Department of Orthopedics Bürgerspital Solothurn, Schöngrünstrasse 42, CH-4500 Solothurn, Switzerland.
School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China; Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, China; Department of Orthopaedic Surgery, Shanghai Key Laboratory of Orthopaedic Implants and Clinical Translational R&D Center of 3D Printing Technology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Knee. 2021 Mar;29:390-398. doi: 10.1016/j.knee.2021.02.007. Epub 2021 Mar 9.
Anterior cruciate ligament (ACL) rupture is often accompanied by an injury to the anterolateral ligament (ALL) of the knee. Detailed knowledge of the ALL attachments in ACL-ruptured patients is essential for an anatomical ALL reconstruction to avoid knee over-constraint and successfully treat the residual rotational instability. The aim of the present study was to investigate the three-dimensional (3D), topographic anatomy of the ALL attachment in both ACL-ruptured and ACL-intact patients using 3 Tesla magnetic resonance imaging (3T MRI).
In the present, retrospective case-control study, the magnetic resonance images of 90 knees with an ACL-rupture and 90 matched-controlled subjects, who suffered a non-contact knee injury without an ACL-rupture, were used to create 3D models of the knee. The femoral and tibial ALL footprints were outlined on each model, and their position was measured using an anatomical coordinate system.
The femoral origin of the ALL was located 4.9 ± 2.8 mm posterior and 3.8 ± 2.4 mm proximal to the lateral epicondyle in a non-isometric location in control subjects. In ACL-ruptured patients, it was located in a more posterior and distal, at 6.0 ± 1.9 mm posterior and 2.4 ± 1.7 mm proximal to the lateral epicondyle (p < 0.01), also in a non-isometric location. No difference was found in the tibial ALL insertion between groups.
The femoral ALL origin was significantly different in ACL-ruptured patients compared to ACL-intact patients. The recommended femoral tunnel position for the anatomical ALL reconstruction, does not represent the femoral ALL origin in the ACL-ruptured knee.
前交叉韧带（ACL）撕裂常伴有膝关节前外侧韧带（ALL）损伤。对于解剖学上的 ALL 重建，了解 ACL 撕裂患者的 ALL 附着至关重要，以避免膝关节过度约束并成功治疗残留的旋转不稳定性。本研究的目的是使用 3 特斯拉磁共振成像（3T MRI）研究 ACL 撕裂和 ACL 完整患者的 ALL 附着的三维（3D）、解剖学特征。
在本回顾性病例对照研究中，使用 90 例 ACL 撕裂患者和 90 例匹配的对照组患者的磁共振图像创建膝关节 3D 模型。在每个模型上勾勒出 ALL 的股骨和胫骨附着点，并使用解剖坐标系测量其位置。
在对照组中，ALL 的股骨起点位于外髁后 4.9 ± 2.8mm 和外髁近端 3.8 ± 2.4mm，位置非等距。在 ACL 撕裂患者中，它位于更靠后的和更靠下的位置，位于外髁后 6.0 ± 1.9mm 和近端 2.4 ± 1.7mm（p < 0.01），位置也非等距。两组间胫骨 ALL 插入点无差异。
与 ACL 完整患者相比，ACL 撕裂患者的 ALL 股骨起点明显不同。推荐的解剖学 ALL 重建股骨隧道位置，不能代表 ACL 撕裂膝关节中的 ALL 股骨起点。
