关节镜下保留残存纤维结合七股自体腘绳肌腱单束重建后交叉韧带

目的研究膝关节镜下保留残存后交叉韧带(PCL)纤维结合7股自体腘绳肌腱单束重建PCL的临床效果。方法对13例PCL损伤,采用胫骨隧道技术结合7股自体腘绳肌腱进行单束重建,术中保留残存PCL纤维,移植物使用悬吊式固定,手术前后采用Lysholm膝关节功能评价表和Tegner下肢运动能力评价表进行评估,并了解患者膝关节的稳定性、活动度。结果所有患者随访12～36个月,术前和术后12个月Lysholm评分分别为(50.20±8.32)分和(87.23±4.20)分(P<0.05),Tegner评分分别为(2.03±0.33)分和(4.11±0.13)分(P<0.05)。术后12个月后抽屉试验阴性7例,Ⅰ度阳性5例,Ⅱ度阳性1例,所有患膝运动能力均较术前有所改善。结论关节镜下采用经胫骨隧道技术保留残存纤维结合7股自体腘绳肌腱单束重建PCL是一种恢复膝关节稳定性和功能的可靠方法。     

Arthroscopic Posterior Cruciate Ligament Augmentation Using an Autogenous Hamstring Tendon Graft and the Posterior-Posterior Triangulation Technique

We describe a modification of the currently practiced arthroscopic posterior cruciate ligament (PCL) reconstruction techniques. We augmented the injured PCL with quadrupled autogenous hamstring tendon grafts using the arthroscopic posterior-posterior triangulation method and a single-incision transtibial approach. The tibial drill guide was introduced through the anteromedial portal and positioned onto the fossa for the PCL on the tibia under arthroscopic guidance from the posterolateral portal. The femoral tunnel was made 10 mm posterior to the articular cartilage of the medial femoral condyle by use of the anterior cruciate ligament Beath pin (Arthrex, Naples, FL) introduced through the far-inferior anterolateral portal. The tendon graft was positioned in the knee joint by use of the tibial and femoral double-folded silk loops that traversed the bony tunnels. The graft was fixed by use of bioabsorbable Intrafix screw systems (DePuy Mitek, Raynham, MA) at both the ends. The arthroscopic posterior-posterior triangulation method provides adequate exposure of the posterior knee compartment; this allows for convenient instrumentation and safe and accurate placement of the bony tunnels with preservation of the PCL remnants. We believe that retention of the remnant PCL fibers is biologic and contributes to earlier healing and strengthening of the tendon graft.     

Arthroscopic reconstruction of the posterior cruciate ligament with quadruple hamstring tendon graft: a double fixation method

BACKGROUND: Surgical reconstruction is indicated for posterior cruciate ligament (PCL) reconstruction for a grade III or IV injury, combined ligament or meniscus injuries, and chronic symptomatic posterior instability. Considerable controversy continues over the choice of graft tissues. Hamstring tendon has been popular in recent years. The purpose of this study is to prospectively assess the outcomes of PCL reconstruction using quadruple hamstring tendon autograft with a double-fixation technique at minimal 2-year follow-up. METHODS: Only patients who received PCL reconstruction without combined associated posterolateral injury reconstruction were included in the series. A hamstring tendon graft is composed of a quadruple-stranded semitendinosus tendon and gracilis tendon 10 cm in length. An arthroscopic technique using a two-incision method and a double-fixation technique were used. Clinical assessments were performed for 30 patients, of which 27 were available for final outcome analysis. Clinical review of patients included the Lysholm knee scores, International Knee Documentation Committee (IKDC) scores, thigh muscle assessment, and radiographic evaluation. RESULTS: On the Lysholm knee rating, 89% of the patients demonstrated good or excellent results in the final assessment. In the IKDC rating analyses, 56% of the patients revealed 3- to 5-mm ligament laxity. Four patients (15%) had grade II laxity. For the IKDC final rating, 26% were normal and 55% were nearly normal. Seventy-eight percent of the patients had less than a 10-mm difference in thigh girth between their reconstructed and opposite limbs. CONCLUSION: Arthroscopic PCL reconstruction with quadruple hamstring tendon autograft appears to produce acceptable results at a minimal 2-year follow-up. The four-stranded hamstring tendon graft is adequate in graft size and associated with minimal harvesting morbidity. The double-fixation method for the graft could provide a rigid fixation. We believe that this technique could afford good ligament function after reconstruction and could be a reasonably acceptable choice for PCL injury.     

Arthroscopic posterior cruciate ligament reconstruction using the posterior trans-septal portal

We describe an arthroscopic technique for the reconstruction of the posterior cruciate ligament (PCL), while preserving the remnant bundle of the original PCL and meniscofemoral ligament, using the posterior trans-septal portal. The posterior trans-septal portal provides an excellent visualization of the PCL tibial attachment and an easy access to the tibial tunnel without injuring any neurovascular structure. The remnant bundle of the original PCL and meniscofemoral ligament, which significantly contributes to the posterior stability of the knee joint, are preserved to be healed with a graft and subsequently form an integrated structure. We report a new arthroscopic technique for an effective reconstruction of the PCL, using the posterior trans-septal portal.     

保残与非保残重建后交叉韧带的病例对照研究

目的:探讨关节镜下保留残端纤维与非保留残端重建后交叉韧带的方法与疗效。方法:2006年1月至2011年1月,在关节镜下自体腘绳肌腱重建后交叉韧带45例,可吸收挤压螺钉固定移植物。非保残技术重建后交叉韧带25例,男19例,女6例;清理断端后胫骨骨道采用双螺钉全骨隧道固定技术。保留残端重建后交叉韧带20例,男15例,女5例;保留残端纤维,采用与非保残组同样的固定方法。两组均随访18个月,采用KT-2000胫骨后移距离、Lysholm膝关节评分、IKDC评分及分级进行疗效评定。结果:在术后18个月随访时,KT-2000测胫骨后移距离、Lysholm膝关节评分及IKDC评分,非保残重建组分别为(4.2±2.1)mm,84.3±10.5和64.5±8.8;保残组(3.9±1.8)mm,86.5±8.9和68.6±7.9,两组差异无统计学意义。IKDC运动能力分级恢复正常或基本正常者,保残组优于非保残组。结论:保留残端纤维关节镜下后交叉韧带重建,在恢复膝关节运动功能方面显示了较非保残重建更好的优势。     

腘绳肌腱结嵌压固定法重建交叉韧带的临床应用与生物力学研究

目的探讨腘绳肌腱结嵌压固定法重建交叉韧带的可行性。方法对52例陈旧性前、后交叉韧带损伤患者在关节镜下行双股腘绳肌腱中间打结,嵌入瓶颈状股骨隧道内固定,胫骨端采用肌腱编织缝合在骨桥上打结固定,重建交叉韧带。其中前交叉韧带25例,前、后十字韧带同时重建15例,后交叉韧带12例。生物力学实验采用猪膝关节。股骨端固定分为肌腱结嵌入组(n=13)和骨髌腱骨(B PT B)介面螺钉固定组(B PT B介面钉组,n=11)。胫骨端固定分为肌腱编织缝合线在骨桥打结组(n=7)、肌腱编织缝合介面螺钉组(n=8)。进行最大拔出强度、最大位移和固定刚度等力学实验。结果术后随访49例,平均14 6个月,Lanchman试验阴性46例,阳性3例。术后Lysholm评分由术前56 7分提高到92 8分。按膝关节疗效评定标准,优46例,良3例。生物力学实验最大拔出强度肌腱结嵌入组高于B PT B介面钉组;固定刚度肌腱结嵌入组小于B PT B介面钉组;最大位移肌腱结嵌入组大于B PT B介面钉组。胫骨端固定抗拉强度和刚度骨桥打结组优于介面螺钉组。结论腘绳肌腱结嵌压固定重建交叉韧带生物力学抗拉强度能满足生理需求,方法可行;可克服位移因素,降低韧带松弛率,提高疗效。     

Arthroscopic single- versus double-bundle posterior cruciate ligament reconstructions using hamstring autograft

This prospective study compared the clinical results of single- and double-bundle posterior cruciate ligament (PCL) reconstruction with a minimum follow-up of 2 years. There were 35 patients including 19 single- and 16 double-bundle posterior cruciate ligament reconstructions using hamstring autograft. The average age was 29.4±13.6 years versus 28.2±10.4 years; and the average follow-up was 41.0±13.1 months versus 28.2±4.2 months for single- and double-bundle reconstruction, respectively. The indication for surgery was functional disability of the knee due to pain and instability as the result of high-energy PCL injury. The evaluation parameters included functional assessment, ligament laxity, functional score and radiographs of the knee. The results showed no significant difference in functional assessment, ligament laxity, functional score and radiographic changes of the knee between the two techniques. The rate of overall satisfaction with the operation was comparable from patient and surgeon perspectives. Contrary to many recent reports, the results of this study showed that single- and double-bundle PCL reconstruction using hamstring autograft produced comparable clinical results in medium-term follow-up. The difference between single- and double-bundle PCL reconstruction, if any, can be concluded only with long-term results and larger number of patients.     

Isolated posterior cruciate ligament injuries associated with closed tibial shaft fractures: a report of two cases

Introduction  Knee ligament injuries associated with tibia shaft fractures are usually neglected and treatment is delayed. To our knowledge, no case presentation discusses the clinical result of closed tibial shaft fracture with concomitant ipsilateral isolated PCL injury. In this literature, we report the clinical result of two cases that sustained closed tibial shaft fracture with concomitant PCL injury and discuss the treatment options. Materials and methods  We report the clinical result of two cases that sustained closed tibial shaft fracture with concomitant posterior cruciate ligament (PCL) injury. Case 1 received open reduction with plate fixation for the tibial shaft fracture, and he also received arthroscopic reconstruction of PCL with bone-patellar tendon-bone graft due to neglecting PCL injury 5 months later after fracture fixation. Case 2 sustained left tibial-fibular shaft fracture with isolated PCL injury confirmed by magnetic resonance image on the first day of injury. She received tibia fixation with intramedullary nail and conservative treatment with bracing and rehabilitation for PCL injury. Results  In case 1, the male patient only focused on fracture healing without any knee rehabilitation. His knee flexed deeply for protected weight bearing in the injured leg which may have exacerbated the posterior instability and reduced the possibility of PCL healing. The end result of knee function was poor even though PCL reconstruction was done later. In case 2, the female patient with diagnosed posterior cruciate ligament injury on the day of injury, her knee was immobilized in brace with full extension, which improved PCL healing. In addition, she received rehabilitation of quadriceps strengthening, and hamstring muscle contraction was avoided in her daily activity. After rehabilitation, the female patient did not complain of severe subjective instability even with an obvious posterior translation on posterior drawer test. Conclusions  We need to perform a careful physical examination of ipsilateral knee in cases of leg fractures, and MRI of knee before surgery if any doubt exists. However, a further research is needed to conclude on the best operation and rehabilitation program in patients with combined tibial shaft fracture and PCL injury. No support from any institution was gained for this study.     

Tibial inlay technique with quadriceps tendon-bone autograft for posterior cruciate ligament reconstruction

Surgical reconstruction of the posterior cruciate ligament (PCL) is indicated in a PCL-deficient knee with symptomatic instability and injury to other ligaments. However, the choice of graft tissues remains controversial. The tibial inlay method has the benefit of preventing the acute turn associated with transtibial reconstruction and permitting accurate anatomic placement of the graft. This study describes an arthroscopic-assisted inlay technique for PCL reconstruction using quadriceps tendon-patellar bone autograft. This technique is a reasonable alternative for PCL reconstruction.     

关节镜下四股腘绳肌腱重建后交叉韧带

目的 探讨关节镜下四股腘绳肌腱重建后交叉韧带及其影响因素。方法 采用开口螺旋肌腱剥离器,保留肌腱远端附着点,肌腱肌肉交界处切断肌腱,对折四股编织转移镜下重腱后交叉韧带,内口侧采用可吸收挤压螺钉固定。结果 12例术后平均随访29个月。术前后抽屉试验10例阳性,术后1例阳性;Lachman试验术前均阳性,术后1例阳性,1例弱阳性;轴移试验术前5例阳性,术后均消失。按照日本骨科协会制定的膝关节疗效评定标准,优良率为83.3％。结论 镜下四股(?)绳肌腱重建后交叉韧带,韧带两端无骨块,通过隧道较B—PT—B顺畅。可吸收螺钉在隧道内口侧固定,愈后内口消失,避免受韧带撞击使之逐渐扩大引起重建韧带松驰、关节不稳。胫骨隧道外口原附着点的牢固附着,股骨隧道外口的坚强固定,使重建后交叉韧带有足够强度。手术具有创伤小,能早期锻炼,功能恢复快的特点。     

自体骨-髌腱-骨移植重建膝后交叉韧带

目的 介绍以自体骨－髌腱－骨重建膝关节后交叉韧带的方法并评价其对治疗膝关节后不稳定的临床效果。方法 采用膝前方入路,经胫骨－肌骨等长点骨隧道植入自体髋腱重建后交叉韧带（ＰＣＬ）,治疗陈旧性ＰＣＬ断裂所致慢性膝关节不稳病例２０例。采用Ｌａｒｓｏｎ膝关节功能评分、患者主观评价和膝关节稳定性检查评价其临床疗效。结果 ２０例患者术前Ｌａｒｓｏｎ评分平均６２分,沐后经６￣５８个月随访,平均评分达９２分,１８     

Arthroscopic posterior cruciate ligament reconstruction by using hamstring tendon autograft and transosseous screw fixation: minimal 3 years follow-up

Background

The aim of this trial is to prospectively evaluate the outcomes of PCL reconstruction by means of quadruple hamstring tendon autograft with a double-fixation method at minimal 3-year follow-up.

Materials and methods

Only patients who underwent PCL reconstruction without any other concomitant injury were included in this study. A hamstring tendon graft is composed of a quadruple-stranded gracilis tendon and semitendinosus tendon about 10 cm in length. An arthroscopic technique via a two incision and a double-fixation method was applied. Clinical evaluations were performed for 52 patients. Clinical assessment of patients included the Lysholm knee scores, International Knee Documentation Committee (IKDC) scores, thigh muscle evaluation, and radiographic investigation.

Results

On the Lysholm knee score, 90 % of the patients displayed good or excellent rating in the final assessment. In the IKDC rating analyses, 60 % of the patients demonstrated 3–5-mm ligament laxity. For the IKDC final rating, 81 % were normal or nearly normal. Seventy-nine percent of the cases revealed less than a 10-mm difference in thigh girth between their reconstructed and contra lateral limbs.

Conclusion

Arthroscopic PCL reconstruction using quadruple hamstring tendon autograft provides acceptable outcomes at a minimum 3-year follow-up. The four-stranded hamstring tendon graft is suitable in graft size and results in minimal harvesting morbidity. We recommend that quadruple hamstring tendon graft be chosen for PCL reconstruction to achieve good ligament reconstruction. A double-fixation method which has been applied in this trial can be used to provide rigid fixation.     

Anatomic double-bundle posterior cruciate ligament reconstruction using hamstring tendons

Recent biomechanical studies have shown that an anatomic double-bundle posterior cruciate ligament (PCL) reconstruction is superior in restoring normal knee laxity compared with the conventional single-bundle isometric reconstruction. We describe a modification of an endoscopic PCL reconstruction technique using a double-bundle Y-shaped hamstring tendon graft. A double- or triple-bundle semitendinosus-gracilis tendon graft is used and directly fixed with soft threaded biodegradable interference screws. In the medial femoral condyle, 2 femoral tunnels are created inside-out through a low anterolateral arthroscopic portal. First, in 80° of flexion, the double-stranded gracilis graft is fixed with an interference screw inside the lower femoral socket, representing the insertion site of the posteromedial bundle. In full extension the combined semitendinosus-gracilis graft is pretensioned and fixed inside the posterior aspect of the single tibial tunnel. The double- or triple-stranded semitendinosus tendon is inserted in the higher femoral tunnel, presenting the insertion site of the anterolateral bundle. Finally, pretension is applied to the semitendinosus bundle in 70° of flexion and a third screw is inserted. Using this technique, the stronger semitendinosus part of the double-bundle graft, which mimics the anterolateral bundle of the PCL, is fixed in flexion, whereas the smaller gracilis tendon part (posteromedial bundle) is fixed in full extension. Thus, a fully arthroscopic anatomic PCL reconstruction technique is available that may better restore normal knee kinematics as compared to the single-stranded isometric reconstruction.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 17, No 1 (January), 2001: pp 88–97     

Arthroscopic-assisted posterior cruciate ligament reconstruction using patellar tendon autograft: a technique for graft passage

During arthroscopic posterior cruciate ligament (PCL) reconstruction, passage of the graft into the knee joint may be difficult, especially when using the patellar tendon. Because of the angle of passage, the bone block ends may become entangled or caught on the superior edge of the posterior tibial tunnel when passing the graft from the tibia to the femur. The use of a blunt trocar through the posteromedial portal avoids impingement of the bone block against the edge of the tibial tunnel. This method uses the pulley principle and permits the graft to pass freely into the knee. This method has been used successfully by the authors in more than 40 PCL arthroscopic reconstructions.     

Anterior cruciate ligament reconstruction with preservation of remnant bundle using hamstring autograft: technical note

During an arthroscopic examination for an anterior cruciate ligament (ACL) reconstruction, there is a relatively thick remnant ACL tibial stump attached to the posterior cruciate ligament (PCL) or rarely remained between the femur origin and the tibia insertion. We thought that preservation of the remnant ACL original bundle might promote graft healing or be helpful in preserving the proprioception and function to stabilize the knee. Therefore, we established a remnant preservation procedure without additional instruments during an ACL reconstruction using a bio-cross pin (RIGIDfix system: Mitek, Johnson & Johnson, USA) for the femoral tunnel fixation. The remnant ACL was sutured (usually three stitches) using a suture hook (Linvatec, Largo, FL), and both ends of the sutures were pulled to the far anteromedial (AM) portal. These sutures protected the remnant tissue during the ACL reconstruction because medial traction of these sutures can provide a wide view during the reconstruction. After the femoral and tibial tunnel formation, these sutures were pulled out to the inferior sleeve of the cross pin using a previously inserted wire loop via an inferior sleeve. After graft passage, a superior cross pin was first fixed and tibial fixation was then performed. Finally, inferior cross pin fixation was performed and ties were made at the entrance of the inferior cross pin.     

Movement of the posterior cruciate ligament during knee flexion--MRI analysis.

The movement of the posterior cruciate ligament (PCL) during flexion of the living knee is unknown. The purpose of the present study was to analyze the movement of the PCL using magnetic resonance imaging (MRI). The posterior cruciate ligaments in 20 normal knees were visualized using MRI from extension to deep flexion. Sagittal inclination relative to the longitudinal axis of the tibia was measured and analyzed with reference to the patellar tendon (PT) and the anterior cruciate ligament (ACL). Although the PCL was slack in extension, it straightened with anterior inclination (24.1+/-5.1 degrees ) at 90 degrees flexion. At active maximum flexion (129.2+/-8.1 degrees ), the ligament was almost parallel (3.9+/-7.4 degrees inclination) to the longitudinal axis of the tibia. At passive maximum flexion (158.8+/-5.8 degrees ), the inclination was reversed anteroposteriorly, measuring -23.0+/-6.7 degrees . The PCL and PT moved in a corresponding manner within 20 degrees of discrepancy. The results of this in vivo study of the PCL have clinical relevance to conservative therapy for PCL knee injuries. The results of this study could also be useful in PCL reconstruction surgery to determine the optimum graft position to allow maximum postoperative motion.     

三明治式后十字韧带重建的临床疗效

目的 评估后十字韧带三明治式重建,即保留残存纤维,采用八股腘绳肌腱双束重建后十字韧带的效果.方法 2005年1月至2005年6月,单纯陈旧性后十字韧带损伤患者18例,男14例,女4例;年龄19～42岁,平均34岁.在关节镜下采用自体腘绳肌腱行双束四隧道重建,其中采用四股半腱肌腱重建前外侧束,四股股薄肌腱重建后内侧束.残存纤维保留于重建的双柬移植物之间.通过微型钢板和纽扣悬吊式固定移植物.根据IKDC、Lysholm和Tegner评分标准进行评估.结果 患者均获得2年以上随访,末次随访时发现,17例患者(94.4%)后抽屉试验阴性,1例后抽屉试验1度阳性.KT-1000检查示,双膝后向松弛度差值从术前的(9.3±1.4)mm改善为术后的(0.7±0.9)mm,两者比较差异有统计学意义(P＜0.01).根据IKDC评估标准,16例患者(88.9%)评级正常,2例患者(11.1%)评级接近正常.IKDC主观评分从(64.1±3.3)分增加到(95.6+3.1)分(P＜0.01).Lysholm评分从(58.6+4.4)分增加到(94.9±3.6)分(R＜0.01).Tegner评分,术前为5.6分,末次随访时为6.9分.结论 关节镜下后十字韧带三明治式重建能使88.9%的患者在术后2年得到正常的IKDC评级,11.1%的患者得到接近正常的IKDC评级.     

A new endoscopic posterior cruciate ligament reconstruction: Minimization of graft angulation

Purpose: The purpose of this report is to present a new surgical technique for endoscopic posterior cruciate ligament (PCL) reconstruction and to elucidate the preliminary results. Surgical Technique: The concept of this surgical technique is to minimize the graft angulation at the inner edge of the bone tunnel. The tibial entry point of the guide pin is under the tibial lateral subcondylar flare approximately 1 to 2 cm anterior to the posterior cortex and 4 cm distal to the joint surface. This creates less graft angulation on the posterior aspect of the tibia. A new drill system has been devised to allow antegrade femoral drilling starting from inside the notch. This method also allows better femoral tunnel orientation. As a substitute graft material, we use autogenous hamstring tendons, and we secure them with an EndoButton (Smith & Nephew, Mansfield, MA) and post screw. Methods: Since 1995, 40 knees have undergone endoscopic PCL reconstruction. Twenty-one patients were evaluated after a minimum follow-up of 1 year (17.9 ± 7.7 mo). The clinical evaluation was performed using the International Knee Documentation Committee (IKDC) form. Results: The range of motion was rated as A for 17 cases, B in 3 cases, and C in one case. The total anteroposterior translation (KT-1000, manual-maximum) showed a range of 1.0 to 5.5 mm (mean, 2.8 mm). The ratings of the ligament examination were A in 9 cases and B in 12 cases. The final IKDC evaluation was A (normal) in 3 cases, B (nearly normal) in 17 cases, and C (abnormal) in 1 case. Conclusions: A good clinical outcome was achieved with our endoscopic PCL reconstruction. The reduction of the graft angulation may contribute to the good results for PCL reconstruction.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 17, No 3 (March), 2001: pp 258–263     

Endoscopic single-bundle posterior cruciate ligament reconstruction: results at minimum 2-year follow-up

Purpose:The goal of this study was to evaluate the clinical outcome of single-bundle posterior cruciate ligament (PCL) reconstruction with retention of the PCL remnant and hamstring tendon autograft with interference screw fixation in patients with isolated PCL laxity.Type of Study:Prospective case series with minimum 2-year follow-up evaluation.Methods:Thirty-one patients for whom conservative management had failed underwent surgery using a 4-strand hamstring tendon autograft with interference screw fixation. The median time from injury to reconstructive surgery was 9 months (range, 4 to 120 months). At a minimum of 2 years after surgery, patients were assessed with the International Knee Documentation Committee (IKDC) Knee Ligament evaluation, Lysholm knee score, and KT-1000 instrumented testing.Results:Before surgery, the median Lysholm knee score was 64 (95% confidence interval, 51 to 67). No patient rated knee function as normal, and all patients showed at least grade 2 posterior drawer laxity. At review, the median Lysholm knee score was 94 (95% confidence interval, 83 to 94), 56% rated the knee as normal and only one patient was found to exhibit grade 2 laxity on posterior drawer testing. Before injury, 94% of patients participated in moderate or strenuous activity. This figure fell to 26% after injury and had increased to 63% at review.Conclusions:Endoscopic reconstruction of PCL laxity using single-bundle 4-strand hamstring tendon autograft, without removal of the PCL stump, provides a significant reduction in knee symptoms and allows 63% of patients to return to moderate or strenuous activity. This is an effective procedure for symptomatic patients who have isolated PCL laxity and for whom conservative management has failed.     

股骨单隧道内分叉双束纤维重建后交叉韧带的实验研究

目的在人膝关节标本上行股骨单隧道分叉双束纤维重建后交叉韧带(posterior cruciate ligament,PCL),探讨其术式的优缺点。方法应用力学试验机对14侧捐赠新鲜冷冻人膝关节标本进行生物力学测试,男12侧,女2侧;年龄20～31岁。标本股骨段长20cm,胫骨段长20cm。首先测量PCL完整时胫骨后移距离和交叉韧带的应变(完整组,n=14);然后切断PCL(切断组,n=14),测量胫骨受力时的后移距离后,再将标本随机分为两组:单束重建组(n=7)和分叉双束重建组(n=7),分别测量屈膝0、30、60、90和120°5个角度时胫骨后移距离和移植韧带的应变。结果胫骨受到100N后向力量,完整组在不同屈膝角度下,胫骨向后移位1.97±0.29～2.60±0.23mm,前外束和后内束纤维交替紧张松弛。切断组膝关节明显松弛,胫骨向后移位达11.27±1.06～14.94±0.67mm,与完整组比较差异有统计学意义(P<0.05);单束纤维重建组,在不同屈膝角度下胫骨向后移位1.99±0.19～2.72±0.38mm,移植韧带持续紧张。双束纤维重建组在不同屈膝角度下胫骨向后移位2.27±0.32～3.05±0.44mm,移植的双束纤维交替紧张,协同作用。组内比较:双束重建组在不同屈膝角度时胫骨向后位移差异无统计学意义(P>0.05),而单束重建组在屈膝90°时与屈膝30、60和120°时相比,胫骨后移增大,差异有统计学意义(P<0.05)。结论股骨单隧道内分叉双束纤维重建PCL术在各屈膝角度均能有效防止胫骨后移,股骨单隧道单束重建术屈膝90°时后移较其他角度时增大。分叉双束重建PCL的两束纤维束交替紧张,生物力学特征更接近于正常PCL。