Graf B K, Henry J, Rothenberg M, Vanderby R
University of Wisconsin, Department of Surgery, Madison.
Am J Sports Med. 1994 Jan-Feb;22(1):131-5. doi: 10.1177/036354659402200120.
Patellar tendon grafts used in the reconstruction of the anterior cruciate ligament may be subjected to thousands of knee flexion-extension cycles during the early postoperative period. The purpose of this study was to model experimentally the patellar tendon graft wear-related damage and failure at the femoral tunnel during simulated knee motion of 0 degrees to 112 degrees of flexion at 1 cycle/sec. To evaluate the effects of 2 different femoral tunnel orientations, tunnel chamfering, and 3 different graft loads on graft survival, 25 calf femurs and patellar tendons were used. All 5 specimens with a "straight-line" femoral tunnel and an applied load of 5 pounds (22.3 N) survived greater than 125,000 cycles. All 5 of the 5-pound unchamfered transverse tunnel grafts failed at an average of 19,869 cycles, but chamfering transverse tunnels resulted in the survival of 4 of 5 specimens. Decreasing the load to 2 pounds (8.9 N) for transverse unchamfered tunnels increased survival to 1 of 5, and cycles to failure to 75,132. If patellar tendon grafts used to reconstruct the anterior cruciate ligament are subjected to large numbers of flexion-extension cycles, the risk of wear-related damage and early failure may be decreased by straight-line femoral tunnel orientation, by chamfering of more transverse tunnels, or by avoiding large graft preloads.
用于重建前交叉韧带的髌腱移植物在术后早期可能要经历数千次膝关节屈伸循环。本研究的目的是在模拟膝关节从0度屈曲到112度、频率为每秒1个循环的运动过程中，通过实验模拟髌腱移植物在股骨隧道处与磨损相关的损伤和失效情况。为了评估2种不同的股骨隧道方向、隧道倒角以及3种不同的移植物负荷对移植物存活情况的影响，使用了25根小牛股骨和髌腱。所有5个具有“直线型”股骨隧道且施加5磅（22.3牛）负荷的标本存活超过125,000个循环。所有5个5磅未倒角横向隧道移植物平均在19,869个循环时失效，但对横向隧道进行倒角后，5个标本中有4个存活。对于未倒角的横向隧道，将负荷降至2磅（8.9牛）可使5个中有1个存活，失效循环数增加到75,132个。如果用于重建前交叉韧带的髌腱移植物要经历大量的屈伸循环，那么通过采用直线型股骨隧道方向、对更多横向隧道进行倒角或避免过大的移植物预负荷，与磨损相关的损伤和早期失效风险可能会降低。
