Department of Orthopedic Surgery and Traumatology, University Hospitals Leuven, Weligerveld 1, B-3212 Pellenberg, Leuven, Belgium,
Knee Surg Sports Traumatol Arthrosc. 2014 Nov;22(11):2735-9. doi: 10.1007/s00167-013-2606-9. Epub 2013 Jul 14.
Based on the anatomy of the deep medial collateral ligament (MCL), it was hypothesized that at least part of its cross-sectional insertion area is jeopardized while performing a standard tibial cut in conventional total knee arthroplasty (TKA). The aim of this study was to determine whether it is anatomically possible to preserve the tibial deep MCL insertion during conventional TKA.
Thirty-three unpaired cadaveric knee specimens were used for this study. Knees with severe varus/valgus deformity or damage to the medial structures of the knee were excluded. In the first part of the study, the dimensions of the tibial insertion of the deep MCL and its relationship to the joint line were recorded. Next, the cross-sectional area of the deep MCL insertion was determined using calibrated digital photographic analysis. In the second part, the effect of a standard 9-mm 3° sloped tibial cut on the structural integrity of the deep MCL cross-sectional insertion area was determined using conventional instrumentation.
The proximal border of the deep MCL insertion site on the tibia was located on average 4.7 ± 1.2 mm distally to the joint line. After performing a standard 9-mm 3° sloped tibial cut, on average 54% of the deep MCL insertion area was resected. In 29% of the cases, the deep MCL insertion area was completely excised.
The deep MCL cannot routinely be preserved in conventional TKA. The deep MCL insertion is at risk and may be jeopardized in case of a tibial cut 9 mm below the native joint line. As the deep MCL is a distinct medial stabilizer and plays an important role in rotational stability, this may have implications in future designs of both unicondylar and total knee arthroplasty, but further research is necessary.
基于深层内侧副韧带（MCL）的解剖结构，我们假设在常规全膝关节置换术（TKA）中进行标准胫骨截骨时，至少部分其横截面积的插入区域会受到威胁。本研究旨在确定在常规 TKA 中是否可以从解剖学上保留胫骨深层 MCL 插入。
本研究使用了 33 个未配对的尸体膝关节标本。排除有严重内翻/外翻畸形或膝关节内侧结构损伤的膝关节。在研究的第一部分中，记录了深层 MCL 的胫骨插入尺寸及其与关节线的关系。接下来，使用校准的数字摄影分析确定深层 MCL 插入的横截面积。在第二部分中，使用常规器械确定标准 9 毫米 3°倾斜胫骨截骨对深层 MCL 横截面插入区域结构完整性的影响。
胫骨上深层 MCL 插入部位的近端边界平均位于关节线以下 4.7±1.2 毫米处。在进行标准的 9 毫米 3°倾斜胫骨截骨后，深层 MCL 插入区域的平均 54%被切除。在 29%的情况下，深层 MCL 插入区域被完全切除。
在常规 TKA 中不能常规保留深层 MCL。深层 MCL 插入部位存在风险，在胫骨截骨低于自然关节线 9 毫米的情况下可能会受到威胁。由于深层 MCL 是内侧的明显稳定器，在旋转稳定性中起着重要作用，这可能对未来的单髁和全膝关节置换术的设计产生影响，但需要进一步研究。
