Wang Huizhi, Yao Gai, He Kaixin, Wang Zimin, Cheng Cheng-Kung
School of Biomedical Engineering and Engineering Research Center for Digital Medicine of the Ministry of Education, Shanghai Jiao Tong University, Shanghai, China.
Center for Intelligent Medical Equipment and Devices (iMED), University of Science and Technology of China, Suzhou, Jiangsu, China.
Front Bioeng Biotechnol. 2024 Aug 6;12:1437684. doi: 10.3389/fbioe.2024.1437684. eCollection 2024.
The biomechanical indication for combining anterolateral structures reconstruction (ASLR) with ACL reconstruction (ACLR) to reduce pivot shift in the knee remains unclear. This study aims to investigate knee functionality after ACL rupture with different combinations of injuries, and to compare the effectiveness of ALSR with ACLR for treating these injuries. A validated finite element model of a human cadaveric knee was used to simulate pivot shift tests on the joint in different states, including 1) an intact knee; 2) after isolated ACL rupture; 3) after ACL rupture combined with different knee injuries or defect, including a posterior tibial slope (PTS) of 20°, an injury to the anterolateral structures (ALS) and an injury to the posterior meniscotibial ligament of the lateral meniscus (LP); 4) after treating the different injuries using isolated ACLR; v. after treating the different injuries using ACLR with ALSR. The knee kinematics, maximum von Mises stress (Max.S) on the tibial articular cartilage (TC) and force in the ACL graft were compared among the different simulation groups. Comparing with isolated ACL rupture, combined injury to the ALS caused the largest knee laxity, when a combined PTS of 20° induced the largest Max.S on the TC. The joint stability and Max.S on the TC in the knee with an isolated ACL rupture or a combined rupture of ACL and LP were restored to the intact level after being treated with isolated ACLR. The knee biomechanics after a combined rupture of ACL and ALS were restored to the intact level only when being treated with a combination of ACLR and ALSR using a large graft diameter (6 mm) for ALSR. However, for the knee after ACL rupture combined with a PTS of 20°, the ATT and Max.S on the TC were still greater than the intact knee even after being treated with a combination of ACLR and ALSR. The finite element analysis showed that ACLR should include ALSR when treating ACL ruptures accompanied by ALS rupture. However, pivot shift in knees with a PTS of 20° was not eliminated even after a combined ACLR and ALSR.
将前外侧结构重建（ASLR）与前交叉韧带重建（ACLR）相结合以减少膝关节旋转不稳定的生物力学指征仍不明确。本研究旨在调查不同损伤组合的前交叉韧带断裂后的膝关节功能，并比较ASLR与ACLR治疗这些损伤的有效性。使用经过验证的人体尸体膝关节有限元模型来模拟关节在不同状态下的旋转不稳定测试，包括：1）完整膝关节；2）单纯前交叉韧带断裂后；3）前交叉韧带断裂合并不同膝关节损伤或缺陷后，包括20°的胫骨后倾（PTS）、前外侧结构（ALS）损伤和外侧半月板后半月板胫韧带（LP）损伤；4）使用单纯ACLR治疗不同损伤后；5）使用ACLR联合ASLR治疗不同损伤后。比较不同模拟组之间的膝关节运动学、胫骨关节软骨（TC）上的最大冯·米塞斯应力（Max.S）以及前交叉韧带移植物中的力。与单纯前交叉韧带断裂相比，ALS合并损伤导致膝关节松弛度最大，而20°的PTS合并损伤导致TC上的Max.S最大。单纯ACLR治疗后，单纯前交叉韧带断裂或前交叉韧带与LP联合断裂的膝关节的关节稳定性和TC上的Max.S恢复到完整水平。只有在使用大直径（6mm）移植物进行ASLR的ACLR联合治疗时，ACLR与ALS联合断裂后的膝关节生物力学才恢复到完整水平。然而，对于前交叉韧带断裂合并20°PTS的膝关节，即使使用ACLR联合ASLR治疗后，TC上的ATT和Max.S仍大于完整膝关节。有限元分析表明，治疗伴有ALS断裂的前交叉韧带断裂时，ACLR应包括ASLR。然而，即使进行ACLR联合ASLR治疗，20°PTS膝关节的旋转不稳定仍未消除。
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