with a load of 39 N. In the augmented reconstructions, the knees in which both graft materials were fixed with 1 N tension showed the strongest and stiffest reconstruction at 3 months. The study suggests that minimal tension should be applied to the graft materials during surgical reconstruction of the ACL.
本研究的目的是检验初始张紧对前交叉韧带重建结果的影响。切除并重建了15只成年杂种犬的前交叉韧带。在前五只犬中，双侧膝关节的前交叉韧带均采用髌腱内侧三分之一进行重建。在一侧膝关节中，移植物在1牛顿（0.22磅）的张力下固定，而在对侧膝关节中则在39牛顿（8.8磅）的张力下固定。在其余的犬中，重建采用涤纶假体进行加强。在加强重建中，两个移植物组件的张紧方式为：一侧膝关节为1牛顿，对侧膝关节为39牛顿；或者对自体材料和假体分别施加1牛顿和39牛顿的不均衡张力。术后3个月处死动物，通过微血管造影/组织学检查和力学测试来评估结果。在单纯髌腱重建中，生物学研究显示，在39牛顿负荷预张紧的移植物内，血管分布较差且有局灶性黏液样变性。在加强重建中，两个移植物材料均在1牛顿张力下固定的膝关节在3个月时显示出最强和最硬的重建效果。该研究表明，在前交叉韧带手术重建过程中，应向移植物材料施加最小的张力。
