Orthopädisch-Unfallchirurgisches Zentrum Mannheim, Universitätsmedizin Mannheim der Ruprecht-Karls-Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany,
Int Orthop. 2014 Feb;38(2):267-72. doi: 10.1007/s00264-013-2100-5. Epub 2013 Sep 18.
The hypothesis of our study is that a routine tibial cut during cruciate retaining TKA may result in a partial or a total removal of the PCL footprint. Therefore providing a reliable landmark is essential to estimate the probability of PCL damage with a tibial cut and to enable the surgeon to decide pre-operatively whether a cruciate retaining implant design is suitable.
In a case series of 175 cruciate retaining TKA, the routinely made standing postoperative AP-view radiographs were evaluated to determine the distance between fibula head and tibial cutting plane. In a second case series knee MRI of 223 subjects were consecutively used to measure the vertical distance between tibial attachment of PCL and fibula head. The probability of partial or total PCL damage was calculated for different vertical distances between tibial cut and fibula head.
The vertical distance between the tibial cut and the most proximal point of the fibula head averaged 6.1 mm ±4.8 mm. The mean vertical distance from fibula head to proximal and to distal PCL footprint revealed to be 11.4 mm ±3.7 mm and 5.4 mm ±2.9 mm, respectively. The location of the insertion was not significantly different between subgroups such as age (<50 or >50 years), gender and side. Based on our results 11 (7%) knees were considered at high risk of an entire PCL removal after implantation of a cruciate retaining TKA design.
Currently available routine tibial preparation techniques result in partial or total posterior cruciate ligament detachment. Fibula head as a landmark aids to predict the PCL location and to estimate its disruption pre- and postoperatively on AP-view radiographs.
我们研究的假设是，在保留交叉韧带的全膝关节置换术中，常规的胫骨截骨可能导致部分或全部切除后交叉韧带止点。因此，提供一个可靠的解剖标志对于评估胫骨截骨时后交叉韧带损伤的概率以及使外科医生能够在术前决定是否使用保留交叉韧带的植入物设计是至关重要的。
在一个 175 例保留交叉韧带的全膝关节置换术的病例系列中，评估了常规制作的术后站立前后位 X 线片，以确定腓骨头和胫骨截骨平面之间的距离。在另一个连续的 223 例膝关节 MRI 病例系列中，测量了后交叉韧带胫骨附着处与腓骨头之间的垂直距离。计算了不同胫骨截骨与腓骨头之间垂直距离时部分或全部后交叉韧带损伤的概率。
胫骨截骨与腓骨头最近端之间的垂直距离平均为 6.1 毫米±4.8 毫米。腓骨头到近端和远端后交叉韧带止点的平均垂直距离分别为 11.4 毫米±3.7 毫米和 5.4 毫米±2.9 毫米。插入点的位置在年龄（<50 岁或>50 岁）、性别和侧别等亚组之间没有显著差异。根据我们的结果，11（7%）例膝关节在植入保留交叉韧带的全膝关节置换设计后被认为存在整个后交叉韧带切除的高风险。
目前可用的常规胫骨准备技术会导致部分或全部后交叉韧带分离。腓骨头作为一个解剖标志，有助于预测后交叉韧带的位置，并在前后位 X 线片上术前和术后评估其断裂情况。
