Orthopaedic Unit and Kirk Kilgour Sports Injury Center, II School of Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
Knee Surg Sports Traumatol Arthrosc. 2012 May;20(5):870-7. doi: 10.1007/s00167-011-1640-8. Epub 2011 Aug 30.
The purpose of this study is to evaluate the kinematics changes of the knee after cutting of the ACL with or without injury of the anterolateral structures.
In this study, the role of the ACL and one of the secondary restraints in controlling knee stability using a navigation system was evaluated. The kinematics of the knee was evaluated in different conditions of instability: ACL intact, after dissection of the posterolateral (PL) bundle, after dissection of the anteromedial (AM) bundle, and after lesion of the lateral capsular ligament (LCL). Anterior tibial translation and rotation were measured with a computer navigation system in 10 fresh-frozen cadaveric knees by use of a manual maximum load. Anterior translation was evaluated at 30°, 60°, and 90° of flexion; rotation at 0°, 15°, 30°, 45°, 60°, and 90°.
Cutting the PL bundle does not increase anterior translation and rotation of the knee. Cutting the AM bundle significantly increased the anteroposterior (AP) translation at 30° and 60° (P = 0.01), but does not increase rotation of the knee. Cutting the LCL increased anterior translation at 60° (P = 0.04) and rotation at 30°, 45°, and 60° (P = 0.03).
Within the testing conditions of this study, the PL bundle does not affect anterior translation and rotation of the knee; the AM bundle is the primary restraint of the anterior translation but does not affect rotation of the knee while the lesion of the LCL increases tibial rotation and could be related to the pivot shift phenomenon, so it is more correct and biomechanical valid to assess and repair the associated lesion of the antero-lateral structure of the knee at the time of ACL surgery.
本研究旨在评估 ACL 切断后，伴有或不伴有前外侧结构损伤时膝关节的运动学变化。
本研究使用导航系统评估 ACL 和其中一个次要稳定结构在控制膝关节稳定性方面的作用。在不同的不稳定情况下评估膝关节的运动学：ACL 完整、后外侧（PL）束解剖后、前内侧（AM）束解剖后和外侧囊韧带（LCL）损伤后。通过使用手动最大负荷，在 10 个新鲜冷冻尸体膝关节中使用计算机导航系统测量胫骨前向平移和旋转。在 30°、60°和 90°屈曲时评估前向平移；在 0°、15°、30°、45°、60°和 90°时评估旋转。
切断 PL 束不会增加膝关节的前向平移和旋转。切断 AM 束显著增加了膝关节在 30°和 60°时的前后（AP）平移（P=0.01），但不增加膝关节的旋转。切断 LCL 增加了膝关节在 60°时的前向平移（P=0.04）和在 30°、45°和 60°时的旋转（P=0.03）。
在本研究的测试条件下，PL 束不会影响膝关节的前向平移和旋转；AM 束是膝关节前向平移的主要限制结构，但不影响膝关节的旋转，而 LCL 的损伤增加了胫骨旋转，可能与枢轴转移现象有关，因此在 ACL 手术时更准确和更符合生物力学地评估和修复前外侧结构的相关损伤。
