Biomechanical evaluation of a newly devised model for the elongation-type anterior cruciate ligament injury with partial laceration and permanent elongation

Objective. To biomechanically evaluate a newly devised model for the elongation-type anterior cruciate ligament injury with partial laceration and permanent elongation.

Design. Thirty-six rabbits were randomly divided into 4 groups of 9 animals each, after a quantitative injury was given to the right anterior cruciate ligament. The 4 groups were sacrificed at 0, 6, 12, and 24 weeks after surgery, respectively. Biomechanical and histological evaluations were performed at each period.

Background. No adequate animal models have been established for the elongation-type anterior cruciate ligament injury in which the mid-substance is permanently elongated with partial laceration.

Methods. The anteromedial and posterolateral half of the anterior cruciate ligament was transected at the proximal and distal one-third levels, respectively. Then, the anterior cruciate ligament was stretched by applying an anterior drawer force to the tibia at 90 degrees of knee flexion.

Results. The treatment significantly increased the anterior translation of the knee into approximately 150–250% at each period after surgery. The maximum load and the stiffness of the femur–anterior cruciate ligament–tibia complex significantly decreased to 30% or less immediately after surgery, and then gradually increased to 50% at 12 weeks.

Conclusions. In this model, this quantitative treatment created serious injuries with partial laceration and permanent elongation in the anterior cruciate ligament to similar degrees. Also, incomplete tissue healing occurred in the anterior cruciate ligament to similar degrees after the treatment.Relevance

This model will be useful to study new therapeutic methods for the elongation-type anterior cruciate ligament injury.     

Mechanical properties of the human anterior cruciate ligament

The aim was to measure the stiffness and strength of the femur-anterior cruciate ligament-tibia complex tested in a physiological manner with a force exerted anteriorly on the tibia, at knee joint flexion angles of 0 degrees, 10 degrees and 30 degrees and at speeds of 50 and 500 mm/min. Ligaments were preconditioned by cycling five times, with data from the fifth cycle used to determine the stiffness of the ligament in a low-load range. The ligaments were then tested to failure with the knee at 30 degrees flexion. The specimens were divided into two groups, middle-aged (40-60) and old (>60). For each group no statistical difference was observed between stiffness of the ligament at different joint flexion angles or speeds. Seven of the 21 specimens in the older age group failed by avulsion at the bone-ligament interface. All the other specimens failed by tears in the substance of the ligament. Ultimate failure load was found to have a significant correlation with bodyweight. It was 1.6 and 1.3 times bodyweight for the middle-aged and older age groups respectively. This study has highlighted the importance of identifying different modes of failure, of making corrections for bodyweight and testing in a physiological manner. The results allow a better understanding of the mechanical behaviour of the anterior cruciate ligament and provide design data for anterior cruciate ligament grafts and prostheses. RELEVANCE:--Our clinical experience indicates that the anterior cruciate ligament is frequently ruptured during uncoordinated contraction of the quadriceps mechanism. The results of this study, in which the mechanical properties of the anterior cruciate ligament have been measured with force exerted anteriorly on the tibia, allow a more complete understanding of the mechanical behaviour of the anterior cruciate ligament and provide design data for anterior cruciate ligament grafts and prostheses.     

Modeling of ACL impingement against the intercondylar notch

Objective. To develop a 3-D mathematical model that accurately evaluates anterior cruciate ligament impingement against the intercondylar notch.

Design. The model simulated physical interactions between the anterior cruciate ligament and the intercondylar notch in tibiofemoral movement.

Background. Anterior cruciate ligament impingement has been evaluated through planar radiographic images, which may not characterize the complex 3-D notch shape associated with impingement.

Methods. After examining potential anterior cruciate ligament impingement in five cadaver knee specimens, the model was implemented using data from an individual cadaveric knee with representative impingement. The knee was loaded passively in various patterns to induce impingement, and the impingement force and six degrees-of-freedom tibiofemoral kinematics were measured. The femur, tibia, and anterior cruciate ligament were digitized. Spatial data points representing the notch surfaces were surface-fitted using bicubic splines. The model detected for impingement during the tibiofemoral movement and used a “crawling algorithm” to determine the deformed geometry of the impinging ligament.

Results. The model detected the impingement accurately and the ligament strain determined by the model was highly correlated with the recorded impingement force when impingement occurred during the tibiofemoral movement. Distance between the anterior cruciate ligament and the notch wall was determined when impingement was not detected.

Conclusion. The model quantitatively characterized impingement of the anterior cruciate ligament against the intercondylar notch in 3-D space.

Relevance The approach helps us better understand anterior cruciate ligament injury mechanisms in individual knees. Clinically, the model could potentially be used to analyze subject-specific potential/actual anterior cruciate ligament impingement based on the subject’s MRI scans.     

Biomechanical response of the passive human knee joint under anterior-posterior forces

Objective. To investigate the detailed biomechanics of the passive tibiofemoral knee joints in full extension under anterior/ posterior drawer forces of up to 400 N.

Design. A nonlinear three-dimensional finite element model of the entire human tibiofemoral joint consisting of bony structures, their articular cartilage layers, menisci, and four principal ligaments was utilized.

Background. The mechanics of the knee joint, specially under drawer forces, have extensively been investigated. Despite all these works, the detailed joint biomechanics, specially the role of boundary conditions, load transmission through menisci/ articular cartilage layers, and coupling between menisci and cruciate ligaments are not yet quantified.

Method. Nonlinear elastostatic analyses were carried out considering the tibiofemoral joint at full extension under anterior and posterior loads of up to 400 N applied either to the tibial or the femoral shaft. Cases with various boundary conditions, cruciate ligament deficiency (anterior or posterior), and total unilateral meniscectomy (medial or lateral) were analysed.

Results. In addition to the total primary anterior-posterior motion of about 9 mm at ± 400 N, significant coupled external tibial rotations of about 9 ° and 10 ° were computed under 400 N femoral posterior and anterior forces, respectively. The response was influenced by the manner of loading and boundary conditions. The anterior cruciate ligament and posterior cruciate ligament were the primary restraints to femoral posterior and anterior drawer forces, respectively. Section of either of these ligaments drastically increased the joint anterior-posterior motion. In the absence of cruciates, the collaterals became the primary restraints in both anterior-posterior forces. In this case, the tibial plateaus, specially the medial one in the anterior cruciate ligament-deficient joint, experienced much larger compressive forces. In addition to causing an increase in joint primary anterior-posterior laxity and anterior cruciate ligament forces, medial meniscectomy substantially increased coupled tibial external rotation, forces on the lateral plateau, and stresses in the articular cartilage of the lateral plateau.     

High-speed subfailure stretch of rabbit anterior cruciate ligament: changes in elastic, failure and viscoelastic characteristics

OBJECTIVE: To study alterations in the ligament mechanical characteristics due to a subfailure stretch delivered at high speed. DESIGN: An in vitro study of rabbit anterior cruciate ligaments. BACKGROUND: Although ligamentous sprains occur more frequently than the complete failures, only a few biomechanical studies have investigated the effects of such injuries. Purpose of the study was to document changes in elastic, failure and viscoelastic properties of a ligament that had been subjected to a high-speed subfailure stretch. METHODS: Thirteen paired fresh adult rabbit femur-anterior cruciate ligament-tibia preparations were used. One ligament of each pair (control) was subjected to two relaxation tests and then stretched until failure. The other ligament (experimental) was subjected sequentially to relaxation test, subfailure stretch (80% of the failure deformation of the control), relaxation test, and then stretched until failure. Load-deformation curve until failure was characterized by nine parameters, which included failure force, deformation and energy absorbed, and deformations measured at various load values, and stiffness. Relaxation curve was parameterized by five relaxation forces measured at 10, 30, 50, 130, and 180 s. RESULTS: Due to subfailure stretch, there were no changes in failure force and stiffness, while deformations increased, and energy absorbed and relaxation forces decreased. CONCLUSIONS: The 80% subfailure stretch delivered at high speed increased the deformations in load-deformation tests, and decreased the forces in relaxation tests. Relevance. Incomplete injuries of the ligaments are more prevalent than the complete injuries. The incomplete injury is a subfailure stretch delivered at high speed. The present study provides the results of simulating the incomplete injury using an in vitro ligament model.     

Komplexe Bandläsion des Kniegelenks

Combined injuries of the main knee ligaments have a broad spectrum, ranging from typical combinations like anterior cruciate ligament (ACL) and medial collateral ligament (MCL) ruptures up to knee luxations with severe combinations of both cruciate ligaments and at least one collateral ligament. Isolated injuries of the MCL and the posterior cruciate ligament (PCL) can be treated conservatively. Indications for surgical repair are mainly combined injuries of cruciate ligaments and ruptures of the lateral structures. Knee luxations are often complex injuries with neurovascular complications. Careful and early detection of these complications can avoid endangering the extremity and therefore prevent massive damage to the patient. Surgical repair of ligament injuries is superior to conservative treatment.     

Healing potential of the anterior cruciate ligament in terms of fiber continuity after a complete rupture: A systematic review

IntroductionComplete rupture of the anterior cruciate ligament is a major problem owing to inadequate surgery outcomes and the limited healing capacity of the ligament. This study aimed to summarise the evidence on the spontaneous healing potential of the anterior cruciate ligament in terms of fiber continuity based on magnetic resonance imaging (MRI) findings.MethodsPubMed, Cochrane Library, Scopus, and MEDLINE databases were searched from their inception to November 1, 2020. Studies that analysed patients diagnosed with complete anterior cruciate ligament rupture were included. Further, studies that used conservative treatment as intervention and MRI finding as an outcome measure were included.ResultsIn total, 9 studies, with a total of 734 participants, met the inclusion criteria. Knee laxity was measured in all studies. Two studies classified patients according to rupture location, where most ligaments with restored fiber continuity had proximal ruptures. All included studies reported spontaneous healing. Furthermore, none of the included studies reported the absence of healing.ConclusionsThis systematic review demonstrates the intrinsic healing capacity of the anterior cruciate ligament, indicating a higher healing potential for proximal ruptures. While our study reveals an emerging need to question general practice, a definitive conclusion could not be drawn owing to the low quality of the studies included and the heterogeneity of results.     

Comparative investigation on the biomechanical properties of ligament replacement in the sheep knee using six different ligament prostheses

Six different ligament prostheses were implanted in 40 sheep to replace the anterior cruciate and medial collateral ligament of the right knee. After one year the explanted knee joints were tested for stability by measurement of the anterior drawer. Tensile tests on the ligament replacements were performed to determine the stiffness and rupture force of the replacement. Gross inspection of the knee joint showed abrasion and partial ruptures for all types of prostheses after one year. Depending on the type of prosthesis total rupture rates between 0 and 66% of all implants could be seen. The anterior drawer for the operated knee was 3-4 times higher than for the non-operated contralateral side. Neither the stiffness nor the rupture strength of the replacements reached the biomechanical properties of the normal ligaments.     

Effect of hamstrings muscle action on stability of the ACL-deficient knee in isokinetic extension exercise

Objective. To quantify the effect of hamstrings muscle action on stability of the anterior cruciate ligament deficient knee during isokinetic exercise at various speeds.

Design. Mathematical modeling and forward-dynamics computer simulation were used to study the interactions between knee-extension speed, hamstrings co-contraction activity, and anterior tibial translation in the intact and anterior cruciate deficient knee.

Background. There is much experimental evidence available to believe that hamstrings co-contraction can reduce anterior tibial translation in the anterior cruciate deficient knee. Little is known, however, about the level of hamstrings activation needed to keep anterior tibial translation within normal limits during functional activity.

Methods. Isokinetic knee-extension was simulated with a sagittal-plane model used previously to study load sharing between the muscles, ligaments, and bones during isometric knee-extension exercise, isokinetic exercise, and squatting exercise.

Conclusions. Some amount of hamstrings activation is needed to stabilize an anterior cruciate deficient knee irrespective of how fast the knee extends. The level of hamstrings co-contraction needed to stabilize an anterior cruciate deficient knee is inversely related to extension speed. Hamstrings co-contraction is more effective in reducing anterior tibial translation than low-resistance extension exercise.Relevance

Excessive anterior tibial translation during knee-extension exercise may lead to damage of the meniscus and other passive structures inside the knee. If anterior cruciate deficient patients can be trained to co-contract their hamstrings during isokinetic knee-extension, then this exercise is appropriate for maintaining strength of the thigh muscles without compromising the anterior stability of the knee.     

VKB-Verletzungsmuster und Augmentation von Partialrupturen

The anterior cruciate ligament (ACL) consists of the anteromedial (AM) and posterolateral (PL) bundles. In the clinical scenario a complete rupture of the ACL from the femoral footprint is most common. Partial ruptures are less frequently seen and involve intact tibial ACL fibres that attach to the posterior cruciate ligament (PCL) or intact tibial ACL fibres that attach high (AM) or low (PL) to the lateral wall of the notch. Conventional imaging techniques mostly miss the distinction between two bundles. The same is true for the conventional arthroscopist who is used to a standard diagnostic arthroscopy, which does not routinely include separation of the AM bundle from the PL bundle through the septum. An isolated rupture of the AM bundle (greatest tension in knee flexion) mainly influences the outcome of the anterior drawer test, whereas an isolated rupture of the PL bundle (greatest tension near knee extension) influences the Lachman test. The pivot shift test is utilized to diagnose anterolateral rotational instability (ALRI) and in some cases to diagnose PL ruptures. The pivot shift can, however, be negative in cases of isolated AM ruptures. Partial ruptures of the ACL should be treated with partial ACL reconstructions (augmentation). Techniques for reconstruction of the PL bundle and AM bundle are described in this article.     

Biomechanical study on the effect of twisted human patellar tendon

Objective. To compare the stiffness and maximum strength between the untwisted and twisted free-tendon.

Design. 22 twisted and untwisted sectioned-specimens of human cadaver patellar tendons were used and pulled to failure to obtain load-deformation profiles from which stiffness, maximum load to failure and elastic elongation limit were derived.

Background. In the reconstruction of the deficient anterior cruciate ligament, the use of the central one-third of the patellar tendon is a well-established procedure in which, prior to insertion, the tendon graft may be twisted to mimic the natural orientation of the anterior cruciate ligament in the knee joint.

Results. The untwisted tendons had a mean stiffness of 36.5 kg/mm (SD, 16.6 kg/mm) and maximum load of 165.9 kg (SD, 86.8 kg). With a 90° twist, the average stiffness of the twisted tendon was 66.5 kg/mm (SD, 25.4 kg/mm), with maximum load at 364.5 kg (SD, 109.9 kg), an increase of over 100%. The elastic elongation limit, or allowable elongation before permanent deformation or failure, was significantly larger in twisted tendons by 35%.

Conclusion. Twisting increased the resistance to deformation of the tendon in this study.

Relevance

The finding supports the surgical practice of pre-twisting tendon grafts for anterior cruciate ligament reconstruction, based on the premise that a stronger and stiffer graft provides a more favourable outcome.     

Injury initiation and progression in the anterior cruciate ligament

OBJECTIVE: To develop a theoretical model to identify mechanisms by which total and partial tears of the anterior cruciate ligament could occur. DESIGN: A sagittal-plane knee model was used to investigate anterior cruciate ligament injury due to excessive anterior tibial translation. The ligament was modelled as an ordered array of fibres linking femur and tibia. BACKGROUND: Despite years of research, the detailed biomechanics of anterior cruciate ligament injury is not well understood. METHODS: A "critical strain criterion" was used to identify the onset and progression of model ligament fibre disruption. The associated forces were also calculated. RESULTS: At low flexion angles (<20 degrees ), the posterior fibre of the model ligament failed first, and the tear progressed anteriorly through the ligament. At higher flexion angles, the anterior fibre failed first, and the tear progressed posteriorly. Near the flexion angle at which the progression of injury changed direction, all fibres failed at approximately the same anterior tibial translation. At all but very high flexion angles, the force supported by the injured ligament was maximum when initial fibre failure occurred; the force then decreased with increasing anterior tibial translation. CONCLUSIONS: Near (20 degrees ) flexion, all model anterior cruciate ligament fibres fail at approximately the same anterior tibial translation, implying that a partial ligament tear may be impossible in this flexion region. Relevance. This study provides insight into possible mechanisms of initiation and progression of anterior cruciate ligament injury. It suggests that a partial tear of the posterior half of the ligament may be difficult to detect clinically.     

On the coupling between anterior and posterior cruciate ligaments,and knee joint response under anterior femoral drawer in flexion: a finite element study

OBJECTIVE: To investigate the extent of coupling between the anterior and posterior cruciate ligaments as well as the role of the posterior cruciate ligament in the knee joint response under anterior femoral force at different flexion angles. DESIGN: A developed finite element model of the tibiofemoral joint is used to perform non-linear elastostatic analyses. BACKGROUND: The structural properties of the posterior cruciate ligament subsequent to an injury (either left untreated or replaced by a graft) would likely change, an event that alters the function of not only the ligament itself but also the other intact cruciate ligament and the entire joint. METHODS: The model consists of two bony structures and their articular cartilage layers, menisci and four principal ligaments. Under 100 N anterior femoral load at different flexion angles from 0 degrees to 90 degrees, kinematics, forces in ligaments and contact forces in the fully unconstrained joint were computed in intact cases and following alterations in joint ligaments. RESULTS: Collateral ligaments were the primary structures to resist the force at full extension under 100 N anterior femoral load with a moderate contribution from the posterior cruciate ligament. With joint flexion up to 90 degrees, however, force in the posterior cruciate ligament substantially increased whereas that in collateral ligaments diminished. CONCLUSIONS: A remarkable coupling was found between the posterior cruciate ligament and the anterior cruciate ligament in flexion; a structural alteration in one of them significantly influenced the mechanical role of both ligaments and not just the one affected. A tauter or stiffer ligament increased the force in both ligaments while an excessive laxity or rupture in one diminished forces in both. RELEVANCE: Alterations in ligament stiffness or initial tautness during reconstruction surgery or following injuries markedly influence the normal role of both cruciate ligaments. Consideration of cruciate ligaments coupled together rather than in isolation should be the rule in the management of ligament injuries towards a successful long-term outcome.     

关节镜下LARS人工韧带在重建前交叉韧带中的临床应用

目的探讨在关节镜下运用韧带增强重建系统（LARS）人工韧带重建前交叉韧带的手术方法和临床疗效。方法 2007年6月起运用法国LARS人工韧带治疗前交叉韧带断裂14例。等距点建立胫骨和股骨骨道,置入韧带后游离纤维位于关节腔内,挤压螺钉固定。结果经平均18个月随访,术后Lysholm评分平均92分,优9例,良5例,优良率为100%。术后无感染、无韧带断裂,无膝关节疼痛。结论运用＂LARS人工韧带＂重建前交叉韧带可达到解剖重建,可有效恢复膝关节稳定性;关节镜下手术拥有创伤小、康复快、疗效好等微创特点。     

Biomechanical evaluation of intra-articular and extra-articular procedures in anterior cruciate ligament reconstruction: a finite element analysis

BACKGROUND: Intra-articular techniques (single and double bundles) are the most widely used procedures for the anterior cruciate ligament reconstruction. Lemaire introduced in 1967 the extra-articular techniques, and combined intra-articular and extra-articular reconstruction, to better restore the stability of the knee. However, the effectiveness of these procedures (intra-articular, extra-articular combined or not with intra-articular) seems to be controversial. METHODS: In the present study, we developed numerical models of a knee joint to evaluate the effects of these different procedures on the kinematics and biomechanics of the knee during an internal rotation test. Six cases were simulated: intact anterior cruciate ligament, intra-articular reconstructed anterior cruciate ligament (single and double bundles), extra-articular reconstructed anterior cruciate ligament alone, and combination of extra- and intra-articular reconstructions. The loading condition was an internal tibial torque of 2 N m at 0 degrees, 15 degrees, 30 degrees and 45 degrees of knee flexion. Internal rotation of the tibia and forces within the grafts and the ligaments were calculated. FINDINGS: This study showed that both single and double bundles intra-articular reconstructions restore similar internal rotation control and biomechanics of the soft structures as the intact anterior cruciate ligament situation. On the other hand, our results indicate that extra-articular reconstruction reduces appreciably the internal rotation and modifies the charges distribution in the soft structures when compared to the intact anterior cruciate ligament. INTERPRETATION: The extra-articular procedure alters the kinematics of the knee, which might overconstraint the ligaments and the femorotibial joints, leading to the failure of the anterior cruciate ligament reconstruction.     

Intraoperative biologische Augmentation an Ligamenten

Background

For an optimal operative treatment of ligament injuries, biological considerations are increasingly being recognized as a key factor in addition to an exact restoration of the ligament anatomy. Following an acute injury of an extraarticular ligament (e.g. medial collateral ligament), formation of a rupture hematoma with infiltration of platelets, growth factors and ligamentous progenitor cells can usually be observed, which may initiate a successful healing response when adequately coordinated. In contrast, only a temporary but unstable formation of a rupture haematoma can be observed in intraarticular ligament ruptures (e.g. anterior cruciate ligament), which mostly causes an insufficient healing process.

Methods

The augmentation of ligaments is considered a biological surgical technique that aims to leave as much natural and intact tissue as possible in order to support the autogenous healing potential. Partial ruptures, e.g. of only one bundle of the anterior cruciate ligament, are restored individually in case of instability. To improve the healing process, several biological techniques have been recently introduced. All these techniques comprise debridement and refreshing of the surrounding original tissue. Tendon grafts can be used to structurally augment primary ligament stabilization approaches in some cases. Blood preparations such as platelet-rich concentrates or cell-based therapies such as application of stem cells may be used to further biologically augment the ligament healing response. These intraoperative biological augmentation techniques will be exemplarily demonstrated in the anterior cruciate ligament and the medial collateral ligament.     

Anterior cruciate ligament rupture translates the axes of motion within the knee

OBJECTIVE: To quantify the dynamic effects of anterior cruciate ligament deficiency on human knee joint motion. DESIGN: Three-dimensional motion was assessed by measuring the kinematics of intact and anterior cruciate ligament deficient knee joint specimens during simulated flexion-extension cycles. BACKGROUND: It is known that the anterior cruciate ligament plays an important role in controlling three-dimensional knee joint motion. Nevertheless, dynamic effects of deficiency are not fully understood. METHODS: Six cadaveric knees were tested in a knee joint motion and loading apparatus prior to and after anterior cruciate ligament resection. To determine if the kinematic results depended on additional loading, internal and external rotation moments of 3.4 Nm were axially applied to the tibia. The kinematics were analysed in terms of finite helical axes. RESULTS: Sectioning the anterior cruciate ligament had little effect on the orientations of the finite helical axes. However, applying moments did affect the axes orientation. In contrast, relative translations of the axes were significantly affected by the deficiency for all rotational moments applied. Referring to the individual knee anatomy the largest translation of 12.5 mm (median) occurred in medial/lateral direction. CONCLUSIONS: Anterior cruciate ligament rupture primarily causes a translation of the finite helical axes in medial/lateral direction. Consequently, increased anterior excursion of the tibia occurs (subluxation) and therefore dynamic instability.     

Dynamische intraligamentäre Stabilisation und vordere Kreuzbandnaht

Following a distortion trauma with a blow to the lateral side of the knee during tackling in soccer, a rupture of the anterior cruciate ligament, a tear of the posterior horn of the lateral meniscus and a depressed fracture of the lateral condyle of the femur were determined in a 23-year-old man. Arthroscopic meniscal repair using the all-inside technique and repair of the anterior cruciate ligament were carried out with dynamic intraligamentary stabilization. In the postoperative course a re-arthroscopy and removal of the screw system was necessary because of pain above the proximal tibia. Arthroscopy showed a completely healed meniscus and a stable and healed anterior cruciate ligament. After removal of the screws and sutures the patient was free of complaints.     

人工合成材料在膝交叉韧带损伤修复中的应用

目的:通过对人工合成材料重建膝交叉韧带研究进展的研究和临床实验观察,着重探讨其重建后在损伤修复中的应用前景.方法:由第一作者应用计算机检索维普数据库与人工合成材料重建膝交叉韧带有关的文献,检索时限为1993-01/2009-10.检索关键词:膝关节交叉韧带;人工韧带:移植重建.纳入标准:①人工合成材料在膝交叉韧带损伤修复中应用等相关文献.②LARS人工韧带重建膝前、后交叉韧带的实验研究与临床应用相关的文章.排除标准:③排除较陈旧的理论观点以及一些重复性研究.对资料进行初审,并查看每篇文献后的引文.结果:计算机初检到105篇文献,阅读标题和摘要进行初筛,排除研究目的与本文无关的文献40篇,内容重复性研究44篇,共21篇文献符合标准.膝关节前交叉韧带断裂是一种严重的膝关节损伤,可导致膝关节不稳,并可继发关节内主要结构损伤,严重影响关节功能.对于要求锻炼的年轻患者,特别是运动员前交叉韧带损伤,LARS人工韧带是理想移植材料.目前为止,LARS人工韧带的并发症报道比例较小,特别是没有滑膜炎的报道,被认为是安全的移植材料.结论:人工韧带为前、后交叉韧带重建的确提供了一种选择,但仍存在不足之处,还不是最理想的移植物,也不能完全代替交叉韧带.     

关节镜治疗部队训练所致的膝关节损伤

目的：探讨部队训练所致膝关节损伤的特点，提出治疗和预防的措施。方法：分析1985年以来我院收治的部队训练所致膝关节损伤的类型及治疗方法。结果：1985年以来共收治357例膝关节训练伤的患者。按各种损伤类型单独统计，半月板损伤321例，内侧副韧带损伤19例，外侧副韧带损伤3例，前交叉韧带损伤36例，后交叉韧带损伤7例，胫骨棘骨折11例。除内外侧副韧带损伤采用开放手术修复重建以外，均采用关节镜下的修复与重建，疗效满意，术后1年时随访优良率达92．43％。结论：膝关节损伤是部队训练伤的常见类型之一，特点主要是半月板和膝关节韧带的损伤。绝大多数膝关节损伤可采用关节镜微创技术治疗，术后进行康复锻练理疗。