A flat posterior cruciate ligament reconstruction restores native knee kinematics, comparable to a double-bundle reconstruction-A biomechanical robotic investigation.

IF 3.3 2区医学 Q1 ORTHOPEDICS Knee Surgery, Sports Traumatology, Arthroscopy Pub Date : 2024-12-30 DOI:10.1002/ksa.12572

Adrian Deichsel, Florian Gellhaus, Christian Peez, Michael J Raschke, Moritz Martinovic, Elmar Herbst, Mirco Herbort, Christian Fink, Christoph Kittl

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Abstract

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).

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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。

目的：对利用矩形股骨隧道重建扁平后交叉韧带（PCL）进行生物力学评价。方法：在六自由度机器人测试装置中对8个新鲜冷冻的人膝关节标本进行测试。在每个测试步骤中，执行力控制测试方案，包括中性，内旋和外旋，从0到90°屈曲的89 N胫骨后平移（PTT）。确定膝关节运动学后，切开PCL。随后，使用带髌骨块的股四头肌腱自体移植物进行带矩形骨隧道的扁平PCL重建（PCLR）。填充骨隧道后，进行单束PCLR，不带或带股骨干涉螺钉固定，以及双束重建。采用混合线性模型进行统计分析。结果：与原始状态相比，PCL的切割导致PTT显著（p≤0.05）增加，从0到90°屈曲，高达10.7 mm。扁平重建和双束重建后，原生状态与重建状态无显著性差异（p≥0.05）。无干涉螺钉的单束PCLR与天然状态相比，在30°时PTT显著增加(平均差[MD] 3.3 mm；95%置信区间[CI] 1.3 ~ 5.2 mm；结论：在所有测试的屈曲角度中，扁平和双束PCLR都能够恢复膝关节的运动学。单束重建不能完全恢复原始运动学，只有少量残留的前后位不稳定。证据水平：不适用（实验实验室研究）。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Knee Surgery, Sports Traumatology, Arthroscopy 医学-外科

CiteScore

8.10

自引率

18.40%

发文量

418

审稿时长

2 months

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).