Muneta T, Yamamoto H, Takakuda K, Sakai H, Furuya K
Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Japan.
Am J Sports Med. 1993 Mar-Apr;21(2):305-13. doi: 10.1177/036354659302100223.
To investigate the effects of postoperative immobilization and limited motion on reconstructed anterior cruciate ligaments, 28 rabbits received an anterior cruciate ligament reconstruction using autogenous Achilles tendon and were then divided into three groups: fully immobilized, 4 weeks immobilized, and limited motion. Two rabbits from each group were evaluated macroscopically, histologically and microangiographically at 4-week intervals until 12 weeks postoperatively. An additional six rabbits in the 4 weeks immobilized and limited motion groups were studied biomechanically at 12 weeks postoperatively. Macroscopically, both immobilized groups showed more proliferation of the infrapatellar fat pad, which was adherent to the reconstructed anterior cruciate ligament. Histology revealed more rapid regeneration of reconstructed anterior cruciate ligaments in the limited motion group, with no findings of necrosis in the mid-substance. Microangiography indicated faster normalization of vascularity in the limited motion group. The biomechanical study showed no significant difference in laxity between the 4 weeks immobilized and limited motion groups. The graft stiffness and maximum load to failure were greater for the limited motion group, although the increase was not statistically significant. The histologic and microangiographic results from the limited number of animals in this study support limited postoperative motion in the anterior cruciate ligament reconstructed knee. However, there were no differences in terms of the biomechanical parameters at 12 weeks postoperatively between the immobilized and limited motion treatment modes.
为研究术后固定和有限活动对重建前交叉韧带的影响，28只兔接受了自体跟腱重建前交叉韧带手术，随后被分为三组：完全固定组、固定4周组和有限活动组。每组取2只兔，在术后4周的间隔时间内进行大体观察、组织学检查和微血管造影检查，直至术后12周。另外，在术后12周对固定4周组和有限活动组的6只兔进行生物力学研究。大体观察发现，两个固定组的髌下脂肪垫增生更明显，且与重建的前交叉韧带粘连。组织学检查显示，有限活动组重建的前交叉韧带再生更快，韧带中部未见坏死。微血管造影显示，有限活动组血管恢复正常的速度更快。生物力学研究表明，固定4周组和有限活动组之间的松弛度无显著差异。有限活动组的移植物刚度和最大破坏负荷更大，尽管增加幅度无统计学意义。本研究中有限数量动物的组织学和微血管造影结果支持前交叉韧带重建膝关节术后进行有限活动。然而，术后12周时，固定和有限活动治疗方式在生物力学参数方面无差异。
