Kim Seong Hwan, Kang Kyu-Tae, Lee Han-Jun, Heo Deokjae, Cha Kyunghwan, Lee Sangmin, Park Yong-Beom
Department of Orthopedic Surgery, Chung-Ang University Hospital, Seoul, Korea.
Department of Mechanical Engineering, Chung-Ang University, Seoul, Korea.
Clin Orthop Surg. 2024 Dec;16(6):925-931. doi: 10.4055/cios24081. Epub 2024 Nov 15.
To compare knee laxity between the conventional round tunnel and oval tunnel techniques in primary anterior cruciate ligament (ACL) reconstruction in a porcine knee model.
Twenty porcine knees were used for evaluating laxity in terms of anterior translation and anterolateral rotation. The study determined porcine knee kinematics on the Instron instruments under simulated Lachman (89 N anterior tibial load) at 15°, 30°, and 60° of flexion and a simulated pivot shift test (89 N anterior tibial load, 10 Nm valgus, and 4 Nm internal tibial torque) at 30° of flexion. Kinematics were recorded for intact (n = 10), ACL-deficient (n = 10), and conventional round (n = 10) or oval tunnel (n = 10) techniques. All measurements were repeated twice, and the average was used for comparison.
Under the Lachman test, the conventional round tunnel and oval tunnel both showed significantly larger anterior tibial translation (ATT) at 30° and 60° compared to the intact knee ( < 0.05), but smaller ATT compared to the ACL-deficient knees ( < 0.05). However, there were no differences in ATT between the conventional round tunnel and oval tunnel techniques ( > 0.05). Under simulated pivot shift at 30° flexion, there was a significant difference between the conventional round tunnel and oval tunnel techniques (round vs. oval: 4.27 ± 0.87 mm vs. 3.52 ± 0.49 mm, = 0.028).
Both conventional round tunnel and oval tunnel techniques reduced ATT compared to ACL-deficient knees but failed to restore normal knee stability. However, the oval tunnel technique showed better rotational stability at 30° than the round tunnel technique. These findings suggest that the oval tunnel technique would be a reasonable option in anatomical single-bundle ACL reconstruction.
在猪膝关节模型中比较传统圆形隧道技术和椭圆形隧道技术在初次前交叉韧带（ACL）重建中的膝关节松弛度。
使用20个猪膝关节，从胫骨前移和前外侧旋转方面评估松弛度。该研究在Instron仪器上测定猪膝关节在模拟Lachman试验（胫骨前负荷89 N）下于15°、30°和60°屈曲时以及模拟轴移试验（胫骨前负荷89 N、外翻10 Nm和胫骨内旋扭矩4 Nm）下于30°屈曲时的运动学情况。记录完整膝关节（n = 10）、ACL缺失膝关节（n = 10）以及传统圆形隧道技术（n = 10）或椭圆形隧道技术（n = 10）的运动学数据。所有测量均重复两次，取平均值用于比较。
在Lachman试验中，与完整膝关节相比，传统圆形隧道技术和椭圆形隧道技术在30°和60°时均显示出明显更大的胫骨前移（ATT）（P < 0.05），但与ACL缺失膝关节相比，ATT更小（P < 0.05）。然而，传统圆形隧道技术和椭圆形隧道技术之间的ATT没有差异（P > 0.05）。在30°屈曲的模拟轴移试验中，传统圆形隧道技术和椭圆形隧道技术之间存在显著差异（圆形隧道与椭圆形隧道：4.27 ± 0.87 mm对3.52 ± 0.49 mm，P = 0.028）。
与ACL缺失膝关节相比，传统圆形隧道技术和椭圆形隧道技术均降低了ATT，但未能恢复正常膝关节稳定性。然而，椭圆形隧道技术在30°时显示出比圆形隧道技术更好的旋转稳定性。这些发现表明，椭圆形隧道技术在解剖单束ACL重建中可能是一个合理的选择。
