Background

Newer repair techniques of anterior cruciate ligament tears, including augmentation with internal brace, have shown promising clinical results. Few biomechanical studies exist comparing anterior cruciate ligament repair only versus repair with internal brace. The purpose of this study was to compare the load to failure and stiffness of anterior cruciate ligament repair with internal brace augmentation versus repair-only.

Methods

Proximal femoral avulsion type anterior cruciate ligament injuries were created in 20 cadaver knees. Anterior cruciate ligament repair-only or repair with internal brace was performed using arthroscopic tools. Load to failure and failure modes were collected, with calculations of stiffness and energy to failure performed.

Findings

The average load to failure for the internal brace group was higher than the repair-only group: 693 N (SD 248) versus 279 N (SD 91), P = .002. The stiffness and energy to failure values were higher for the internal brace group than the repair-only group: 83 N/mm versus 58 N/mm, P = .02 and 16.88 J (SD 12.44) versus 6.91 J (SD 2.49), P = .04, respectively. Failure modes differed between groups (P = .00097) with 80% failure in the repair-only due to suture pull through the anterior cruciate ligament and 90% failure in the internal brace group due to suture button pull through the femur.

Interpretation

There was higher load to failure, stiffness, and energy to failure for the internal brace group compared to the repair-only group, and a high positive correlation between bone density and load to failure for the internal brace group.

Clinical significance

Anterior cruciate ligament repair with internal brace augmentation demonstrates significantly higher load to failure. It may be a useful adjunct to protect the anterior cruciate ligament repair from failure during the early stages of healing.

中文翻译：

---

内支架加前交叉韧带修复与不加前交叉韧带修复的生物力学比较。

背景

较新的修复前交叉韧带撕裂的技术，包括增加内部支撑，已显示出令人鼓舞的临床效果。很少有生物力学研究比较仅将前交叉韧带修复与使用内部支架修复。这项研究的目的是比较采用内部撑大的前交叉韧带修复与单纯修复相比的载荷，失效和刚度。

方法

在20具尸体膝盖中产生了股骨撕脱型前交叉韧带损伤。仅使用关节镜工具进行前交叉韧带修复或带内部支架的修复。收集了失效载荷和失效模式，并进行了刚度和失效能量的计算。

发现

内部支架组的平均失效载荷高于仅维修组：693 N（SD 248）对279 N（SD 91），P  = .002。内部支架组的刚度和破坏能量值高于仅维修组：83 N / mm对58 N / mm，P  = .02和16.88 J（SD 12.44）对6.91 J（SD 2.49），P 分别为0.04。两组之间的失败模式不同（P  = .00097），其中仅80％的失败是由于缝合线穿过前交叉韧带而造成的，而内支架的90％的失败是由于缝合纽扣穿过了股骨。

解释

与仅进行修复的组相比，内部支架组的破坏载荷，刚度和破坏能量更高，并且内部支架组的骨密度与破坏载荷之间呈正相关。

临床意义

前交叉韧带修复与内部撑杆增大显示出明显更高的失败负荷。在愈合的早期阶段，保护前十字韧带修复免于失败可能是有用的辅助工具。