He Jinshen, Kanto Ryo, Fayed Aly M, Price Taylor M, DiNenna Michael A, Linde Monica A, Smolinski Patrick, van Eck Carola F
Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Department of Orthopaedic Surgery, Third Xiangya Hospital of Central South University, Changsha, Hunan, China.
Orthop J Sports Med. 2023 Apr 27;11(4):23259671221146013. doi: 10.1177/23259671221146013. eCollection 2023 Apr.
Anterior cruciate ligament (ACL) repair is an alternative to reconstruction; however, suture tape support may be necessary to achieve adequate outcomes.
To investigate the influence of suture tape augmentation (STA) of proximal ACL repair on knee kinematics and to evaluate the effect of the 2 flexion angles of suture tape fixation.
Controlled laboratory study.
Fourteen cadaveric knees were tested using a 6 degrees of freedom robotic testing system under anterior tibial (AT) load, simulated pivot-shift (PS) load, and internal rotation (IR) and external rotation loads. Kinematics and in situ tissue forces were evaluated. Knee states tested were (1) ACL intact, (2) ACL cut, (3) ACL repair with suture only, (4) ACL repair with STA fixed at 0° of knee flexion, and (5) ACL repair with STA fixed at 20° of knee flexion.
ACL repair alone did not restore the intact ACL AT translation at 0°, 15°, 30°, or 60° of flexion. Adding suture tape to the repair significantly decreased AT translation at 0°, 15°, and 30° of knee flexion but not to the level of the intact ACL. With PS and IR loadings, only ACL repair with STA fixed at 20° of flexion was not significantly different from the intact state at all knee flexion angles. ACL suture repair had significantly lower in situ forces than the intact ACL with AT, PS, and IR loadings. With AT, PS, and IR loadings, adding suture tape significantly increased the in situ force in the repaired ACL at all knee flexion angles to become closer to that of the intact ACL state.
For complete proximal ACL tears, suture repair alone did not restore normal knee laxity or normal ACL in situ force. However, adding suture tape to augment the repair resulted in knee laxity closer to that of the intact ACL. STA with fixation at 20° of knee flexion was superior to fixation with the knee in full extension.
The study findings suggest that ACL repair with STA fixed at 20° could be considered in the treatment of femoral sided ACL tears in the appropriate patient population.
前交叉韧带（ACL）修复是重建的一种替代方法；然而，可能需要缝线带支撑才能取得理想的效果。
研究近端ACL修复的缝线带增强（STA）对膝关节运动学的影响，并评估缝线带固定的两个屈曲角度的效果。
对照实验室研究。
使用六自由度机器人测试系统对14个尸体膝关节在前胫骨（AT）负荷、模拟轴移（PS）负荷以及内旋（IR）和外旋负荷下进行测试。评估运动学和原位组织力。测试的膝关节状态包括：（1）ACL完整；（2）ACL切断；（3）仅用缝线进行ACL修复；（4）在膝关节屈曲0°时用STA进行ACL修复；（5）在膝关节屈曲20°时用STA进行ACL修复。
单纯ACL修复在屈曲0°、15°、30°或60°时未恢复完整ACL的前向平移。在修复中添加缝线带在膝关节屈曲0°、15°和30°时显著减少了前向平移，但未达到完整ACL的水平。在PS和IR负荷下，仅在膝关节屈曲20°时用STA进行的ACL修复在所有膝关节屈曲角度下与完整状态无显著差异。ACL缝线修复在AT、PS和IR负荷下的原位力明显低于完整ACL。在AT、PS和IR负荷下，添加缝线带在所有膝关节屈曲角度下显著增加了修复的ACL中的原位力，使其更接近完整ACL状态。
对于完全性近端ACL撕裂，单纯缝线修复不能恢复正常的膝关节松弛度或正常的ACL原位力。然而，添加缝线带增强修复可使膝关节松弛度更接近完整ACL。膝关节屈曲20°时的STA固定优于膝关节完全伸直时的固定。
研究结果表明，对于合适的患者群体，在治疗股骨侧ACL撕裂时可考虑采用膝关节屈曲20°时用STA进行ACL修复。
