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前交叉韧带中响应旋转负荷的原位力分布。

Distribution of in situ forces in the anterior cruciate ligament in response to rotatory loads.

作者信息

Gabriel Mary T, Wong Eric K, Woo Savio L-Y, Yagi Masayoshi, Debski Richard E

机构信息

Department of Orthopaedic Surgery, Musculoskeletal Research Center, University of Pittsburgh, P.O. Box 71199, E1641 Biomedical Science Tower, 210 Lothrop Street, Pittsburgh, PA 15213, USA.

出版信息

J Orthop Res. 2004 Jan;22(1):85-9. doi: 10.1016/S0736-0266(03)00133-5.

Abstract

The anterior cruciate ligament (ACL) can be anatomically divided into anteromedial (AM) and posterolateral (PL) bundles. Current ACL reconstruction techniques focus primarily on reproducing the AM bundle, but are insufficient in response to rotatory loads. The objective of this study was to determine the distribution of in situ force between the two bundles when the knee is subjected to anterior tibial and rotatory loads. Ten cadaveric knees (50+/-10 years) were tested using a robotic/universal force-moment sensor (UFS) testing system. Two external loading conditions were applied: a 134 N anterior tibial load at full knee extension and 15 degrees, 30 degrees, 60 degrees, and 90 degrees of flexion and a combined rotatory load of 10 Nm valgus and 5 Nm internal tibial torque at 15 degrees and 30 degrees of flexion. The resulting 6 degrees of freedom kinematics of the knee and the in situ forces in the ACL and its two bundles were determined. Under an anterior tibial load, the in situ force in the PL bundle was the highest at full extension (67+/-30 N) and decreased with increasing flexion. The in situ force in the AM bundle was lower than in the PL bundle at full extension, but increased with increasing flexion, reaching a maximum (90+/-17 N) at 60 degrees of flexion and then decreasing at 90 degrees. Under a combined rotatory load, the in situ force of the PL bundle was higher at 15 degrees (21+/-11 N) and lower at 30 degrees of flexion (14+/-6 N). The in situ force in the AM bundle was similar at 15 degrees and 30 degrees of knee flexion (30+/-15 vs. 35+/-16 N, respectively). Comparing these two external loading conditions demonstrated the importance of the PL bundle, especially when the knee is near full extension. These findings provide a better understanding of the function of the two bundles of the ACL and could serve as a basis for future considerations of surgical reconstruction in the replacement of the ACL.

摘要

前交叉韧带(ACL)在解剖学上可分为前内侧(AM)束和后外侧(PL)束。目前的ACL重建技术主要侧重于重现AM束,但在应对旋转负荷方面存在不足。本研究的目的是确定膝关节承受胫骨前向和旋转负荷时两束之间的原位力分布。使用机器人/通用力-力矩传感器(UFS)测试系统对10个尸体膝关节(50±10岁)进行测试。施加了两种外部负荷条件:在膝关节完全伸展以及屈曲15度、30度、60度和90度时施加134 N的胫骨前向负荷,以及在屈曲15度和30度时施加10 Nm外翻和5 Nm胫骨内旋的联合旋转负荷。确定了由此产生的膝关节6个自由度的运动学以及ACL及其两束中的原位力。在胫骨前向负荷下,PL束的原位力在完全伸展时最高(67±30 N),并随屈曲增加而降低。AM束的原位力在完全伸展时低于PL束,但随屈曲增加而增加,在屈曲60度时达到最大值(90±17 N),然后在90度时降低。在联合旋转负荷下,PL束的原位力在15度时较高(21±11 N),在屈曲30度时较低(14±6 N)。AM束的原位力在膝关节屈曲15度和30度时相似(分别为30±15 N和35±16 N)。比较这两种外部负荷条件表明了PL束的重要性,尤其是当膝关节接近完全伸展时。这些发现有助于更好地理解ACL两束的功能,并可为未来ACL置换手术重建的考虑提供依据。

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