Department of Orthopedic Surgery, Seoul Veterans Hospital, 6-2 Dunchon Dong, Kangdong Ku, Seoul, Korea.
Knee Surg Sports Traumatol Arthrosc. 2011 Oct;19(10):1669-74. doi: 10.1007/s00167-011-1442-z. Epub 2011 Feb 17.
Descriptive laboratory study.
The femoral anatomic insertion site and the optimal isometric point of popliteus tendon for posterolateral reconstruction are not well known. Purpose of this study was to determine the relative relationship between the femoral anatomic insertion and isometric point of popliteus muscle-tendon complex with the lateral epicondyle of femur.
Thirty unpaired cadaveric knees were dissected to determine the anatomic femoral insertion of the popliteus tendon. The distance and the angle from the lateral epicondyle of femur to the center of the anatomic insertion of the popliteus tendon were measured using digital caliper and goniometer. Eight unpaired fresh cadaveric knees were examined to determine the optimal isometric point of femoral insertion of popliteus tendon using computer-controlled motion capture analysis system (Motion Analysis, CA, USA). Distances from targeted tibial tunnel for popliteus tendon reconstruction to the 35 points gained on the lateral surface of femur were recorded at 0, 30, 60, 90, and 120° knee flexion. A point with the least excursion (<2.0 mm) was determined as the isometric point.
The center of anatomic insertion points and the optimal isometric point for the main fibers of popliteus tendon were found to be posterior and distal to the lateral epicondyle of femur. The distance from the lateral epicondyle of femur to the center of anatomic femoral insertion of popliteus tendon was 11.3 ± 1.2 mm (mean ± SD). The angle between long axis of femur and the line from lateral epicondyle of femur to anatomic femoral insertion of popliteus tendon was 31.4 ± 5.3°. The isometric points for the femoral insertion of popliteus muscle-tendon complex were situated posterior and distal to the lateral epicondyle in all 8 knees. The distance between the least excursion point and the lateral epicondyle was calculated as 10.4 ± 1.7 mm. The angle between the long axis of femur and the line from lateral epicondyle of femur to optimum isometric point of popliteus tendon was calculated as 41.3 ± 14.9°.
The optimal isometric point for the femoral insertion of popliteus muscle-tendon complex is situated posterior and distal to the lateral epicondyle of femur. Femoral tunnel for "posterolateral corner sling procedure" should be placed at this point to achieve least amount of graft excursion during knee motion.
描述性实验室研究。
股部解剖止点和腘肌腱等距点在进行后外侧重建时并不明确。本研究旨在确定腘肌腱肌腹复合体相对于股骨外上髁的解剖止点和等距点的相对关系。
30 个未配对的尸体膝关节被解剖以确定腘肌腱的解剖股骨止点。使用数字卡尺和量角器测量股骨外上髁至腘肌腱解剖止点中心的距离和角度。使用计算机控制运动捕捉分析系统（美国加利福尼亚州莫德斯托市的 Motion Analysis）检查 8 个未配对的新鲜尸体膝关节，以确定腘肌腱股骨止点的最佳等距点。记录从目标胫骨隧道到股骨外侧面 35 个点的距离，在 0°、30°、60°、90°和 120°膝关节屈曲时。确定最小偏移（<2.0mm）的点作为等距点。
发现腘肌腱的解剖止点中心和主要纤维的最佳等距点位于股骨外上髁的后方和下方。股骨外上髁至腘肌腱解剖股骨止点中心的距离为 11.3±1.2mm（均值±标准差）。股骨长轴与股骨外上髁至腘肌腱解剖股骨止点连线之间的角度为 31.4±5.3°。8 个膝关节的腘肌腱肌腹复合体股骨止点的等距点均位于股骨外上髁的后方和下方。最小偏移点与外上髁之间的距离为 10.4±1.7mm。股骨长轴与股骨外上髁至腘肌腱最佳等距点连线之间的角度为 41.3±14.9°。
腘肌腱肌腹复合体股骨止点的最佳等距点位于股骨外上髁的后方和下方。“后外侧角吊索术”的股骨隧道应置于该点，以在膝关节运动过程中使移植物的偏移量最小。
