Clinic of Orthopaedics and Traumatology, Department of Surgery, Kantonsspital, Winterthur, Switzerland.
Numex GmbH, Winterthur, Switzerland.
Am J Sports Med. 2023 Apr;51(5):1162-1170. doi: 10.1177/03635465231159069. Epub 2023 Mar 14.
Persistent instability of the knee is reported in up to 30% of patients after anterior cruciate ligament (ACL) reconstruction. Based on anatomic findings showing that ACL is a flat ribbon-like structure that twists during knee flexion, a new surgical ACL reconstruction technique using a ribbon-like graft has been developed. However the effect of this surgical technique on knee kinematics has not yet been evaluated.
To compare the anteroposterior and rotational stability of the knee after ACL reconstruction using single-bundle (SB) round and ribbon-like grafts in anterolateral-intact/deficient knees.
Controlled laboratory study.
Twelve human fresh-frozen cadaveric knees were tested with a 6 degrees of freedom robotic system. Internal rotation and anterior translation of the knee were recorded from 0° to 90° of flexion. A full kinematic assessment was performed in each of the following conditions: (1) intact knee, (2) after sectioning of the ACL, (3) after ACL reconstruction using a SB hamstring tendon graft in a round configuration and a ribbon-like configuration, and (4) after sectioning of the anterolateral structures. One-way analysis of variance and post hoc Tukey tests were used for statistical analyses.
When compared with the intact knee, the ACL-deficient knee demonstrated a mean ± SD increase in anterior translation and internal rotation of 6.3 ± 2.5 mm ( < .01) and 5.8°± 2.3° ( < .01), respectively. After ACL reconstruction using a SB ribbon-like graft, the mean difference in anterior translation and internal rotation as compared with the intact knee was -0.1 ± 1.5 mm ( = .842) and 0.0°± 1.1° ( = .999). These differences from the intact knee were also not significant after ACL reconstruction using a round graft (-0.1 ± 1.3 mm, = .999; -0.5°± 1.5°, = .401). In the ACL-reconstructed knee using either a ribbon-like or round graft, sectioning of the anterolateral structures did not induce a significant increase of anterior translation and internal rotation of the knee.
ACL reconstruction using a SB ribbon-like or round graft restored the kinematics of the intact knee at time zero. Secondary sectioning of the anterolateral structures in the ACL-reconstructed knee using both types of graft did not significantly affect the anterior translation and internal rotation of the knee.
This is the first biomechanical study on the new ACL reconstruction technique using a ribbon-like graft.
据报道，在前交叉韧带（ACL）重建后，多达 30%的患者膝关节持续不稳定。基于解剖学发现 ACL 是一种扁平的带状结构，在膝关节弯曲时会扭曲，因此开发了一种新的 ACL 重建技术，使用带状移植物。然而，这种手术技术对膝关节运动学的影响尚未得到评估。
比较前交叉韧带重建中使用单束（SB）圆形和带状移植物在前外侧完整/缺陷膝关节中的前后和旋转稳定性。
对照实验室研究。
12 个人体冷冻尸体膝关节用 6 自由度机器人系统进行测试。从 0°到 90°的屈曲记录膝关节的内旋和前向平移。在以下每种情况下进行全面运动学评估：（1）完整膝关节，（2）ACL 切断后，（3）使用 SB 腘绳肌腱移植物以圆形构型和带状构型重建 ACL 后，以及（4）切断前外侧结构后。使用单向方差分析和事后 Tukey 检验进行统计分析。
与完整膝关节相比，ACL 缺失膝关节的前向平移和内旋分别平均增加了 6.3±2.5mm（<0.01）和 5.8°±2.3°（<0.01）。使用 SB 带状移植物重建 ACL 后，与完整膝关节相比，前向平移和内旋的平均差值为-0.1±1.5mm（=0.842）和 0.0°±1.1°（=0.999）。使用圆形移植物重建 ACL 后，这些差异与完整膝关节也无显著性差异（-0.1±1.3mm，=0.999；-0.5°±1.5°，=0.401）。在使用带状或圆形移植物重建 ACL 的膝关节中，切断前外侧结构不会导致膝关节的前向平移和内旋显著增加。
使用 SB 带状或圆形移植物重建 ACL 可恢复初始状态下完整膝关节的运动学。在使用这两种移植物重建的 ACL 膝关节中，进一步切断前外侧结构不会显著影响膝关节的前向平移和内旋。
这是第一项关于使用带状移植物的新 ACL 重建技术的生物力学研究。
