Eastern Virginia Medical School, School of Medicine, Norfolk, Virginia.
Jordan Young Institute, Orthopaedic Surgery, Sports Medicine, Virginia Beach, Virginia.
J Knee Surg. 2024 May;37(6):444-451. doi: 10.1055/s-0043-1775983. Epub 2023 Oct 17.
To determine femoral construct fixation strength as bone plug length decreases in anterior cruciate ligament reconstruction (ACLR).
Sixty fresh-frozen bone-patellar tendon-bone allografts were utilized and divided into 20-, 15-, and 10-mm length bone plug groups, subdivided further so that half utilized the patella side (P) for testing and half used the tibial side (T). Ten mm diameter recipient tunnels were created within the anatomic anterior cruciate ligament footprint of 60 cadaveric femurs. All bone plugs were 10 mm in diameter; grafts were fixed using a 7 × 23 mm metal interference screw. An Instron was used to determine the load to failure of each group. A one-way multivariate analysis of variance (MANOVA) was conducted to test the hypothesis that there would be one or more mean differences in fixation stability between 20- or 15-mm plug lengths (P or T) versus 10 mm T plug lengths when cross-compared, with no association between other P or T subgroups.
The mean load to failure of the 20 mm plugs (20 P + T) was 457 ± 66N, 15 mm plugs (15 P + T) was 437 ± 74N, and 10 mm plugs (10 P + T) was 407 ± 107N. There was no significant difference between P + T groups: 20-versus 15-mm ( = 1.000), 15-versus 10-mm ( = 0.798), and 20-versus 10-mm ( = 0.200); P + T MANOVA ( = 0.291). Within groups, there was no significant difference between patella and tibial bone plug subgroups with a pullout force range between 469 ± 56N and 374 ± 116N and -value ranging from = 1.000 for longer bone plugs to = 0.194 for shorter bone plugs; P versus T MANOVA ( = 0.113).
In this human time zero cadaver model, there was no significant difference in construct failure between 20-,15-, and 10-mm bone plugs when fixed with an interference screw within the femoral tunnel, although fixation strength did trend down when from 20- to 15- to 10-mm bone plugs.
There is a balance between optimal bone plug length on the femoral side for achieving adequate fixation as well as minimizing donor site morbidity and facilitating graft passage in ACLR. This study reveals utilizing shorter plugs with interference screw fixation is potentially acceptable on the femoral side if shorter plugs are harvested.
确定在前交叉韧带重建 (ACLR) 中随着骨栓长度的减少，股骨结构固定的强度。
使用 60 个新鲜冷冻的髌腱骨同种异体移植物，分为 20、15 和 10mm 长度的骨栓组，进一步分为一半使用髌骨侧 (P) 进行测试，另一半使用胫骨侧 (T)。在 60 个尸体股骨的解剖前交叉韧带足迹内创建 10mm 直径的受体隧道。所有骨栓的直径均为 10mm；使用 7×23mm 金属干扰螺钉固定移植物。使用 Instron 确定每组的失效负荷。进行了单向多元方差分析 (MANOVA)，以检验以下假设：当相互比较时，20 或 15mm 插塞长度（P 或 T）与 10mm T 插塞长度之间的固定稳定性存在一个或多个平均值差异，而其他 P 或 T 亚组之间没有关联。
20mm 插塞（20P+T）的平均失效负荷为 457±66N，15mm 插塞（15P+T）为 437±74N，10mm 插塞（10P+T）为 407±107N。P+T 组之间无显著差异：20 与 15mm（ = 1.000），15 与 10mm（ = 0.798），20 与 10mm（ = 0.200）；P+T MANOVA（ = 0.291）。在组内，髌骨和胫骨骨栓亚组之间没有显著差异，拔出力范围在 469±56N 和 374±116N 之间，-值范围从较长骨栓的 = 1.000 到较短骨栓的 = 0.194；P 与 T MANOVA（ = 0.113）。
在这个零时间的人体尸体模型中，当使用股骨隧道内的干扰螺钉固定时，20、15 和 10mm 骨栓之间的结构失效没有显著差异，尽管从 20mm 到 15mm 再到 10mm 骨栓，固定强度确实呈下降趋势。
在前交叉韧带重建中，股骨侧获得足够固定的最佳骨栓长度与最小化供体部位发病率以及促进移植物通过之间存在平衡。本研究表明，如果采集较短的骨栓，使用干扰螺钉固定较短的骨栓在股骨侧可能是可以接受的。
