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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >NOVEL TECHNIQUE FOR REPAIRING PARTIAL ACL TEARS: BIOMECHANICAL ANALYSIS OF AN OSTEOTOMY USING A CADAVERIC MODEL
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NOVEL TECHNIQUE FOR REPAIRING PARTIAL ACL TEARS: BIOMECHANICAL ANALYSIS OF AN OSTEOTOMY USING A CADAVERIC MODEL

机译：修复部分ACL撕裂的新技术：使用CADAVERIC模型的骨塑体的生物力学分析

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Introduction: Partial ACL tears can result in knee instability despite continuity of native ACL tissue with its femoral and tibial attachments. Though current treatment consists of replacement of the residual ACL, we propose that retensioning the residual ACL can restore knee stability. Thus, our aim was to assess if a coring osteotomy restores joint stability after a partial ACL tear in a cadaveric model. Methods: Adult cadaveric knees were used. Baseline translational and rotational measurements were obtained for each knee at 30° and 90° of knee flexion with a MTS Bionix 858 machine with the ACL intact, as well as after each subsequent intervention. First, we sectioned the anteromedial ACL bundle to replicate a partial ACL injury. Subsequently, an oblique coring osteotomy was performed. The osteotomy was both rotated to centralize and then distalized to retension the posterolateral ACL bundle. Finally, an ACL deficient knee was created as a control, involving complete sectioning of the ACL. Results: Each of the eight knees demonstrated varying degrees of baseline translational (range 3.9-15.8 mm at 90° and 6.2-15.6 mm at 30°) and rotational laxity. Sectioning of the anteromedial ACL bundle resulted in a significantly increased anterior translation in all of the knees at both 90° (p=0.041) and 30° (p=0.0088), without a statistically significant change in rotation (p=0.45). The coring osteotomy improved knee translation compared to the partial ACL injury state in all of the knees at 90° (p=0.0022) and 30° (p&0.001), again without a change in rotation (p=0.053). Five of the 8 osteotomized knees had less translation than the intact state, and the other 3, the values neared the intact state, had greater anterior translation than the intact state. Finally the ACL deficient knees demonstrated both increased translation compared to both the intact (p=0.0015 at 90° and p&0.001 at 30°) and partially sectioned states (p=0.036 at 90° and p=0.0094 at 30°). Conclusions: In our cadaveric model, we demonstrate that a coring osteotomy of the residual ACL fibers can be used to restore knee stability after a partial ACL tear, while preserving the native ACL. Further studies are needed to validate this procedure. Fig. 1: Displacements Across Each State at 90 Degrees Knee Flexion Fig. 2: Displacements Across Each State at 30 Degrees Knee Flexion
机译：简介：尽管自然ACL组织及其股骨和胫骨附件连续存在，但部分ACL撕裂仍可导致膝盖不稳定。尽管目前的治疗方法是更换残留的ACL，但我们建议重新张紧残留的ACL可以恢复膝盖的稳定性。因此，我们的目的是评估尸体模型中部分ACL撕裂后取芯截骨是否能恢复关节稳定性。方法：使用成人尸体膝盖。使用具有完整ACL的MTS Bionix 858机器以及在每次后续干预后，在30°和90°屈膝时，对每个膝盖进行基线平移和旋转测量。首先，我们将前内侧ACL包切开以复制部分ACL损伤。随后，进行斜心取骨截骨术。截骨术既旋转到集中，然后向远侧收紧后外侧ACL束。最终，创建了一个ACL缺陷膝盖作为对照，涉及ACL的完整切片。结果：八个膝盖中的每一个都表现出不同程度的基线平移（90°范围为3.9-15.8 mm，30°范围为6.2-15.6 mm）和旋转松弛。前内侧ACL束的切片导致90°（p = 0.041）和30°（p = 0.0088）的所有膝盖的前移明显增加，而旋转没有统计学上的显着变化（p = 0.45）。与在90°（p = 0.0022）和30°（p <0.001）的所有膝盖中的部分ACL损伤状态相比，取芯截骨术改善了膝盖的平移，同样没有旋转变化（p = 0.053）。 8个切骨的膝盖中有5个比完整状态的平移少，另外3个接近完整状态的值的前平移比完整状态大。最后，与完整的（90°时p ＝ 0.0015和30°时p ＜0.001）和部分切面状态（90°时p ＝ 0.036，而30°时p ＝ 0.0094）相比，ACL缺陷型膝关节均显示出增加的平移。结论：在我们的尸体模型中，我们证明了残余ACL纤维的取芯截骨术可用于在部分ACL撕裂后恢复膝关节稳定性，同时保留天然ACL。需要进一步研究以验证该程序。图1：膝盖屈曲90度时各状态的位移图2：膝盖屈曲30度时各状态的位移

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