Weiler A, Hoffmann R F, Stähelin A C, Bail H J, Siepe C J, Südkamp N P
Virchow Klinikum, Humboldt-University of Berlin, Germany.
Arthroscopy. 1998 Jan-Feb;14(1):29-37. doi: 10.1016/s0749-8063(98)70117-3.
It has recently been shown that graft fixation close to the ACL insertion site is optimal in order to increase anterior knee stability. Hamstring tendon fixation using interference screws offers this possibility and a round threaded titanium interference screw has been previously developed. The use of a round threaded biodegradable interference screw may be equivalent. In addition, to increase initial fixation strength, graft harvest with a distally attached bone plug may be advantageous, but biomechanical data do not exist. This study compares the initial pullout force, stiffness of fixation, and failure modes of three strand semitendinosus grafts in 36 proximal calf tibiae using either biodegradable poly-(D,L-lactide) (Sysorb; Sulzer Orthopaedics Ltd, Münsingen, Switzerland) or round threaded titanium (RCI; Smith & Nephew DonJoy, Carlsbad, CA) interference screws, harvested either without (biodegradable: group I, titanium III) or with (biodegradable: group II, titanium: group IV) attached tibial bone plugs. Maximum pullout force in group I (507 +/- 93 N) was significantly higher than in group III (419 +/- 77 N). Pullout force of bone plug fixation was significantly higher than that of direct tendon fixation (717 +/- 90 N in group II and 602 +/- 117 N in group IV). Pullout force of biodegradable fixation was significantly higher in both settings. These results indicate that initial pullout force of hamstring-tendon graft interference screw fixation can be increased by using a biodegradable interference screw. In addition, initial pullout force of hamstring-tendon graft fixation with an interference screw can be greatly increased by harvesting the graft with its distally attached tibial bone plug.
最近研究表明，为增加膝关节前向稳定性，在靠近前交叉韧带（ACL）附着点处进行移植物固定是最佳选择。使用挤压螺钉固定腘绳肌腱可实现这一点，此前已研发出一种圆形螺纹钛制挤压螺钉。使用圆形螺纹可生物降解挤压螺钉可能具有同等效果。此外，为提高初始固定强度，采用带有远端附着骨块的移植物采集方式可能具有优势，但尚无生物力学数据支持。本研究比较了使用可生物降解的聚（D，L-丙交酯）（Sysorb；瑞士穆辛根苏尔寿骨科有限公司）或圆形螺纹钛制（RCI；美国加利福尼亚州卡尔斯巴德的施乐辉旗下唐乔公司）挤压螺钉，在36个近端小腿胫骨上对三股半腱肌移植物进行固定时的初始拔出力、固定刚度及失效模式。移植物采集时，一组（可生物降解材料：I组）和三组（钛制材料：III组）不带附着胫骨骨块，二组（可生物降解材料）和四组（钛制材料）带附着胫骨骨块。I组的最大拔出力（507±93 N）显著高于III组（419±77 N）。骨块固定的拔出力显著高于直接肌腱固定（II组为717±90 N，IV组为602±117 N）。在两种情况下，可生物降解材料固定的拔出力均显著更高。这些结果表明，使用可生物降解挤压螺钉可提高腘绳肌腱移植物挤压螺钉固定的初始拔出力。此外，采用带有远端附着胫骨骨块的移植物采集方式，可极大提高腘绳肌腱移植物挤压螺钉固定的初始拔出力。
