Battaglia Michael J, Lenhoff Mark W, Ehteshami John R, Lyman Stephen, Provencher Matthew T, Wickiewicz Thomas L, Warren Russell F
Shoulder and Sports Orthopedic Surgery, United States Naval Academy, 250 Wood Road, Annapolis, MD 21402, USA.
Am J Sports Med. 2009 Feb;37(2):305-11. doi: 10.1177/0363546508324969. Epub 2008 Dec 19.
Numerous studies have documented the effect of complete medial collateral ligament injury on anterior cruciate ligament loads; few have addressed how partial medial collateral ligament disruption affects knee kinematics.
To determine knee kinematics and subsequent change in anterior cruciate ligament load in a partial and complete medial collateral ligament injury model.
Controlled laboratory study.
Ten human cadaveric knees were sequentially tested by a robot with the medial collateral ligament intact, in a partial injury model, and in a complete injury model with a universal force-moment sensor measuring system. Tibial translation, rotation, and anterior cruciate ligament load were measured under 3 conditions: anterior load (125 N), valgus load (10 N x m), and internal-external rotation torque (4 N x m; all at 0 degrees and 30 degrees of flexion).
Anterior and posterior translation did not statistically increase with a partial or complete medial collateral ligament injury at 0 degrees and 30 degrees of flexion. In response to a 125 N anterior load, at 0 degrees , the anterior cruciate ligament load increased 8.7% (from 99.5 to 108.2 N; P = .006) in the partial injury and 18.3% (117.7 N; P < .001) in the complete injury; at 30 degrees , anterior cruciate ligament load was increased 12.3% (from 101.7 to 114.2 N; P = .001) in the partial injury and 20.6% (122.7 N; P < .001) in the complete injury. In response to valgus torque (10 N x m) at 30 degrees , anterior cruciate ligament load was increased 55.3% (30.4 to 47.2 N; P = .044) in the partial injury model and 185% (86.8 N; P = .001) in the complete injury model. In response to internal rotation torque (4 N.m) at 30 degrees , anterior cruciate ligament load was increased 29.3% (27.6 to 35.7 N; P = .001) in the partial injury model and 65.2% (45.6 N; P < .001) in the complete injury model. The amount of internal rotation at 30 degrees of flexion was significantly increased in the complete injury model (22.8 degrees ) versus the intact state (19.5 degrees ; P < .001).
Partial and complete medial collateral ligament tears significantly increased the load on the anterior cruciate ligament. In a partial tear, the resultant load on the anterior cruciate ligament was increased at 30 degrees of flexion and with valgus load and internal rotation torque.
Patients may need to be protected from valgus and internal rotation forces after anterior cruciate ligament reconstruction in the setting of a concomitant partial medial collateral ligament tear. This information may help clinicians understand the importance of partial injuries of the medial collateral ligament with a combined anterior cruciate ligament injury complex.
众多研究记录了内侧副韧带完全损伤对前交叉韧带负荷的影响；但很少有研究探讨内侧副韧带部分断裂如何影响膝关节运动学。
确定在部分和完全内侧副韧带损伤模型中膝关节的运动学以及随后前交叉韧带负荷的变化。
对照实验室研究。
使用通用力-力矩传感器测量系统，通过机器人对10个尸体膝关节依次进行测试，测试状态包括内侧副韧带完整、部分损伤模型和完全损伤模型。在三种情况下测量胫骨平移、旋转和前交叉韧带负荷：前向负荷（125 N）、外翻负荷（10 N·m）和内外旋扭矩（4 N·m；均在0°和30°屈曲位）。
在0°和30°屈曲位时，内侧副韧带部分或完全损伤后，前后向平移在统计学上没有显著增加。在0°时，对于125 N的前向负荷，部分损伤时前交叉韧带负荷增加8.7%（从99.5 N增加到108.2 N；P = 0.006），完全损伤时增加18.3%（达到117.7 N；P < 0.001）；在30°时，部分损伤时前交叉韧带负荷增加12.3%（从101.7 N增加到114.2 N；P = 0.001），完全损伤时增加20.6%（达到122.7 N；P < 0.001）。在30°时，对于外翻扭矩（10 N·m），部分损伤模型中前交叉韧带负荷增加55.3%（从30.4 N增加到47.2 N；P = 0.044），完全损伤模型中增加185%（达到86.8 N；P = 0.001）。在30°时，对于内旋扭矩（4 N·m），部分损伤模型中前交叉韧带负荷增加29.3%（从27.6 N增加到35.7 N；P = 0.001），完全损伤模型中增加65.2%（达到45.6 N；P < 0.001）。在30°屈曲位时，完全损伤模型中的内旋角度（22.8°）与完整状态（19.5°；P < 0.001）相比显著增加。
内侧副韧带部分和完全撕裂均显著增加了前交叉韧带的负荷。在部分撕裂时，在30°屈曲位以及外翻负荷和内旋扭矩作用下，前交叉韧带的合成负荷增加。
在伴有内侧副韧带部分撕裂的情况下，前交叉韧带重建术后患者可能需要避免外翻和内旋力。这些信息可能有助于临床医生理解内侧副韧带部分损伤合并前交叉韧带损伤复合体的重要性。
