Grood E S, Stowers S F, Noyes F R
Noyes-Giannestras Biomechanics Laboratories, Department of Aerospace Engineering, University of Cincinnati, Ohio 45221-0048.
J Bone Joint Surg Am. 1988 Jan;70(1):88-97.
We applied specific forces and moments to the knees of fifteen whole lower limbs of cadavera and measured, with a six degrees-of-freedom electrogoniometer, the position of the tibia at which the ligaments and the geometry of the joint limited motion. The limits were determined for anterior and posterior tibial translation, internal and external rotation, and varus and valgus angulation from zero to 90 degrees of flexion. The limits were measured in the intact knee and then the changes that occurred with removal of the posterior cruciate ligament, the lateral collateral ligament, the popliteus tendon at its femoral attachment, and the arcuate complex were measured. The cutting order was varied, allowing us to determine the changes in the limits that occurred when each structure was cut alone and the amount of motion of the joint that was required for each structure to become taut and to limit additional motion when the other supporting structures had been removed. Removal of only the posterior cruciate ligament increased the limit for posterior tibial translation, with no change in the limits for tibial rotation or varus and valgus angulation. The additional posterior translation was least at full extension and increased progressively, reaching 11.4 millimeters at 90 degrees of flexion. The progressive increase in posterior translation with flexion was apparently due to slackening of the posterior portion of the capsule, as the translation nearly doubled when the posterolateral structures subsequently were removed. Removal of only the posterolateral extra-articular restraints increased the amount of external rotation and varus angulation. The average increase in external rotation depended on the angle of flexion; it was greatest at 30 degrees of flexion and decreased with additional flexion. At 90 degrees of flexion, the intact posterior cruciate ligament limited the increase in external rotation to only 5.3 degrees, less than one-half of the 13.0-degree increase that occurred at 30 degrees of flexion. Subsequent removal of the posterior cruciate ligament markedly increased external rotation at 90 degrees of flexion, resulting in a total increase of 20.9 degrees. The limit for varus angulation was normal as long as the lateral collateral ligament was intact. When the lateral collateral ligament was cut, the limit increased 4.5 degrees (approximately 4.5 millimeters of additional joint opening) when the knee was partially flexed (to 15 degrees).(ABSTRACT TRUNCATED AT 400 WORDS)
我们对15具尸体的整个下肢膝关节施加特定的力和力矩，并使用六自由度电子测角仪测量韧带和关节几何结构限制运动时胫骨的位置。确定了从0度到90度屈曲时胫骨前后平移、内旋和外旋以及内翻和外翻成角的限度。首先在完整膝关节中测量这些限度，然后测量在切除后交叉韧带、外侧副韧带、腘肌腱在股骨附着处以及弓状复合体后发生的变化。切割顺序有所不同，这使我们能够确定单独切断每个结构时限度的变化，以及当其他支撑结构被移除后，每个结构变得绷紧并限制额外运动所需的关节运动量。仅切除后交叉韧带会增加胫骨后向平移的限度，而胫骨旋转以及内翻和外翻成角的限度没有变化。额外的后向平移在完全伸展时最小，并逐渐增加，在90度屈曲时达到11.4毫米。随着屈曲后向平移的逐渐增加显然是由于关节囊后部松弛所致，因为当随后切除后外侧结构时，平移几乎增加了一倍。仅切除后外侧关节外约束会增加外旋和内翻成角的量。外旋的平均增加量取决于屈曲角度；在30度屈曲时最大，随着进一步屈曲而减小。在90度屈曲时，完整后交叉韧带将外旋增加限制在仅5.3度，不到30度屈曲时13.0度增加量的一半。随后切除后交叉韧带在90度屈曲时显著增加外旋，导致总增加量达到20.9度。只要外侧副韧带完整，内翻成角的限度就是正常的。当切断外侧副韧带时，膝关节部分屈曲（至15度）时，限度增加4.5度（额外关节开口约4.5毫米）。（摘要截选至400字）
