Zantop Thore, Petersen Wolf, Sekiya Jon K, Musahl Volker, Fu Freddie H
Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
Knee Surg Sports Traumatol Arthrosc. 2006 Oct;14(10):982-92. doi: 10.1007/s00167-006-0076-z. Epub 2006 Aug 5.
Recently, the interest in surgical techniques that reconstruct the anteromedial (AM) and the posterolateral (PL) bundles of the anterior cruciate ligament (ACL) has risen. This review focuses on the structural as well as the mechanical properties of the ACL and the anatomical details of the femoral origin, midsubstance, and tibial insertion of AM and PL bundles of the ACL. The terminology of AM and PL bundles is chosen according to the tibial insertion and determined by their functional tensioning pattern throughout knee flexion. Close to extension the AM is moderately loose and the PL is tight. As the knee is flexed, the femoral attachment of the ACL becomes more horizontally oriented, causing the AM bundle to tighten and the PM bundle to loosen up. The ACL has been described to be restraint to anterior tibial displacement and internal tibial rotation. The rotational component might be represented by the PL bundle. The femoral origin has an oval shape with the center of the AM close to over-the-top position and the center of the PL close to the anterior and inferior cartilage margin. Tibial and femoral insertions of the ACL are over 3.5 times larger when compared to the midsubstance and tunnel placement is more challenging because of the limited size of potential grafts selection of tunnel site placement. For reconstruction, both bone-patellar tendon-bone (BPTB) and quadrupled hamstring grafts are used. Structural properties of a 10 mm wide BPTB or quadrupled hamstring graft have been reported to be comparable with those of the native ACL.
最近，对重建前交叉韧带（ACL）前内侧（AM）束和后外侧（PL）束的手术技术的关注度有所提高。本综述重点关注ACL的结构和力学特性，以及ACL的AM束和PL束在股骨起源、中间部分和胫骨附着处的解剖细节。AM束和PL束的术语是根据胫骨附着情况选择的，并由它们在整个膝关节屈曲过程中的功能张力模式决定。接近伸展时，AM束适度松弛，PL束紧张。随着膝关节屈曲，ACL的股骨附着点变得更加水平，导致AM束收紧，PM束松弛。ACL被描述为可限制胫骨前移和胫骨内旋。旋转成分可能由PL束代表。股骨起源呈椭圆形，AM束的中心靠近过顶位置，PL束的中心靠近前下方软骨边缘。与中间部分相比，ACL的胫骨和股骨附着点面积超过3.5倍，并且由于潜在移植物选择有限以及隧道部位放置的尺寸限制，隧道放置更具挑战性。对于重建，骨-髌腱-骨（BPTB）和四股绳肌移植物均被使用。据报道，10毫米宽的BPTB或四股绳肌移植物的结构特性与天然ACL相当。
