Biomechanical characteristics of suturing the ligament end during anterior cruciate ligament reconstruction

doi:10.3969/j.issn.2095-4344.2014.42.020

Abstract

Abstract:

BACKGROUND: During autologous tendon grafting, the ultimate tensile strength used for suturing the end of the ligament is important for successful surgery. Improving suturing strength and increasing the number of stitches is a good choice for increasing the fixed intensity. But excess amount of stitches can produce too many thread residues, thereby affecting tendon healing.
OBJECTIVE: To investigate the essential number of suturing pins for the anterior cruciate ligament revascularization in ligament end suture fixation to reduce suturing thread exposure.
METHODS: (1) In vitro biomechanics test: 12 patellar ligament specimens were divided into two groups: the specimens were sutured with 5 or 3 stitches using Krackow suture method. The suturing thread was J&J tendon suture thread. The strength of tensile was compared between the two groups by Tensile mechanical test was conducted to compare the strength of tensile between the two groups and to explore the optimal number of stitches and suturing method. (2) Clinical application: According to the results of in vitro experiments, modified Krackow suture method was used clinically for arthroscopic anterior cruciate ligament reconstruction in 125 cases, including 62 cases receiving 3-stitch suture, and 63 cases undergoing 5-stitch suture.
RESULTS AND CONCLUSION: The fixed strength of tensile at suture sites was over 100 N for 3-stitch double-lock suture and 110 N for 5-stitch double-lock suture. There was no significant difference in the fixed strength between the two groups, but their strength values were both over the breaking strength of suturing materials. Moreover, the fixed strength could not be reduced by suturing throughout the ligament at the first stitch. All the 125 cases were followed for 6.4 months averagely, and both 3-stitch and 5-stitch suture methods achieved good outcomes. The satisfaction rate was up to 99%, and no suture breakage or loosing occurred at early and late stages. These findings suggest that, using 3-stitch double-lock suture method, a satisfactory fixed strength can be achieved with reduced thread exposure. The suturing thread can run through the ligament at the first stitch, which can reduce thread exposure but not reduce the fixed strength.

中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程

全文链接：

Key words: anterior cruciate ligament, posterior cruciate ligament, biomechanics, arthroscopy

CLC Number:

R318

Chen Xiao, Huang Jing-min. Biomechanical characteristics of suturing the ligament end during anterior cruciate ligament reconstruction[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(42): 6827-6831.

Figures/Tables 1

2 临床应用 Clinical application 2.1 对象和方法设计：病例回顾性分析。时间及地点：2013年7月至2014年6月在天津医院运动与损伤关节镜2病区完成。对象：2013年7月至2014年6月，本科共施行关节镜下前、后交叉韧带重建术315例，选取了其中125例前交叉韧带重建患者进行临床缝线方式拉力比较，男88例，女37例；年龄(35.3±6.7)岁；均为膝关节运动性损伤。纳入标准：①膝关节运动性损伤患者。②行关节镜下前交叉韧带重建者。③患者对治疗均知情同意，签署“知情同意书”。排除标准：膝关节骨性关节炎、类风湿关节炎、肿瘤等。方法：所有患者施行关节镜下前交叉韧带重建，采用改良的Krackow双锁边缝合法(肌腱缝合线由强生公司提供，商品名爱惜康缝线)，移植物的胫骨端全部采用缝线固定，经胫骨骨隧道拉出，在保持移植物张力的情况下，胫骨前面挤压螺钉固定。 3针固定组：在2013年12月以前，62例次采用两条缝线双锁边法缝合3针固定，借鉴张春礼[16]方法，第一针贯穿韧带缝合。康复计划为：术后当日开始直腿抬高训练；术后7 d佩戴交叉韧带型铰链支具，扶双拐患肢不完全负重下地行走，术后2周30°，3周60°，4周90°，5周120°，2个月可完全负重逐步弃拐行走，3个月去支具，然后恢复自由行走，1年后经医生检查允许后可开始参加体育运动。 5针固定组：2013年12月以后的63例采用两条缝线双锁边法缝合5针固定，第一针同样贯穿韧带，术后功能恢复计划同前。主要观察指标：①随访时行抽屉试验检查前交叉韧带及后交叉韧带功能。②患者满意率。③不良反应及材料宿主反应。 2.2 结果 2.2.1 参与者数量分析 125例患者肌腱重建后随访2-14个月，平均随访6.4个月，无脱落者，按意向性处理分析，全部进入结果分析。 2.2.2 两组基线资料比较两组前交叉韧带重建患者的性别、年龄、病程等比较差异无显著性意义(P > 0.05)，有可比性，见表1。 2.2.3 随访结果抽屉试验阳性患者2例，患者满意率99%。3针固定组及5针固定组组间比较差异无显著性意义(P > 0.05)。 2.2.4 不良反应及材料宿主反应未见早期或晚期缝线断裂松脱，患者康复顺利，无意外情况发生；无二次手术、无伤口感染等并发症发生。"

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