Swensen Buza Stephanie, Meyers Kathleen N, Adamec Dakota, Ode Gabriella E, Maher Suzanne A, Sutton Karen
Sports Medicine Institute, Hospital for Special Surgery, New York, New York, U.S.A.
Department of Biomechanics, Hospital for Special Surgery, New York, New York, U.S.A.
Arthrosc Sports Med Rehabil. 2023 Dec 12;6(1):100824. doi: 10.1016/j.asmr.2023.100824. eCollection 2024 Feb.
To quantify the maximum load to fracture in patellae from which bone-patellar tendon-bone (BPTB) and bone-quadriceps tendon (BQT) autografts have been harvested for anterior cruciate ligament reconstruction in a cadaveric model.
Forty-six fresh-frozen patellae were isolated and divided into the BPTB harvest and BQT harvest groups with matching based on donor age and sex. Computed tomography scans were obtained to calculate bone mineral density (BMD) and patellar height, width, and thickness. BPTB and BQT grafts were harvested from the inferior patella and superior patella, respectively, and then ramped to failure in a 3-point bend test configuration to simulate a postoperative fracture produced by a direct impact after a fall. The presence of fracture, fracture pattern, and maximum load to fracture were recorded. Donor demographic characteristics; patellar height, width, and thickness; and maximum load were compared by the Student test. Pearson correlations were used to determine whether maximum load was affected by BMD or patellar morphology. The level of significance was set at < .05.
Maximum load to fracture was not significantly different ( = .91) between the BPTB (5.0 ± 2.3 kN) and BQT (5.1 ± 2.6 kN) groups. Maximum load to fracture in the BPTB group did not correlate with BMD ( = .57) or patellar measurements ( = .57 for thickness, = .43 for width, and = .45 for height). Maximum load to fracture in the BQT group positively correlated with BMD and negatively correlated with patellar height. Maximum load to fracture in the BQT group did not correlate with patellar thickness or width. Fracture through the harvest site was observed in 87% of BPTB specimens and 78% of BQT specimens.
The location of the BPTB or BQT autograft harvest site did not significantly affect patellar load to fracture in a cadaveric model.
It is important to understand patellar morphology and the effect of BPTB and BQT graft harvest-site locations on the biomechanical strength of the patella after anterior cruciate ligament reconstruction.
在尸体模型中，量化取自髌骨用于前交叉韧带重建的骨-髌腱-骨（BPTB）和骨-股四头肌肌腱（BQT）自体移植物的髌骨骨折最大负荷。
分离46个新鲜冷冻的髌骨，根据供体年龄和性别匹配，分为BPTB取材组和BQT取材组。进行计算机断层扫描以计算骨密度（BMD）以及髌骨的高度、宽度和厚度。分别从髌骨下方和上方获取BPTB和BQT移植物，然后在三点弯曲试验配置中加载直至破坏，以模拟跌倒后直接撞击导致的术后骨折。记录骨折的发生情况、骨折类型和骨折最大负荷。通过Student检验比较供体人口统计学特征、髌骨高度、宽度和厚度以及最大负荷。使用Pearson相关性分析确定最大负荷是否受BMD或髌骨形态的影响。显著性水平设定为P <.05。
BPTB组（5.0±2.3 kN）和BQT组（5.1±2.6 kN）的骨折最大负荷无显著差异（P =.91）。BPTB组的骨折最大负荷与BMD（P =.57）或髌骨测量值（厚度P =.57、宽度P =.43、高度P =.45）均无相关性。BQT组的骨折最大负荷与BMD呈正相关，与髌骨高度呈负相关。BQT组的骨折最大负荷与髌骨厚度或宽度无相关性。87%的BPTB标本和78%的BQT标本观察到取材部位骨折。
在尸体模型中，BPTB或BQT自体移植物取材部位对髌骨骨折负荷无显著影响。
了解髌骨形态以及BPTB和BQT移植物取材部位在前交叉韧带重建后对髌骨生物力学强度的影响非常重要。
