UNASSIGNED:对于前交叉韧带(ACL)和后交叉韧带(PCL)的联合重建,对于应首先张紧和固定哪种移植物,尚无共识。
UNASSIGNED:这项研究的目的是确定哪种顺序的移植物张紧和固定更好地恢复正常的膝关节运动学。假设是ACL-first固定术可以更紧密地恢复正常的膝关节运动学,移植力,与PCL首次固定相比,在中性(静息)位置的胫骨方向。
未经评估:对照实验室研究。
UNASSIGNED:在以下4种条件下,使用机器人测试系统检查了总共15个不成对的人类尸体膝盖:(1)不同膝盖角度下的89.0-N胫骨前负荷;(2)不同膝盖角度下的89.0-N胫骨后负荷;(3)在0°时的组合旋转7.0-N·m外翻和5.0-N·m内旋转载荷(模拟15°,屈曲30°;(4)0°外旋载荷5.0-N·m,15°,和30°的屈曲。4种评估的膝关节状态是(1)完整的ACL和PCL(完整),(2)ACL和PCL缺陷(缺陷),(3)结合解剖ACL-PCL重建固定ACL优先(ACL优先),和(4)组合的解剖ACL-PCL重建首先固定PCL(PCL优先)。使用9.0毫米直径的股四头肌腱自体移植物进行ACL移植物,在30°屈曲时用40.0N张紧。直径9.5毫米的绳肌肌腱自体移植物(gra肌和半腱肌,四倍环,并在需要时增加额外的同种异体移植链),在90°弯曲时用40.0N张紧,用于PCL移植物。
UNASSIGNED:在膝关节运动学方面,ACL-first和PCL-first固定之间没有统计学上的显着差异。ACL-first固定术在所有测试的膝关节角度下恢复了胫骨前平移至完整状态,而PCL-first固定在90°屈曲时显示胫骨前平移高于完整状态(9.05±3.05和5.87±2.40mm,分别为;P=.018)。两种序列均未将胫骨后平移恢复到30°时的完整状态,60°,和90°的屈曲。在15°屈曲时,PCL-first固定恢复了胫骨后平移至完整状态,而ACL-first固定没有。
UNASSIGNED:ACL-first和PCL-first固定的膝关节松弛度没有差异,ACL移植物固定在30°,PCL移植物固定在90°。
UNASSIGNED:这项研究表明,没有证据支持在单阶段多韧带膝关节重建中使用一种张紧序列。
UNASSIGNED: For combined reconstruction of both the anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL), there is no consensus regarding which graft should be tensioned and fixed first.
UNASSIGNED: The purpose of this study was to determine which sequence of graft tensioning and fixation better restores normal knee kinematics. The hypothesis was that ACL-first fixation would more closely restore normal knee kinematics, graft force, and the tibiofemoral orientation in the neutral (resting) position compared with PCL-first fixation.
UNASSIGNED: Controlled laboratory study.
UNASSIGNED: A total of 15 unpaired human cadaveric knees were examined using a robotic testing system under the following 4 conditions: (1) 89.0-N anterior tibial load at different knee angles; (2) 89.0-N posterior tibial load at different knee angles; (3) combined rotational 7.0-N·m valgus and 5.0-N·m internal rotation load (simulated pivot shift) at 0°, 15°, and 30° of flexion; and (4) 5.0-N·m external rotation load at 0°, 15°, and 30° of flexion. The 4 evaluated knee states were (1) intact ACL and PCL (intact), (2) ACL and PCL deficient (deficient), (3) combined anatomic ACL-PCL reconstruction fixing the ACL first (ACL-first), and (4) combined anatomic ACL-PCL reconstruction fixing the PCL first (PCL-first). A 9.0 mm-diameter quadriceps tendon autograft was used for the ACL graft, tensioned with 40.0 N at 30° of flexion. A 9.5 mm-diameter hamstring tendon autograft (gracilis and semitendinosus, quadrupled loop, and augmented with an additional allograft strand if needed), tensioned with 40.0 N at 90° of flexion, was used for the PCL graft.
UNASSIGNED: There were no statistically significant differences between ACL-first and PCL-first fixation regarding knee kinematics. ACL-first fixation restored anterior tibial translation to the intact state at all tested knee angles, while PCL-first fixation showed higher anterior tibial translation than the intact state at 90° of flexion (9.05 ± 3.05 and 5.87 ± 2.40 mm, respectively; P = .018). Neither sequence restored posterior tibial translation to the intact state at 30°, 60°, and 90° of flexion. At 15° of flexion, PCL-first fixation restored posterior tibial translation to the intact state, whereas ACL-first fixation did not.
UNASSIGNED: There were no differences in knee laxity between ACL-first and PCL-first fixation with the ACL graft fixed at 30° and the PCL graft fixed at 90°.
UNASSIGNED: This study showed that there was no evidence to support the use of one tensioning sequence over the other in single-stage multiligament knee reconstruction.