解剖双束前十字韧带重建术后过度约束的影响因素

IF 1.5 Q3 ORTHOPEDICS

Asia-Pacific Journal of Sport Medicine Arthroscopy Rehabilitation and Technology Pub Date : 2024-02-06 DOI:10.1016/j.asmart.2024.01.002

Miki Kuroda , Tatsuo Mae , Hidenori Otsubo , Tomoyuki Suzuki , Shinichiro Okimura , Norinao Matsumoto

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引用次数: 0

摘要

目的移植物固定时的初始张力是前交叉韧带（ACL）重建术取得良好疗效的关键因素之一。确定影响术后膝关节在胫骨前负荷下松弛的术前因素有助于确定移植物固定时的初始张力。因此，本研究旨在明确影响解剖双束前交叉韧带重建术后即刻前方松弛侧向差异的术前因素，并确定恒定的初始张力。在麻醉下进行前交叉韧带重建前，使用 KT-2000 膝关节测量仪在前牵引负荷 67 N、89 N、134 N 和屈曲 30°手动最大负荷下测量双膝的胫骨前位移（ATD），并在麻醉下进行前交叉韧带重建后立即在 89 N 负荷下测量手术膝的胫骨前位移（ATD）。然后计算前交叉韧带重建前和重建后的侧向差（SSD）。结果在 89 N 的前负荷作用下，术后即刻的 ATD 侧-侧差为 -3.8 ± 1.7 mm（0 至 -8mm）。前交叉韧带重建术后的SSD与双膝关节的所有ATD之间存在相关性，但受伤膝关节在人工最大负荷下的ATD除外，而前交叉韧带重建术后的SSD与前交叉韧带重建术前的SSD之间几乎没有相关性。结论由于对侧膝关节的胫骨前位移在 89 N 以下和受伤膝关节的胫骨前位移在 134 N 以下与前交叉韧带重建后的 SSD 有显著相关性，这些值可能有助于判断移植物固定时初始张力的增减。

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Factors affecting the post-operative over-constraint after anatomic double-bundle anterior cruciate ligament reconstruction

Objective

Initial tension at graft fixation is one of key factors for good outcomes in anterior cruciate ligament (ACL) reconstruction. Identifying the pre-operative factors that influence postoperative knee laxity under the anterior tibial load is useful in determining the initial tension at graft fixation. Thus, the purpose of this study was to clarify the pre-operative factors affecting the side-to-side difference in anterior laxity immediately after the anatomic double-bundle ACL reconstruction with a constant initial tension.

Methods

Fifty-five patients underwent the anatomic double-bundle ACL reconstruction with hamstring tendon grafts. Anterior tibial displacement (ATD) was measured on both knees using KT-2000 Knee Arthrometer under anterior drawer load of 67 N, 89 N, 134 N and manual maximum load at 30° of flexion before ACL reconstruction under anesthesia, and was also measured on the operated knees under 89 N immediately after ACL reconstruction under anesthesia. Then, side-to-side difference (SSD) before and immediately after ACL reconstruction was calculated. Correlative relation between the SSD immediately after ACL reconstruction and the ATD/the SSD in each condition was analyzed.

Results

The side-to-side difference of ATD immediately after surgery was −3.8 ± 1.7 mm (0 to -8mm) in response of 89 N of anterior load. There was correlation between the SSD immediately after ACL reconstruction and all ATD on both knees except for the ATD under manual maximum load on the injured knee, while little correlation between the SSD immediately after ACL reconstruction and that before ACL reconstruction was found. Especially, ATD under 89 N on the opposite knees and ATD under 134 N on the injured knees showed selective correlation with the SSD immediately after surgery in the step-wise multiple regression analysis.

Conclusion

As the anterior tibial displacements under 89 N on the contra-lateral knee and under 134 N on the injured knee had a significant correlation with the SSD immediately after ACL reconstruction, those values may be helpful in determining the increase or decrease in initial tension at graft fixation.

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来源期刊

Asia-Pacific Journal of Sport Medicine Arthroscopy Rehabilitation and Technology Multiple-

CiteScore

3.80

自引率

0.00%

发文量

审稿时长

98 days

期刊介绍： The Asia-Pacific Journal of Sports Medicine, Arthroscopy, Rehabilitation and Technology (AP-SMART) is the official peer-reviewed, open access journal of the Asia-Pacific Knee, Arthroscopy and Sports Medicine Society (APKASS) and the Japanese Orthopaedic Society of Knee, Arthroscopy and Sports Medicine (JOSKAS). It is published quarterly, in January, April, July and October, by Elsevier. The mission of AP-SMART is to inspire clinicians, practitioners, scientists and engineers to work towards a common goal to improve quality of life in the international community. The Journal publishes original research, reviews, editorials, perspectives, and letters to the Editor. Multidisciplinary research with collaboration amongst clinicians and scientists from different disciplines will be the trend in the coming decades. AP-SMART provides a platform for the exchange of new clinical and scientific information in the most precise and expeditious way to achieve timely dissemination of information and cross-fertilization of ideas.