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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >Aircast Award for Basic Science - The Effect of Dynamic Changes in ACL Graft Force on Soft Tissue ACL Graft-Tunnel Incorporation
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Aircast Award for Basic Science - The Effect of Dynamic Changes in ACL Graft Force on Soft Tissue ACL Graft-Tunnel Incorporation

机译：航空广播基础科学奖-ACL移植力的动态变化对软组织ACL移植-隧道合并的影响

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Objectives: Anterior cruciate ligament grafts that are placed for reconstruction are subject to complex forces with joint motion. Current “anatomic” ACL reconstructions result in greater in situ graft forces. The biologic effect of changing magnitudes of ACL graft force on graft-tunnel osseointegration is not completely understood. The objective of the present study is to determine the effects of dynamic mechanical ACL graft tension or load on graft-tunnel incorporation. Methods: One hundred male Sprague-Dawley rats underwent unilateral ACL resection followed by reconstruction with a soft tissue autograft. The animals were allocated into one of three groups during surgery: (1) ACL reconstruction followed by limb immobilization for the entire duration of the study, (2) ACL reconstruction with a "high-tension" ACL graft and daily knee motion, or (3) ACL reconstruction with an "isometric" low-tension ACL graft and daily knee motion. ACL graft isometry was assessed intraoperatively. External fixators were used to eliminate graft load during cage activity. Daily knee motion was then started on post-operative day 3 for all animals that were allocated to a knee motion group using a custom computerized knee flexion device. Graft-tunnel healing was assessed at 3 and 6 weeks via biomechanical, micro-CT, and histologic analyses. Biomechanical and micro-CT data was analyzed using ANOVA with significance set at p<0.05. Results: Intraoperative ACL graft force measurements demonstrated two distinct ACL graft curves (high-tension versus isometric ACL graft) were achieved with the two different femoral graft tunnel locations. At 90 degrees of knee flexion, there is a 1.6 fold increase in ACL graft force between a high-tension ACL graft and isometric ACL graft at the time of surgery. High ACL graft force with joint motion appeared to be deleterious to early ACL graft-tunnel incorporation. The load to failure for knees with high-tension ACL grafts (5.50 ± 2.30N) was significantly lower when compared to immobilized (10.90 ± 2.78N, p<0.01) and isometric grafts (9.91 ± 3.36N, p=0.01) at 3 weeks. At 6 weeks, isometric ACL grafts coupled with daily knee motion had greater load to failure than immobilized knees (24.16 ± 5.72N versus 16.56 ± 3.51N, p=0.01). Immobilized and isometric grafts had greater femoral bone volume fraction than knees with high-tension grafts at both 3 and 6 weeks (p<0.01 and p<0.001, respectively). Greater cellularity and collagen gaping were seen in loaded ACL graft (those that underwent motion) versus immobilized grafts, particularly within the tibial tunnel. Higher prevalence of osteoclasts were seen along the graft-tunnel interface in high-tension ACL grafts. Conclusion: There is limited data on how the ACL graft mechanical environment affects its healing. We were able to demonstrate that ACL graft-tunnel incorporation is sensitive to dynamic load from joint motion using a novel small animal model. ACL soft tissue grafts that experience higher in situ force have inferior early biomechanical properties. Maintaining graft isometry allows early joint motion without deleterious biomechanical consequences when compared to immobilized grafts in this animal model. Our findings regarding the effects of graft isometry may not only have clinical implications in terms of post-operative rehabilitation with modern anatomic ACL reconstructions, but it also raises questions regarding existing preclinical ACL healing studies where isometry may not have been considered.
机译：目的：放置用于重建的前交叉韧带移植物会受到联合运动的复杂作用力。当前的“解剖” ACL重建导致更大的原位移植力。 ACL移植力改变幅度对移植物隧道骨整合的生物学影响尚不完全清楚。本研究的目的是确定动态机械ACL移植物张力或负荷对移植物通道合并的影响。方法：对一百只雄性Sprague-Dawley大鼠进行单侧ACL切除，然后用软组织自体移植重建。在手术过程中将动物分为三组之一：（1）在整个研究过程中先进行ACL重建，然后固定肢体;（2）通过“高压” ACL移植和每日膝盖运动进行ACL重建，或3）用“等距”低张力ACL移植物和每天的膝盖运动进行ACL重建。术中评估ACL移植物等轴测图。外固定器用于在笼活动期间消除移植物负荷。然后，在术后第3天开始对所有使用定制的电脑屈膝装置分配到膝盖运动组的动物进行每日膝盖运动。通过生物力学，显微CT和组织学分析在3和6周评估移植物隧道的愈合情况。使用ANOVA分析生物力学和微CT数据，显着性设置为p <0.05。结果：术中ACL移植物力的测量结果表明，在两个不同的股骨移植隧道位置上，获得了两条截然不同的ACL移植物曲线（高压与等距ACL移植物）。在膝盖屈曲90度时，手术时高压ACL移植物和等距ACL移植物之间的ACL移植力增加了1.6倍。具有关节运动的高ACL移植力似乎对早期ACL移植隧道的合并有害。与固定的（10.90±2.78N，p <0.01）和等距的移植物（9.91±3.36N，p = 0.01）在3点时相比，高压ACL移植（5.50±2.30N）膝关节的失败负荷明显更低周。在第6周，等距ACL移植物与每日膝盖运动相结合的失败负荷要比固定膝盖更大（24.16±5.72N对16.56±3.51N，p = 0.01）。在3周和6周时，固定和等距的移植物的股骨骨体积分数均高于使用高压移植物的膝盖（分别为p <0.01和p <0.001）。与固定的ACL移植物（经过运动的那些）相比，在固定的ACL移植物中，尤其是在胫骨隧道内，观察到更大的细胞性和胶原蛋白的间隙。在高压ACL移植物中，沿移植物-隧道界面观察到破骨细胞的患病率更高。结论：关于ACL移植物机械环境如何影响其愈合的数据有限。我们能够证明，使用一种新型的小动物模型，ACL移植隧道的合并对关节运动产生的动态负荷敏感。经历较高原位力的ACL软组织移植物的早期生物力学性能较差。与固定在动物模型中的移植物相比，保持移植物等轴测距可以使关节早期运动而没有有害的生物力学后果。我们关于移植物等轴测图的影响的发现，不仅对现代解剖ACL重建术后康复具有临床意义，而且还提出了关于可能未考虑等轴测图的现有临床前ACL愈合研究的问题。

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