DOI QR코드

DOI QR Code

The Posterior Cruciate Ligament (PCL) Reconstruction by the Transtibial Tunnel Method using Cadaveric Achilles Tendon Grafts - Evaluation of the Initial Lengthening and the Slippage Ratio due to the Interference Screw Fixation and Double Cross-Pin Fixation -

사체 아킬레스건을 이용한 경골관통터널방식의 후방십자인대 재건술 - 간섭나사 및 이중고정핀 방식에 따른 초기연신 및 활주율 평가 -

  • 김철웅 (고려대 공학기술연구소/(주)트리플씨메디칼) ;
  • 배지훈 (고려대학교 의과대학 정형외과) ;
  • 오동준 (안동대학교 기계교육과)
  • Published : 2009.04.01

Abstract

Posterior Cruciate Ligament (PCL) plays an important role in knee extension. Rotational instability due to injured PCL can be restored by various PCL reconstruction methods. In this study, the initial lengthening affected by fixation device and location was demonstrated, and furthermore, the slippage and the relationship between lengthening ratio and slippage ratio in the calcaneus and soft tissue fixation methods was newly suggested. Eight specimens of proximal tibia and Achilles tendon grafts were harvested from four cadavers and divided into four groups in regard to the four different types of transtibial fixation techniques. The cyclic load ranged from 50 N to 250 N applied to each graft fixed to proximal tibia in 55 degrees. The initial lengthening ratio to the total elongation has been approximately constant regardless of the fixation methods. The soft tissue fixation method with an interference screw showed about 56.4% slippage ratio to the total elongation and the same method with a double cross-pin presented about 45.4% slippage ratio. The soft tissue fixation method with an interference screw demonstrated approximately 2 mm less total elongation and about 13% more slippage than lengthening because of poor fixation compared to the same method with a double cross-pin.

Keywords

Posterior Cruciate Ligament(PCL);Cadaveric Achilles Tendon;Reconstruction;Transtibial Tunnel;Interference Screw;Double Cross-Pin;Initial Lengthening;Slippage Ratio

References

  1. Hong Chul Lim, Jae Chul Yoo, and Sang Hwan Han, 2002, 'Anatomic Double-Bundle Posterior Cruciate Ligament Reconstruction Using Achilles Allograft -Preliminary Report-,' Journal of KoreanArthroscopy Society, Vol. 6, No. 1, pp. 7-13
  2. Claude T. Moorman, Siobhan Murphy Zane, Sanjiv Bansai, Stephen J. Cina, Thomas L. Wickiewicz, Tussel F. Warren, and Maria Kyriaki Kaseta, 2008, 'Tibial Insertion of the Posterior Cruciate Ligament: A Sagittal Plane Analysis Using Gross, Histologic, and Radiographic Methods,' Arthroscopy: The Journal of Arthroscopic & Related Surgery, Vol. 24, Issue 3, pp. 269-275 https://doi.org/10.1016/j.arthro.2007.08.032
  3. Christopher J. Wahl and Gregg Nicandri, 2008, 'Single-Achilles Allograft Posterior Cruciate Ligament and Medial Collateral Ligament Reconstruction: A Technique to Avoid Osseous Tunnel Intersection, Improve Construct Stiffness, and Save on Allograft Utilization,' Arthroscopy: The Journal of Arthroscopic & Related Surgery, Vol. 24, Issue 4, pp. 486-489 https://doi.org/10.1016/j.arthro.2007.08.003
  4. Andre Weimann, Alexandra Wolfert, Thore Zantop, Anne-Kathleen Eggers, Michael Raschke, and Wolf Petersen, 2007, "Reducing the 'Killer Turn" in Posterior Cruciate Ligament Reconstruction by Fixation Level and Smoothing the Tibial Aperture,' The Journal of Arthroscopic and Related Surgery, Vol. 23, No.10, pp. 1104-1111 https://doi.org/10.1016/j.arthro.2007.04.014
  5. Yong Seuk Lee, Young Bok Jung, Jin Hwan Ahn, Bun Jung Kang, Yun Chang Shin, and Chae Gwan Kong, 2006, 'Transtibial Double Bundle PCL Reconstruction Using TransFix Tibial Fixation-Technical Note-.' Journal of Korean Arthroscopy Society, Vol. 10, No. 2, pp. 203-208
  6. Jin Hwan Ahn, Jae Chul Yoo, and Joon Ho Wang, 2005, 'The Clinical Results of Posterior Cruciate Ligament Reconstruction - Preservation of Remnant Posterior Cruciate Ligament-,' Journal of Korean Orthopaedic Association, Vol. 40, No. 7, pp. 889-896 https://doi.org/10.4055/jkoa.2005.40.7.889
  7. Thore Zantop, Markus Ruemmler, Barbara Wlbers, Martin Langer, Andre Weimann, and Wolf Petersen, 2005, 'Cyclic Loading Comparison Between Biodegradable Interference Screw Fixation and Biodegradable Double Cross-Pin Fixation of Human Bone-Patellar Tendon-Bone Grafts,' Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol. 21, No. 8, pp.934-941 https://doi.org/10.1016/j.arthro.2005.05.022
  8. Brand J., Weiler A., Caborn D.N.M., Brown C., and Johnson D., 2000, 'Graft Fixation in Cruciate Ligament Reconstruction,' American Journal of Sports Medicine, Vol. 28, pp. 761-773 https://doi.org/10.1177/03635465000280052501
  9. Kleipool, AE., Van Loon, T. and Morti, RK.,1994, 'Pain After use of the Central Third of the Patellar Tendon for Cruciate Ligament Reconstruction: 33 Patients Followed for 2-3 Years,' Acta Orthop Scand, Vol. 65, pp. 62-66 https://doi.org/10.3109/17453679408993720
  10. Patricia Niedzwietzki, Thore Zantop, Andre Weimann, Mirco Herbort, Michael J. Raschke, and Wolf Petersen, 2007, 'Femoral Fixation of Hamstring Grafts in Posterior Cruciate Ligament Reconstruction: Biomechanical Evaluation of Different Fixation Techniques,' The American Journal of Sports Medicine, Vol. 35, No.5, pp. 780-786 https://doi.org/10.1177/0363546506297906
  11. In, Y., Bahk, W.J. and Kwon, O.S., 2004, 'Cross-Pin Femoral Fixation for Hamstring Posterior Cruciate Ligament Reconstruction,' Arthroscopy Association of North America, Vol. 33, No.12, pp. 29-33
  12. Thomas Nau, Yan Chevalier, Nicola Hagemeister, Jacques A. deGuise and Nicolas Duval, 2005, 'Comparison of 2 Surgical Techniques of Posterolateral Coner Reconstruction of the Knee,' The American Journal of Sports Medicine, Vol. 33, No.12, pp. 1838-1845
  13. Thore Zantop, Andre Weimann, Kerstin Wolle, Volker Musahl, Martin Langer, and Wolf Petersen, 2007, 'Initial and 6 Weeks Postoperative Structural Properties of Soft Tissue Anterior Cruciate Ligament Reconstructions With Cross-Pin or Interference Screw Fixation: An In Vivo Study in Sheep,' Arthroscopy Association of North America, Vol. 23, No.1, pp. 14-20
  14. Beom Ku Lee, In Ho Seong, Young Hun Jang, and Seung Jeong Baek, 1999, 'Clinical Study After Reconstruction of the Posterior Cruciate Ligament-Factors on Posterior Stability-,' Journal of Korean Arthroscopy Society, Vol. 11, No. 6, pp. 62-68
  15. Dong Chul Lee, Oog Jin Sohn, Woo Hyuk Jang, and Sang Keun Bae, 2006, 'Evaluation of Posterior Cruciate Ligament Reconstruction Using the Femoral Double Tunnel and Tibial Inlay Techniques,' Journal of Korean Orthopaedic Association, Vol. 41, No. 4, pp. 658-664 https://doi.org/10.4055/jkoa.2006.41.4.658
  16. Eun Kyoo Song and Jong Kuen Sun, 2005, 'Comparative Study of Posterior Cruciate Ligament Reconstruction -Transtibial Tunnel Method Versus Tibial Inlay Method-,' Journal of Korean Arthroscopy Society, Vol. 9, No. 1, pp. 13-15
  17. Kousa P., Jarvinen T.L., Pohjonen T., Kannus P., and Jarvinen M, 2001, 'Initial Fixation Strength of Biodegradable and Titanium Screws in Anterior Ligament Reconstruction. Biomechanical Evaluation by Single Cycle and Cyclic Loading,' American Journal of Sports Medicine, Vol. 29, pp. 420-425 https://doi.org/10.1177/03635465010290040601
  18. Song, E.K., Yoon, T.R. and Jung, J.W., 2001, 'Widening of Bony Tunnel After ACL Reconstruction using Hamstring with Ligament Anchor (LA) Screw, Journal of Korean Arthroscopy Society, No. 5, pp. 69-73