Adrian Deichsel, Florian Gellhaus, Christian Peez, Michael J Raschke, Moritz Martinovic, Elmar Herbst, Mirco Herbort, Christian Fink, Christoph Kittl
{"title":"平后交叉韧带重建恢复膝关节运动学，可与双束重建相媲美-生物力学机器人研究。","authors":"Adrian Deichsel, Florian Gellhaus, Christian Peez, Michael J Raschke, Moritz Martinovic, Elmar Herbst, Mirco Herbort, Christian Fink, Christoph Kittl","doi":"10.1002/ksa.12572","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>To biomechanically evaluate a flat posterior cruciate ligament (PCL) reconstruction utilizing rectangular femoral bone tunnels.</p><p><strong>Methods: </strong>Eight fresh-frozen human knee specimens were tested in a six-degrees-of-freedom robotic test setup. In each testing step, a force-controlled test protocol was performed, including 89 N posterior tibial translation (PTT) in neutral, internal and external rotation, from 0 to 90° of flexion. After determining the native knee kinematics, the PCL was cut. Subsequently, a flat PCL reconstruction (PCLR) with a rectangular bone tunnel was performed, utilizing a quadriceps tendon autograft with a patellar bone block. After filling the bone tunnel, a single-bundle PCLR without and with femoral interference screw fixation, as well as a double-bundle reconstruction, was performed. Statistical analysis was performed using mixed linear models.</p><p><strong>Results: </strong>Cutting of the PCL led to significant (p ≤ .05) increases in PTT, from 0 to 90° of flexion, up to 10.7 mm, in comparison to the native state. After flat reconstruction and double-bundle reconstruction, no significant difference was found between the native and reconstructed state (p ≥ .05). The single-bundle PCLR without interference screw showed significantly increased PTT in comparison to the native state in 30° (mean difference [MD] 3.3 mm; 95% confidence interval [CI] 1.3 - 5.2 mm; p < .001), 60° (MD 4.4 mm; 95% CI 2.5-6.4 mm; p < .001) and 90° of flexion (MD 4.0 mm; 95% CI 2.1-6.0 mm; p < .001). The single-bundle PCLR with additional interference screw showed significantly increased PTT in comparison to the native state only in 30° (MD 1.9 mm; 95% CI 0.05-3.8 mm; p = .01).</p><p><strong>Conclusion: </strong>Both a flat and a double-bundle PCLR were able to restore the native knee kinematics in all tested flexion angles. A single-bundle reconstruction was not able to fully restore native kinematics, with only small residual anteroposterior instability.</p><p><strong>Level of evidence: </strong>Not applicable (an experimental laboratory study).</p>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":" ","pages":""},"PeriodicalIF":3.3000,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"A flat posterior cruciate ligament reconstruction restores native knee kinematics, comparable to a double-bundle reconstruction-A biomechanical robotic investigation.\",\"authors\":\"Adrian Deichsel, Florian Gellhaus, Christian Peez, Michael J Raschke, Moritz Martinovic, Elmar Herbst, Mirco Herbort, Christian Fink, Christoph Kittl\",\"doi\":\"10.1002/ksa.12572\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>To biomechanically evaluate a flat posterior cruciate ligament (PCL) reconstruction utilizing rectangular femoral bone tunnels.</p><p><strong>Methods: </strong>Eight fresh-frozen human knee specimens were tested in a six-degrees-of-freedom robotic test setup. In each testing step, a force-controlled test protocol was performed, including 89 N posterior tibial translation (PTT) in neutral, internal and external rotation, from 0 to 90° of flexion. After determining the native knee kinematics, the PCL was cut. Subsequently, a flat PCL reconstruction (PCLR) with a rectangular bone tunnel was performed, utilizing a quadriceps tendon autograft with a patellar bone block. After filling the bone tunnel, a single-bundle PCLR without and with femoral interference screw fixation, as well as a double-bundle reconstruction, was performed. Statistical analysis was performed using mixed linear models.</p><p><strong>Results: </strong>Cutting of the PCL led to significant (p ≤ .05) increases in PTT, from 0 to 90° of flexion, up to 10.7 mm, in comparison to the native state. After flat reconstruction and double-bundle reconstruction, no significant difference was found between the native and reconstructed state (p ≥ .05). The single-bundle PCLR without interference screw showed significantly increased PTT in comparison to the native state in 30° (mean difference [MD] 3.3 mm; 95% confidence interval [CI] 1.3 - 5.2 mm; p < .001), 60° (MD 4.4 mm; 95% CI 2.5-6.4 mm; p < .001) and 90° of flexion (MD 4.0 mm; 95% CI 2.1-6.0 mm; p < .001). The single-bundle PCLR with additional interference screw showed significantly increased PTT in comparison to the native state only in 30° (MD 1.9 mm; 95% CI 0.05-3.8 mm; p = .01).</p><p><strong>Conclusion: </strong>Both a flat and a double-bundle PCLR were able to restore the native knee kinematics in all tested flexion angles. A single-bundle reconstruction was not able to fully restore native kinematics, with only small residual anteroposterior instability.</p><p><strong>Level of evidence: </strong>Not applicable (an experimental laboratory study).</p>\",\"PeriodicalId\":17880,\"journal\":{\"name\":\"Knee Surgery, Sports Traumatology, Arthroscopy\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":3.3000,\"publicationDate\":\"2024-12-30\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Knee Surgery, Sports Traumatology, Arthroscopy\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1002/ksa.12572\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Knee Surgery, Sports Traumatology, Arthroscopy","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1002/ksa.12572","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
A flat posterior cruciate ligament reconstruction restores native knee kinematics, comparable to a double-bundle reconstruction-A biomechanical robotic investigation.
Purpose: To biomechanically evaluate a flat posterior cruciate ligament (PCL) reconstruction utilizing rectangular femoral bone tunnels.
Methods: Eight fresh-frozen human knee specimens were tested in a six-degrees-of-freedom robotic test setup. In each testing step, a force-controlled test protocol was performed, including 89 N posterior tibial translation (PTT) in neutral, internal and external rotation, from 0 to 90° of flexion. After determining the native knee kinematics, the PCL was cut. Subsequently, a flat PCL reconstruction (PCLR) with a rectangular bone tunnel was performed, utilizing a quadriceps tendon autograft with a patellar bone block. After filling the bone tunnel, a single-bundle PCLR without and with femoral interference screw fixation, as well as a double-bundle reconstruction, was performed. Statistical analysis was performed using mixed linear models.
Results: Cutting of the PCL led to significant (p ≤ .05) increases in PTT, from 0 to 90° of flexion, up to 10.7 mm, in comparison to the native state. After flat reconstruction and double-bundle reconstruction, no significant difference was found between the native and reconstructed state (p ≥ .05). The single-bundle PCLR without interference screw showed significantly increased PTT in comparison to the native state in 30° (mean difference [MD] 3.3 mm; 95% confidence interval [CI] 1.3 - 5.2 mm; p < .001), 60° (MD 4.4 mm; 95% CI 2.5-6.4 mm; p < .001) and 90° of flexion (MD 4.0 mm; 95% CI 2.1-6.0 mm; p < .001). The single-bundle PCLR with additional interference screw showed significantly increased PTT in comparison to the native state only in 30° (MD 1.9 mm; 95% CI 0.05-3.8 mm; p = .01).
Conclusion: Both a flat and a double-bundle PCLR were able to restore the native knee kinematics in all tested flexion angles. A single-bundle reconstruction was not able to fully restore native kinematics, with only small residual anteroposterior instability.
Level of evidence: Not applicable (an experimental laboratory study).
期刊介绍：
Few other areas of orthopedic surgery and traumatology have undergone such a dramatic evolution in the last 10 years as knee surgery, arthroscopy and sports traumatology. Ranked among the top 33% of journals in both Orthopedics and Sports Sciences, the goal of this European journal is to publish papers about innovative knee surgery, sports trauma surgery and arthroscopy. Each issue features a series of peer-reviewed articles that deal with diagnosis and management and with basic research. Each issue also contains at least one review article about an important clinical problem. Case presentations or short notes about technical innovations are also accepted for publication.
The articles cover all aspects of knee surgery and all types of sports trauma; in addition, epidemiology, diagnosis, treatment and prevention, and all types of arthroscopy (not only the knee but also the shoulder, elbow, wrist, hip, ankle, etc.) are addressed. Articles on new diagnostic techniques such as MRI and ultrasound and high-quality articles about the biomechanics of joints, muscles and tendons are included. Although this is largely a clinical journal, it is also open to basic research with clinical relevance.
Because the journal is supported by a distinguished European Editorial Board, assisted by an international Advisory Board, you can be assured that the journal maintains the highest standards.
Official Clinical Journal of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA).
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
