All-epiphyseal ACL Reconstruction Improves Tibiofemoral Contact: An In Vitro Study

作者：Stonestreet Matthew J; Jones Kerwyn C; Kirkpatrick Marcus S; Shah Kushal S; Frampton Caroline E; Morscher Melanie A; Elias John J^*

来源：Journal of Pediatric Orthopaedics, 2012, 32(1): 15-20.

DOI：10.1097/BPO.0b013e31823b18bd

• ACL reconstruction
• pediatric
• tibiofemoral joint
• contact

Background: Anterior cruciate ligament (ACL) injury alters tibiofemoral contact during function, with a posterior shift of the point of contact on the tibia. An all-epiphyseal approach to ACL reconstruction is performed in pediatric patients to improve tibiofemoral contact without disturbing the physis. The hypothesis of the study is that all-epiphyseal ACL reconstruction will shift contact anteriorly on the tibia, as compared with the ACL-deficient knee. %26lt;br%26gt;Methods: Ten cadaver knees were tested with the ACL cut and with an all-epiphyseal reconstruction. The knees were set at multiple flexion angles (0, 15, 30, and 45 degrees) and loaded with a quadriceps force of 596N in combination with an anterior force of 100N, with the quadriceps loaded in isolation, and with the quadriceps loaded in combination with a hamstrings force of 200N. Sensors under the menisci characterized the center of force on the tibia. Paired t tests were used to identify significant (P %26lt; 0.05) differences between the reconstructed and cut conditions for all loading conditions at all flexion angles. %26lt;br%26gt;Results: On the medial plateau, the average center of force was 2 to 5mm more anterior for the reconstructed condition than for the ACL cut, with the difference significant for all test conditions. The largest differences between the ACL conditions occurred for the combination of quadriceps forces plus an anterior force. On the lateral plateau, the anterior shift in the center of force from the ACL cut to reconstructed condition was significant for all flexion angles except 0 degree for all loading conditions, with an average difference of approximately 2mm for all significant differences. %26lt;br%26gt;Conclusions: All-epiphyseal ACL reconstruction shifts contact anteriorly on the tibia compared with the injured knee. %26lt;br%26gt;Clinical Relevance: The anterior shift of contact on the femur related to all-epiphyseal ACL reconstruction reduces changes related to ACL injury, which could reduce the risk of cartilage damage and meniscal injuries without violating the growth plate in pediatric patients.

• 出版日期2012-2