Nabors E D, Richmond J C, Vannah W M, McConville O R
Department of Orthopaedics, Tufts University School of Medicine, Boston, Massachusetts, USA.
Am J Sports Med. 1995 Jul-Aug;23(4):488-92. doi: 10.1177/036354659502300420.
The purpose of this study was to determine anterior laxity and graft forces in cadaveric knees after anterior cruciate ligament reconstruction in which the graft is tensioned with the knee in full extension. We also analyzed the clinical results from a series of patients who had ligament reconstructions using this technique. We performed anterior cruciate ligament reconstructions on seven fresh cadaveric knees and then measured the anterior laxity, graft set force, and graft tension. We also did a prospective minimum 2-year followup on 57 patients who underwent anterior cruciate ligament reconstruction. The in vitro data showed average anterior laxity of 1.1 mm greater than the intact knee with an 89-N anterior force at 30 degrees of knee flexion. Average graft set force was 68 N, and graft tension in extension was 18 N. In the clinical portion of the study, knee laxity improved from 7.5 to 0.8 mm (side-to-side difference at 89 N). The patients' Lysholm and Tegner scores improved from 65 to 90 and 3.9 to 5.6, respectively. Only one patient had a postoperative contracture. The results of this study suggest that graft tensioning in full extension provides a low incidence of flexion deformity, maintaining excellent functional results and satisfactory biomechanics.
本研究的目的是确定在尸体膝关节前交叉韧带重建术中，当移植物在膝关节完全伸直状态下张紧时的前向松弛度和移植物受力情况。我们还分析了一系列采用该技术进行韧带重建的患者的临床结果。我们对七个新鲜尸体膝关节进行了前交叉韧带重建，然后测量了前向松弛度、移植物初始固定力和移植物张力。我们还对57例行前交叉韧带重建的患者进行了至少为期2年的前瞻性随访。体外数据显示，在膝关节屈曲30度时，平均前向松弛度比完整膝关节大1.1毫米，前向力为89牛。平均移植物初始固定力为68牛，伸直位时移植物张力为18牛。在该研究的临床部分，膝关节松弛度从7.5毫米改善至0.8毫米（89牛时的左右差值）。患者的Lysholm评分和Tegner评分分别从65分提高到90分以及从3.9提高到5.6。仅1例患者术后出现挛缩。本研究结果表明，在完全伸直状态下张紧移植物可使屈曲畸形发生率较低，能保持优异的功能结果和令人满意的生物力学性能。
