健康膝关节前外侧等长的体内模拟
An in Vivo Simulation of Isometry of the Anterolateral Aspect of the Healthy Knee.
作者信息
Kernkamp Willem A, Van de Velde Samuel K, Tsai Tsung-Yuan, van Arkel Ewoud R A, Asnis Peter D, Nelissen Rob G H H, LaPrade Robert F, Zarins Bertram, Li Guoan
机构信息
1Bioengineering Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 2Focus Clinic Orthopedic Surgery, Medical Center Haaglanden and Bronovo-Nebo, The Hague, the Netherlands 3Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, the Netherlands 4Steadman Philippon Research Institute, Vail, Colorado.
出版信息
J Bone Joint Surg Am. 2017 Jul 5;99(13):1111-1118. doi: 10.2106/JBJS.16.01139.
BACKGROUND
To assess the isometry of theoretical lateral extra-articular reconstruction (LER), we evaluated theoretical grafts attached to various points on the lateral femoral condylar area and to either Gerdy's tubercle or the anatomic attachment site of the anterolateral ligament to the tibia.
METHODS
In 18 subjects, healthy knees with no history of either injury or surgery involving the lower extremity were studied. The subjects performed a sit-to-stand motion (from approximately 90° of flexion to full extension), and each knee was studied using magnetic resonance and dual fluoroscopic imaging techniques. The 3-dimensional wrapping paths of each theoretical LER graft were measured. Grafts showing the least change in length during the sit-to-stand motion were considered to be the most isometric.
RESULTS
The most isometric attachment site on the lateral femoral epicondyle to either of the studied tibial attachment sites was posterior-distal to the femoral attachment site of the fibular collateral ligament. The LER graft had a mean change in length of approximately 3%. Moving the femoral attachment site anteriorly resulted in increased length of the graft with increasing flexion; more posterior attachment sites resulted in decreased length with increasing flexion. Moving the attachment site in the proximal-distal direction had a less profound effect. Moving the tibial attachment site from Gerdy's tubercle to the tibial attachment site of the anterolateral ligament affected the overall isometric distribution on the lateral femoral epicondyle.
CONCLUSIONS
The most isometric attachment site on the femur for an LER would be posterior-distal to the femoral attachment site of the fibular collateral ligament. Different length changes for LER grafts were identified with respect to different femoral attachment sites. Desirable graft fixation locations for treating anterolateral rotatory instability were found posterior-proximal to the femoral fibular collateral ligament attachment.
CLINICAL RELEVANCE
The present data could be used both in biomechanical studies and in clinical studies as guidelines for planning LER surgical procedures.
背景
为评估理论上的外侧关节外重建（LER）的等长性，我们评估了附着于股骨外侧髁区域不同点以及Gerdy结节或前外侧韧带在胫骨上的解剖附着点的理论移植物。
方法
对18名无下肢损伤或手术史的健康受试者的膝关节进行研究。受试者进行从坐位到站立的动作（从大约90°屈曲到完全伸展），并使用磁共振和双荧光透视成像技术对每个膝关节进行研究。测量每个理论LER移植物的三维缠绕路径。在从坐位到站立的动作中长度变化最小的移植物被认为是最等长的。
结果
在股骨外侧髁上，相对于所研究的胫骨附着点，最等长的附着点位于腓侧副韧带股骨附着点的后远端。LER移植物的长度平均变化约为3%。将股骨附着点向前移动会导致移植物长度随着屈曲增加而增加；更靠后的附着点会导致移植物长度随着屈曲增加而减少。在近端 - 远端方向移动附着点的影响较小。将胫骨附着点从Gerdy结节移至前外侧韧带的胫骨附着点会影响股骨外侧髁上的整体等长分布。
结论
LER在股骨上最等长的附着点位于腓侧副韧带股骨附着点的后远端。针对不同的股骨附着点，LER移植物的长度变化不同。发现治疗前外侧旋转不稳定的理想移植物固定位置在腓侧副韧带股骨附着点的后近端。
临床意义
本数据可用于生物力学研究和临床研究，作为规划LER手术程序的指导原则。
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