Wijdicks Coen A, Griffith Chad J, LaPrade Robert F, Johansen Steinar, Sunderland Adam, Arendt Elizabeth A, Engebretsen Lars
Orthopaedic Biomechanics Laboratory, Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Minneapolis, MN 55454, USA.
J Bone Joint Surg Am. 2009 Mar 1;91(3):521-9. doi: 10.2106/JBJS.H.00909.
Radiographic landmarks for medial knee attachment sites during anatomic repairs or reconstructions are unknown. If identified, they could assist in the preoperative evaluation of structure location and allow for postoperative assessment of reconstruction tunnel placement.
Radiopaque markers were implanted into the femoral and tibial attachments of the superficial medial collateral ligament and the femoral attachments of the posterior oblique and medial patellofemoral ligaments of eleven fresh-frozen, nonpaired cadaveric knee specimens. Both anteroposterior and lateral radiographs were made. Structures were assessed within quadrants formed by the intersection of reference lines projected on the lateral radiographs. Quantitative measurements were performed by three independent examiners. Intraobserver reproducibility and interobserver reliability were determined with use of intraclass correlation coefficients.
The overall intraclass correlation coefficients for intraobserver reproducibility and interobserver reliability were 0.996 and 0.994, respectively. On the anteroposterior radiographs, the attachment sites of the superficial medial collateral ligament, posterior oblique ligament, and medial patellofemoral ligament were 30.5 +/- 2.4 mm, 34.8 +/- 2.7 mm, and 42.3 +/- 2.1 mm from the femoral joint line, respectively. On the lateral femoral radiographs, the attachment of the superficial medial collateral ligament was 6.0 +/- 0.8 mm from the medial epicondyle and was located in the anterodistal quadrant. The attachment of the posterior oblique ligament was 7.7 +/- 1.9 mm from the gastrocnemius tubercle and was located in the posterodistal quadrant. The attachment of the medial patellofemoral ligament was 8.9 +/- 2.0 mm from the adductor tubercle and was located in the anteroproximal quadrant. On the lateral tibial radiographs, the proximal and distal tibial attachments of the superficial medial collateral ligament were 15.9 +/- 5.2 and 66.1 +/- 3.6 mm distal to the tibial inclination, respectively.
The attachment locations of the main medial knee structures can be qualitatively and quantitatively correlated to osseous landmarks and projected radiographic lines, with close agreement among examiners.
在解剖修复或重建过程中，膝关节内侧附着点的影像学标志尚不清楚。若能确定这些标志，它们可有助于术前评估结构位置，并能在术后评估重建隧道的放置情况。
将不透射线的标志物植入11个新鲜冷冻、不成对的尸体膝关节标本的浅层内侧副韧带的股骨和胫骨附着点以及后斜韧带和髌股内侧韧带的股骨附着点。拍摄前后位和侧位X线片。在侧位X线片上由参考线相交形成的象限内对结构进行评估。由三名独立的检查者进行定量测量。使用组内相关系数确定观察者内的可重复性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为0.996和0.994。在前后位X线片上，浅层内侧副韧带、后斜韧带和髌股内侧韧带的附着点分别距股关节线30.5±2.4mm、34.8±2.7mm和42.3±2.1mm。在股骨侧位X线片上，浅层内侧副韧带的附着点距内侧髁6.0±0.8mm，位于前下象限。后斜韧带的附着点距腓肠肌结节7.7±1.9mm，位于后下象限。髌股内侧韧带的附着点距内收肌结节8.9±2.0mm，位于前上象限。在胫骨侧位X线片上，浅层内侧副韧带的胫骨近端和远端附着点分别位于胫骨倾斜度远端15.9±5.2mm和66.1±3.6mm处。
主要膝关节内侧结构的附着位置可以在质量和数量上与骨性标志及投射的影像学线相关联，检查者之间的一致性良好。
