Orthopaedic Biomechanics Laboratory, Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota 55454, USA.
Am J Sports Med. 2010 Feb;38(2):339-47. doi: 10.1177/0363546509347996. Epub 2009 Dec 4.
An anatomical medial knee reconstruction has not been described in the literature.
Knee stability and ligamentous load distribution would be restored to the native state with an anatomical medial knee reconstruction.
Controlled laboratory study.
Ten nonpaired cadaveric knees were tested in the intact, superficial medial collateral ligament and posterior oblique ligament-sectioned, and anatomically reconstructed states. Each knee was tested at 0 degrees , 20 degrees , 30 degrees , 60 degrees , and 90 degrees of knee flexion with a 10-N.m valgus load, 5-N.m external and internal rotation torques, and 88-N anterior and posterior drawer loads. A 6 degrees of freedom electromagnetic motion tracking system measured angulation and displacement changes of the tibia with respect to the femur. Buckle transducers measured the loads on the intact and reconstructed proximal and distal divisions of the superficial medial collateral ligament and the posterior oblique ligament.
A significant increase was found in valgus angulation and external rotation after sectioning the medial knee structures at all tested knee flexion angles. This was restored after an anatomical medial knee reconstruction. The authors also found a significant increase in internal rotation at 0 degrees , 20 degrees , 30 degrees , and 60 degrees of knee flexion after sectioning the medial knee structures, which was restored after the reconstruction. A significant increase in anterior translation was observed after sectioning the medial knee structures at 20 degrees , 30 degrees , 60 degrees , and 90 degrees of knee flexion. This increase in anterior translation was restored following the reconstruction at 20 degrees and 30 degrees of knee flexion, but was not restored at 60 degrees and 90 degrees . A small, but significant, increase in posterior translation was found after sectioning the medial knee structures at 0 degrees and 30 degrees of knee flexion, but this was not restored after the reconstruction. Overall, there were no clinically important differences in observed load on the ligaments when comparing the intact with the reconstructed states for valgus, external and internal rotation, and anterior and posterior drawer loads. Conclusion An anatomical medial knee reconstruction restores near-normal stability to a knee with a complete superficial medial collateral ligament and posterior oblique ligament injury, while avoiding overconstraint of the reconstructed ligament grafts.
This anatomical medial knee reconstruction technique provides native stability and ligament load distribution in patients with chronic or severe acute medial knee injuries.
目前文献中尚未描述解剖学内侧膝关节重建。
通过解剖学内侧膝关节重建，可以恢复膝关节的稳定性和韧带负荷分布，使其恢复到正常状态。
对照实验室研究。
10 个非配对的尸体膝关节分别在完整、浅层内侧副韧带和后斜韧带切断以及解剖重建状态下进行测试。每个膝关节在 0 度、20 度、30 度、60 度和 90 度膝关节屈曲时，施加 10-N.m 的外翻负荷、5-N.m 的外旋和内旋扭矩以及 88-N 的前后抽屉负荷进行测试。一个 6 自由度电磁运动跟踪系统测量胫骨相对于股骨的角度和位移变化。扣式传感器测量完整和重建的浅层内侧副韧带和后斜韧带的近端和远端分支上的负荷。
在所有测试的膝关节屈曲角度下，切断内侧膝关节结构后，发现外翻角度和外旋明显增加。这种情况在进行解剖学内侧膝关节重建后得到了恢复。作者还发现，在切断内侧膝关节结构后，在 0 度、20 度、30 度和 60 度膝关节屈曲时，内旋明显增加，重建后也得到了恢复。在 20 度、30 度、60 度和 90 度膝关节屈曲时，切断内侧膝关节结构后，前向平移明显增加。重建后，在 20 度和 30 度膝关节屈曲时，这种前向平移的增加得到了恢复，但在 60 度和 90 度时没有恢复。在 0 度和 30 度膝关节屈曲时，切断内侧膝关节结构后，发现后向平移略有增加，但重建后并未恢复。总的来说，与完整状态相比，在重建状态下观察到的外侧、外旋和内旋以及前后抽屉负荷对韧带的负荷没有临床意义上的显著差异。
解剖学内侧膝关节重建可恢复完全性浅层内侧副韧带和后斜韧带损伤膝关节的接近正常稳定性，同时避免重建韧带移植物的过度约束。
这种解剖学内侧膝关节重建技术为慢性或严重急性内侧膝关节损伤的患者提供了原生稳定性和韧带负荷分布。
