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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >Knee Kinematics Following Anatomic Single vs. Double Bundle ACL Reconstruction: A Randomized Clinical Trial
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Knee Kinematics Following Anatomic Single vs. Double Bundle ACL Reconstruction: A Randomized Clinical Trial

机译：解剖单束与双束ACL重建后的膝关节运动学：一项随机临床试验

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Objectives: A randomized clinical trial was conducted to compare knee kinematics during gait and running 24 months after ACL reconstruction, using either single-bundle (SB) or double-bundle (DB) quadriceps tendon grafts. We hypothesized that DB reconstruction would better restore kinematics than SB reconstruction, in comparison to the uninjured, contralateral knee. Methods: Subjects were between 14 and 50 years of age, participated in at least 100 hours of Level 1 or 2 sports activities and presented within 12 months of injury to both bundles of the ACL (with or without meniscal injury). Exclusion criteria included prior injury or surgery of the ipsilateral or contralateral knee or greater than a grade 1 concomitant knee ligament injury. Subjects were randomized to undergo SB or DB ACL reconstruction with a 10 mm quadriceps tendon autograft harvested with a patellar bone block. A single, anatomically placed femoral tunnel was used for all cases. For DB ACL reconstruction, the soft tissue portion of the graft was split and passed through two anatomically placed tibial tunnels. Biplane radiographic images were acquired 24 months after surgery while subjects performed downhill running on a treadmill (3.0 m/s, 10 degree slope, 150 images/s) and level gait (1.3 m/s, 100 images/s). Subject specific bone models were generated from computed tomography images and matched to the biplane radiographs using a previously validated model-based tracking process to determine tibiofemoral kinematics. Rotations of the tibia relative to the femur were calculated using the rotational component of the Joint Coordinate System originally described by Grood and Suntay. Displacements of the tibia relative to the femur were expressed in an orthogonal anatomical coordinate system fixed to the tibia. Primary outcome variables were based on previous findings of abnormalities in knee kinematics after ACL injury/reconstruction, and included peak knee external rotation, adduction and anterior translation during heelstrike to mid-stance. Three trials were collected for each limb and each task, and averaged for statistical analysis. Differences between SB and DB kinematics were determined using Wilcoxon Signed Rank tests, with significance level p < 0.05. Results: No significant differences were found in any of the primary kinematic variables between single and double bundle anatomic ACL reconstruction (Table). Differences between reconstructed and contralateral (uninjured) limbs were small, averaging less than 2 degrees in rotation and 2 mm in translation. Rotational differences were smaller during gait than during downhill running. Conclusion: Conclusions: Contrary to the study hypothesis, DB reconstruction was not found to be superior to SB reconstruction. While some abnormalities remained (particularly during the more stressful downhill running evaluation), both anatomical reconstructions were equally effective at restoring normal knee kinematics. kinematic differences between limbs (affected-contralateral) during gait and downhill running Single Bundle Single Bundle Single Bundle Double Bundle Double Bundle Double Bundle N Mean Std Dev N Mean Std Dev Wilcoxon p Running Peak Knee Adduction 25 -0.23 1.12 21 -0.21 1.16 0.71 Running Peak External Rotation 25 -1.56 4.04 21 -0.17 3.12 0.20 Running Peak Anterior Translation 25 0.57 2.62 21 2.02 2.75 0.13 Gait Peak Knee Adduction 26 -0.06 1.19 21 -0.05 1.11 0.83 Gait Peak External Rotation 26 -0.44 4.34 21 -0.11 3.55 0.77 Gait Peak Anterior Translation 26 0.83 2.97 21 2.00 2.56 0.20.
机译：目的：进行了一项随机临床试验，以比较使用单束（SB）或双束（股四头肌）股四头肌腱移植的步态和ACL重建后24个月的跑步运动学。我们假设，与未受伤的对侧膝盖相比，DB重建比SB重建更能恢复运动学。方法：受试者年龄在14至50岁之间，参加了至少100小时的1或2级体育活动，并且在两个ACL损伤（有或没有半月板损伤）的12个月内出现。排除标准包括先前受伤或同侧或对侧膝关节手术或大于1级伴随膝韧带损伤的手术。受试者随机接受10毫米股四头肌肌腱自体移植，并用bone骨阻滞进行SB或DB ACL重建。在所有情况下均使用单个解剖放置的股骨隧道。对于DB ACL重建，将移植物的软组织部分分开并通过两个解剖学放置的胫骨隧道。手术后24个月获取双翼射线照相图像，而受试者在跑步机上进行下坡跑步（3.0 m / s，10度坡度，150幅图像/秒）和步态（1.3 m / s，100幅图像/秒）。从计算机断层扫描图像生成受试者特定的骨骼模型，并使用先前验证的基于模型的跟踪过程将其与双翼X线照片相匹配，以确定胫股运动学。使用最初由Grood和Suntay描述的关节坐标系的旋转分量来计算胫骨相对于股骨的旋转。胫骨相对于股骨的位移以固定在胫骨上的正交解剖坐标系表示。主要结果变量是基于先前对ACL损伤/重建后膝运动学异常的发现，包括最大的膝关节外旋，内收和足跟前移至中位时的前移。为每个肢体和每个任务收集了三个试验，并取平均值进行统计分析。使用Wilcoxon Signed Rank检验确定SB和DB运动学之间的差异，显着性水平p <0.05。结果：单束和双束解剖ACL重建之间的任何主要运动学变量均未发现显着差异（表）。重建和对侧（未受伤）肢体之间的差异很小，平均旋转角度小于2度，平移角度小于2 mm。步态时的旋转差异小于下坡时的旋转差异。结论：结论：与研究假设相反，未发现DB重建优于SB重建。虽然仍然存在一些异常（特别是在压力更大的下坡跑步评估中），但两种解剖结构重建在恢复正常的膝部运动学方面同样有效。步态和下坡跑步过程中四肢之间的运动学差异（单向运动）单束单束单束单束双束双束双束双束N均值标准差N均值标准差Wilcoxon p跑步膝关节内收25 -0.23 1.12 21 -0.21 1.16 0.71峰值外旋25 -1.56 4.04 21 -0.17 3.12 0.20跑步峰前平移25 0.57 2.62 21 2.02 2.75 0.13步态峰值膝关节内收26 -0.06 1.19 21 -0.05 1.11 0.83步态峰值外旋26 -0.44 4.34 21 -0.11 3.55 0.77步态峰前平移26 0.83 2.97 21 2.00 2.56 0.20。

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