Tajima Goro, Nozaki Masahiro, Iriuchishima Takanori, Ingham Sheila J M, Shen Wei, Smolinski Patrick, Fu Freddie H
Department of Orthopaedic Surgery, Iwate Medical University, 19-1 Uchimaru, Morioka 020-8505, Japan.
J Bone Joint Surg Am. 2009 Apr;91(4):859-66. doi: 10.2106/JBJS.H.00991.
It has been demonstrated that double-bundle reconstruction of the posterior cruciate ligament restores knee kinematics better than does single-bundle reconstruction. The objective of this study was to identify the tibial insertion site of the posterior cruciate ligament and the related osseous landmarks to help guide surgeons in the performance of an anatomical double-bundle reconstruction of the posterior cruciate ligament.
Twenty-one unpaired human cadaver knees were evaluated. The geometric data and surface features of the tibial insertion site of the posterior cruciate ligament and its bundles were studied with macroscopic observation and with three-dimensional laser photography.
The mean surface areas (and standard deviations) of the anterolateral and posteromedial insertion sites were 93.1+/-16.6 mm2 and 150.8+/-31.0 mm2, respectively, and the distance between their centers was 8.2+/-1.3 mm. The mean length and width of the anterolateral insertion site were 7.8+/-1.5 mm and 9.2+/-1.6 mm, and the mean length and width of the posteromedial insertion site were 9.4+/-1.4 mm and 15.0+/-2.7 mm. The average distances from the anterior and medial margins of the tibial plane to the center of the anterolateral insertion, defined as percentage ratios of the anteroposterior and mediolateral dimensions, were 83.4%+/-3.4% and 47.1%+/-1.9%, respectively, and the average distances from the anterior and medial margins of the tibial plane to the center of the posteromedial insertion were 95.5%+/-1.9% and 43.8%+/-2.2%. A notable change in angle, of >10 degrees, was observed between the anterolateral and posteromedial slopes in sixteen of the twenty-one knees. The average angle between the anterolateral and posteromedial slopes was 14.5 degrees+/-6.4 degrees.
The tibial insertion site of the posterior cruciate ligament and its bundles is very complex. However, the shapes and positions of the insertion sites of the two bundles are consistent in that they are located in different planes on the posterior intercondylar fossa. We noted a consistent change in slope between the tibial insertion sites of the anterolateral and posteromedial bundles.
已证实后交叉韧带双束重建比单束重建能更好地恢复膝关节运动学。本研究的目的是确定后交叉韧带的胫骨附着点及相关骨性标志，以帮助指导外科医生进行后交叉韧带的解剖双束重建。
评估21个未配对的人体尸体膝关节。通过宏观观察和三维激光摄影研究后交叉韧带及其束的胫骨附着点的几何数据和表面特征。
前外侧和后内侧附着点的平均表面积（及标准差）分别为93.1±16.6mm²和150.8±31.0mm²，它们中心之间的距离为8.2±1.3mm。前外侧附着点的平均长度和宽度分别为7.8±1.5mm和9.2±1.6mm，后内侧附着点的平均长度和宽度分别为9.4±1.4mm和15.0±2.7mm。从胫骨平台前缘和内侧缘到前外侧附着点中心的平均距离，以前后径和内外侧径的百分比表示，分别为83.4%±3.4%和47.1%±1.9%，从胫骨平台前缘和内侧缘到后内侧附着点中心的平均距离分别为95.5%±1.9%和43.8%±2.2%。21个膝关节中有16个的前外侧和后内侧斜面之间观察到角度有>10度的显著变化。前外侧和后内侧斜面之间的平均角度为14.5度±6.4度。
后交叉韧带及其束的胫骨附着点非常复杂。然而，两束附着点的形状和位置是一致的，因为它们位于髁间后窝的不同平面上。我们注意到前外侧和后内侧束的胫骨附着点之间的斜面有一致的变化。
