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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >Biomechanical analysis of ideal knee flexion angle for ACL graft tensioning utilizing multiple femoral and tibial tunnel locations
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Biomechanical analysis of ideal knee flexion angle for ACL graft tensioning utilizing multiple femoral and tibial tunnel locations

机译：利用多股胫骨隧洞位置的ACL移植张紧理想膝关屈曲角度的生物力学分析

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Objectives: Despite more anatomic reconstruction of the ACL, graft failure rate has been reported to be greater than 5% at 5 years. There is concern that anatomic reconstructions may not result in an isometric graft and may predispose the graft to stretching. The current biomechanical study evaluated excursion of the ACL with different drill points for both femoral and tibial tunnels. The purpose was to evaluate the excursion of the ACL with both anatomic and non-anatomic tunnel combinations and determine the optimal flexion angle to tension the ACL to minimize stretching of the graft during motion. Methods: Ten cadaveric knee specimens, mid-femur to mid-tibia, were dissected of skin and subcutaneous tissue. The ACL was sectioned and the femoral and tibial attachments were marked prior to excision. A 1/16 inch drill was used to create a tunnel in the center of the ACL footprint on the tibia and femur and additional tunnels were made 5mm from the original tunnel (Figure 1). A suture was passed through each tunnel combination (Femur A-F; Tibia A-E) and was attached to a string potentiometer. The knee was ranged from full extension to 120 degrees of flexion for 10 cycles while mounted in a custom fixture that measured angle of flexion in the sagittal plane. The change in length (excursion) of the suture during movement was recorded for each combination of femoral and tibial tunnels. Results: Anatomic reconstruction of the ACL with tunnel placement in the center of the femoral (femoral tunnel A) and tibial (tibial tunnel A) footprint did not result in an isometric graft, with excursion of the ACL during knee motion of 7.46mm (SD 2.7mm). The tunnel combination that resulted in the least amount of excursion during knee motion was a reconstruction with a femoral footprint 5mm anterior to the femoral (femoral tunnel D) and 5mm posterior to the tibial footprint (tibial tunnel D) (4.2mm, SD 1.37mm). The tunnel combination that resulted in the most amount of excursion during knee motion was utilized femoral footprint 5mm proximal to the femoral (femoral tunnel F) and 5mm posterior to the tibial footprint (tibial tunnel D) (9.81mm, SD 2.68mm). In an anatomic tunnel placement, we found the angle with the most excursion of the ACL to occur at 2.84 degrees of flexion (SD 4.22). Conclusions: Anatomic ACL reconstruction results in significant excursion of the ACL during range of motion. If not tensioned properly, the ACL can stretch during range of motion, potentially leading to re-rupture. In order to prevent stretching of the graft, the current biomechanical study recommends tensioning an anatomic ACL reconstruction at its point of maximal exertion, or about 10 degrees of flexion. We also determined optimal flexion angles for tensioning the ACL for tunnel combinations that may be non-anatomic.
机译：目标：尽管有更多的解剖学重建ACL，但据报告嫁接失败率在5年内大于5％。旨在担心解剖重建可能不会导致等距移植物，并且可以使移植物易于拉伸。目前的生物力学研究评估了对股骨和胫骨隧道的不同钻孔点的偏移。目的是评估ACL的偏移，具有解剖学和非解剖隧道组合，并确定最佳屈曲角度，以张力ACL在运动期间最小化移植物的拉伸。方法：解剖皮肤和皮下组织的十个尸体膝关节标本，股骨中股份。 ACL被切断，并且在切除之前标记了股骨和胫骨附着物。 1/16英寸钻头用于在胫骨上的ACL占地面积中创建隧道，股骨距离原始隧道5mm（图1）。缝合线通过每个隧道组合（股骨A-F;胫骨A-e）并附在弦电位器上。膝盖的范围从全延伸到120度屈曲，10个循环，同时安装在定制夹具中，以测量矢状平面中的屈曲角度。为股骨和胫骨隧道的每个组合记录了运动期间缝合缝合线的长度的变化（偏移）。结果：股骨（股骨隧道A）中央的隧道放置的ACL解剖重建和胫骨（胫骨隧道A）占地面积没有导致等距移植物，在7.46mm的膝关节运动期间，ACL的偏移（SD 2.7mm）。导致膝关节运动期间最少的偏移量的隧道组合是股骨（股骨隧道D）和胫骨脚印（胫骨隧道D）后部的股骨占地面积5mm（4.2mm，SD 1.37mm）的重建）。导致膝关节运动期间最多的偏移的隧道组合被股骨（股骨隧道F）近端的股骨占地面积5mm（胫骨隧道D）（胫骨隧道D）（9.81mm，SD 2.68mm）近端。在解剖隧道放置中，我们发现了与ACL最偏移的角度发生在2.84度屈曲（SD 4.22）。结论：解剖学ACL重建导致运动范围内ACL的显着偏移。如果没有正确张紧，ACL可以在运动范围内伸展，可能导致重新破裂。为了防止移植物的拉伸，目前的生物力学研究建议在其最大施加点或大约10度屈曲点处张紧解剖学ACL重建。我们还确定了用于张紧ACL的最佳屈曲角度，用于可能是非解剖学的隧道组合。

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