Service d'Orthopédie Traumatologie, Centre Hospitalier de Versailles, Hôpital André Mignot, Le Chesnay, France.
Service d'Orthopédie Traumatologie, Centre Hospitalier de Versailles, Hôpital André Mignot, Le Chesnay, France.
Arthroscopy. 2017 Sep;33(9):1703-1709. doi: 10.1016/j.arthro.2017.03.019.
To investigate the effect of the anterior cruciate ligament (ACL) torsion in 90° knee flexion on the morphological appearance of the ACL.
Sixty knees from fresh frozen anatomical specimens were dissected. Eighteen knees were excluded according to selection criteria (torn ACL, mucoid degeneration of the ACL, arthritic lesions of the notch, or knees harboring synovial inflammatory pathologies). After the removal of the synovial membrane, the morphology of the ligamentous fibers of the ACL and the twist were analyzed. Twisting of the ACL was measured using a goniometer in 90° knee flexion and defined by the angle of external rotation of the femur on the axis of the tibia required to visualize a flat ACL. The orientation of tibial and femoral footprint was described in a coronal plane for the tibia and a sagittal plane for the femur.
In the 42 knees that were finally included, the ACL was always displayed as a single ribbon-like structure. The torsion of the fibers was on average 83.6° (± 9.4°) in 90° knee flexion. The twisting could be explained by the different orientations of the femoral (vertical in a sagittal plane) and tibial (horizontal in a coronal plane) footprints. An intraligamentous proximal cleavage area was encountered in 11 cases (i.e., 26%).
The ACL is a twisted structure with 83.6° of external torsion of fibers in 90° knee flexion. It is the torsion in the fibers, due to the relative position of bone insertions, which gives the ACL the appearance of being double bundle.
The concept of the torsional flat structure of the native ACL may be of importance during ACL reconstruction, both in terms of graft choice (flat rather than cylindrical) and of technical positioning (torsion).
研究 90°膝关节屈曲时前交叉韧带（ACL）扭转对 ACL 形态外观的影响。
对 60 个来自新鲜冷冻解剖标本的膝关节进行解剖。根据选择标准（ACL 撕裂、ACL 粘液样变性、切迹的关节炎病变或存在滑膜炎症性病变的膝关节）排除了 18 个膝关节。去除滑膜后，分析 ACL 的韧带纤维形态和扭转情况。使用量角器在 90°膝关节屈曲时测量 ACL 的扭转，并通过可视化 ACL 变平所需的股骨在胫骨轴上的外旋角度来定义。在冠状面描述胫骨和矢状面描述股骨的胫骨和股骨附着点的方向。
在最终纳入的 42 个膝关节中，ACL 始终呈现为单一的带状结构。纤维扭转平均为 90°膝关节屈曲时的 83.6°（±9.4°）。扭转可以用股骨（矢状面垂直）和胫骨（冠状面水平）附着点的不同方向来解释。在 11 例（即 26%）中发现了韧带内近侧分裂区。
ACL 是一种扭转结构，在 90°膝关节屈曲时有 83.6°的纤维外扭转。正是由于骨插入的相对位置，纤维的扭转赋予了 ACL 看起来像双束的外观。
在 ACL 重建中，考虑到移植物的选择（扁平而不是圆柱形）和技术定位（扭转），了解天然 ACL 的扭转扁平结构概念可能很重要。
