Pietrini Sean D, LaPrade Robert F, Griffith Chad J, Wijdicks Coen A, Ziegler Connor G
Division of Sports Medicine and the Orthopaedic Biomechanics Laboratory, Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota 55454, USA.
Am J Sports Med. 2009 Mar;37(3):542-51. doi: 10.1177/0363546508328117.
It is often difficult to identify the attachment sites of the fibular collateral ligament, popliteus tendon, and popliteofibular ligament for chronic posterolateral knee injuries or during revision surgeries. Descriptions of radiographic landmarks for these attachment sites would assist in the intraoperative identification of their locations and also allow for postoperative assessment of the placement of reconstruction tunnels.
Identification of qualitative and quantitative radiographic landmarks for the attachments of the main posterolateral knee structures are reproducible among observers of various experience levels and allow for improved intraoperative and postoperative identification of these attachment sites.
Descriptive laboratory study.
Dissections were performed on 11 cadaveric knee specimens. The attachments and locations of the investigated structures were labeled with radiopaque markers. The positions of the attachments relative to other attachment sites, labeled bony landmarks, and superimposed reference lines were quantified on anteroposterior and lateral radiographs. Measurements were performed by 3 independent examiners. Intraobserver and interobserver reliability was determined using intraclass correlation coefficients.
Overall intraclass correlation coefficients for intraobserver reproducibility and interobserver reliability were calculated to be 0.981 and 0.983, respectively. On the anteroposterior view, the perpendicular distances from a line intersecting the femoral condyles to the popliteus tendon, proximal fibular collateral ligament, and lateral gastrocnemius tendon were 14.5, 27.1, and 34.5 mm, respectively. On the lateral view, the femoral attachments of the fibular collateral ligament, popliteus tendon, and lateral gastrocnemius tendon were 4.3, 12.2, and 13.1 mm, respectively, from the lateral epicondyle. In addition, the fibular collateral ligament and popliteus tendon were located within 1 mm of a reference line projected along the posterior femoral cortex distally, and also were located within the posteroinferior quadrant bound by the posterior femoral cortex extension reference line and another reference line perpendicular to it at the posterior margin of Blumensaat's line.
Comprehensive qualitative and quantitative guidelines for assessing posterolateral knee structures on both anteroposterior and lateral knee radiographs were described.
This radiographic information regarding the attachment sites of posterolateral structures can serve as a valuable reference for preoperative, intraoperative, and postoperative assessments of surgical reconstructions.
对于慢性膝关节后外侧损伤或翻修手术，常常难以确定腓侧副韧带、腘肌腱和腘腓韧带的附着点。描述这些附着点的影像学标志将有助于术中确定其位置，并便于术后评估重建隧道的放置情况。
对于膝关节主要后外侧结构附着点的定性和定量影像学标志，在不同经验水平的观察者之间具有可重复性，并能改善术中及术后对这些附着点的识别。
描述性实验室研究。
对11个尸体膝关节标本进行解剖。用不透射线的标记物标记所研究结构的附着点和位置。在前后位和侧位X线片上，对附着点相对于其他附着点、标记的骨性标志以及叠加的参考线的位置进行量化。测量由3名独立的检查者进行。使用组内相关系数确定观察者内和观察者间的可靠性。
观察者内可重复性和观察者间可靠性的总体组内相关系数分别计算为0.981和0.983。在前后位片上，与股骨髁相交的线到腘肌腱、腓侧副韧带近端和腓肠肌外侧头肌腱的垂直距离分别为14.5、27.1和34.5mm。在侧位片上，腓侧副韧带、腘肌腱和腓肠肌外侧头肌腱在股骨上的附着点分别距离外侧髁4.3、12.2和13.1mm。此外，腓侧副韧带和腘肌腱位于沿股骨后皮质向远端投射的参考线的1mm范围内，并且也位于由股骨后皮质延伸参考线和在布卢门萨特线后缘与其垂直的另一条参考线所界定的后下象限内。
描述了在膝关节前后位和侧位X线片上评估膝关节后外侧结构的全面定性和定量指南。
关于后外侧结构附着点的这些影像学信息可作为手术重建术前、术中和术后评估的有价值参考。
