Scherer M A, Früh H J, Ascherl R, Siebels W
Institut für Experimentelle Chirurgie der Technischen Universität München.
Aktuelle Traumatol. 1993 May;23(3):129-32.
The reconstruction of the anterior cruciate ligament deficient knee with the patellar tendon is the "gold standard". Dislocation of the patella, rupture of the patellar tendon and fracture of the patella were reported to occur. In this biomechanical investigation on the changes of the patellar tendon following harvesting of a graft, 51 sheep knee underwent destructive testing at t0 (n = 11), 4 weeks p.op. (n = 5), 3 months p.op. (n = 14), 6 months p.op. (n = 15), and 12 months p.op. (n = 6). Harvesting of a graft produces a stiffness and strength of the patellar tendon of 50-70% of normal. There was no significant change of free patellar tendon length up to 12 months p.op. The cross-sectional area is definitely increased (p < 0.05). The tensile stress is always above normal, nevertheless the strength shows a massive decline until 6 months p.op. and does not regain normal strength by one year p.op. Stiffness shows comparable biomechanical pattern like tensile stress. There are time-dependent changes, the structural weakness is compensated by an increase of cross-sectional area. There is no restitution of the patellar tendon ad integrum, the remainder is a defect with scar tissue and alterated biomechanical properties. Revision surgery using the same host patellar tendon cannot be recommended.
采用髌腱重建前交叉韧带损伤的膝关节是“金标准”。据报道，会发生髌骨脱位、髌腱断裂和髌骨骨折。在这项关于取腱后髌腱变化的生物力学研究中，51只羊的膝关节在术后即刻（t0，n = 11）、术后4周（n = 5）、术后3个月（n = 14）、术后6个月（n = 15）和术后12个月（n = 6）接受了破坏性测试。取腱会使髌腱的刚度和强度降至正常的50 - 70%。直至术后12个月，游离髌腱长度无显著变化。横截面积明显增加（p < 0.05）。拉伸应力始终高于正常水平，然而强度在术后6个月前大幅下降，术后1年仍未恢复至正常强度。刚度呈现出与拉伸应力类似的生物力学模式。存在时间依赖性变化，结构弱点通过横截面积的增加得到补偿。髌腱无法完全恢复原状，剩余部分是带有瘢痕组织且生物力学特性改变的缺损。不建议使用同一供体髌腱进行翻修手术。
