Department of Biomedical Engineering, Kocaeli University, Umuttepe Campus, Izmit, Kocaeli, Turkey.
Int Orthop. 2023 Oct;47(10):2487-2496. doi: 10.1007/s00264-023-05881-z. Epub 2023 Jul 14.
The anterior cruciate ligament (ACL) is crucial in maintaining knee stability. Some motion mechanisms, which are common in sports, cause excessive load to be passed on the ACL. In non-contact ACL injuries, the ACL cannot sustain the high stress and becomes injured or ruptures in the valgus-external rotation mechanism (VERM) and varus-internal rotation mechanism (VIRM). The mechanical strength of the grafts used to repair the torn ligament varies. The purpose of this study is to look at the alterations in the menisci after anterior cruciate ligament repair with autografts and synthetic grafts in cases of non-contact re-injury mechanisms.
In the finite element analysis, VERM and VIRM motions of the injury were simulated with different ACL graft materials. During the simulations of these mechanism motions with polyethylene terephthalate (PET) and patellar tendon (PT), the contact pressures, contact areas, and von mises stress values created in the medial and lateral meniscus were compared.
The peak contact pressures on the menisci during the VERM are higher than the peak contact pressures during the VIRM, except for one variation. The peak contact pressure of the medial meniscus is almost the same for both graft materials and mechanisms. Furthermore, the peak contact pressures in the menisci are higher than in the VERM. For all injury mechanisms, the peak contact stresses on the lateral meniscus are higher than on the medial meniscus.
The findings suggest that VERM can induce further knee joint injury. It was found that the PET will lessen the pressure on the menisci even more. It is also advantageous since it does not damage the anterior extremities and transmits less pressure to the menisci. In conclusion, using a high-strength ACL is healthier for the menisci. Even though synthetic grafts are not clinically preferred, the study demonstrates that enhancing the material properties of synthetic grafts will increase the chance of their use in the future, based on the current results.
前交叉韧带（ACL）对维持膝关节稳定性至关重要。一些在运动中常见的运动机制会导致 ACL 承受过大的负荷。在非接触性 ACL 损伤中，ACL 无法承受高应力，在外翻外旋机制（VERM）和内翻内旋机制（VIRM）中受伤或断裂。用于修复撕裂韧带的移植物的机械强度有所不同。本研究旨在观察在非接触性再损伤机制中，使用自体移植物和合成移植物修复 ACL 后半月板的变化。
在有限元分析中，使用不同的 ACL 移植物材料模拟 VERM 和 VIRM 损伤运动。在对这些机制运动进行模拟时，比较了聚对苯二甲酸乙二醇酯（PET）和髌腱（PT）的内侧和外侧半月板的接触压力、接触面积和 von Mises 应力值。
在 VERM 中，半月板上的峰值接触压力高于 VIRM 中的峰值接触压力，但有一种变化除外。两种移植物材料和机制下内侧半月板的峰值接触压力几乎相同。此外，半月板上的峰值接触压力高于 VERM。对于所有损伤机制，外侧半月板上的峰值接触应力高于内侧半月板。
研究结果表明，VERM 会导致膝关节进一步受伤。发现 PET 甚至会进一步减轻半月板的压力。由于它不会损伤前肢，并且向半月板传递的压力较小，因此这也是有益的。总之，使用高强度 ACL 对半月板更健康。尽管合成移植物在临床上不受青睐，但根据目前的结果，研究表明，增强合成移植物的材料性能将增加它们在未来使用的机会。
