Department of Mechanical Engineering, Imperial College London, London, England; Department of Sports Medicine and Joint Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Department of Musculoskeletal Surgery, Imperial College London, London, England; Orthopaedic Surgery Department, University of Malaya Medical Centre, Kuala Lumpur, Malaysia.
Arthroscopy. 2014 Mar;30(3):335-43. doi: 10.1016/j.arthro.2013.12.003.
The purpose of this study was to clarify the changes in the kinematics of the knee that result from isolated deficiency of the anteromedial (AM) or posterolateral (PL) bundle.
Fourteen cadaveric knees were mounted in a 6-df rig and tested using the following 5 loading conditions: 90-N anterior and posterior tibial loads, 5-Nm internal and external tibial torques, and a simulated pivot-shift test. Tibiofemoral kinematics during flexion-extension was recorded with an optical tracking system for (1) intact knees, (2) knees in which the isolated AM bundle was cut, (3) knees in which the isolated PL bundle was cut, and (4) anterior cruciate ligament (ACL)-deficient knees. The distances between the femoral and tibial attachments of the AM and PL bundles of the ACL were also calculated.
Anterior translation laxity under an anterior tibial load, rotational laxity under an internal tibial torque, and anterior translation laxity under pivot-shift loading were significantly different between the knees with AM and PL bundle deficiencies (P < .024), but the changes were small: less than 3 mm or 1.5°. The AM bundle distance increased significantly more after an AM bundle tear (P = .004) than after a PL bundle tear in flexion. Cutting the PL bundle did not have a significant effect on the lengths between the bundle attachments.
An isolated AM or PL bundle tear caused a small increase in laxity (<3 mm or <1.5°).
If there is a clinically identifiable increase in laxity, then--in addition to the isolated tear of the AM or PL bundle--there must also be a tear of the other bundle of the ACL, or at least a partial tear.
本研究旨在阐明前内侧（AM）或后外侧（PL）束单独缺失时膝关节运动学的变化。
将 14 个尸体膝关节安装在 6-DF 夹具中，并使用以下 5 种加载条件进行测试：90-N 胫骨前、后负荷，5-Nm 内、外胫骨扭矩，以及模拟的枢轴移位试验。使用光学跟踪系统记录膝关节在屈伸过程中的胫股运动学，包括（1）完整膝关节、（2）单独 AM 束切断膝关节、（3）单独 PL 束切断膝关节和（4）前交叉韧带（ACL）缺失膝关节。还计算了 ACL 的 AM 和 PL 束在股骨和胫骨附着处之间的距离。
在胫骨前负荷下，前向平移松弛度、内胫骨扭矩下的旋转松弛度以及枢轴移位加载下的前向平移松弛度在 AM 和 PL 束缺失的膝关节之间存在显著差异（P<.024），但变化较小：小于 3mm 或 1.5°。在屈曲时，AM 束撕裂后 AM 束距离显著增加（P=0.004），而 PL 束撕裂后距离增加不明显。切断 PL 束对束附着处之间的长度没有显著影响。
单独的 AM 或 PL 束撕裂会导致松弛度略有增加（<3mm 或 <1.5°）。
如果存在可临床识别的松弛度增加，则-除了 AM 或 PL 束的单独撕裂-还必须存在 ACL 的另一个束撕裂，或者至少是部分撕裂。
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