Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
Arthroscopy. 2022 Sep;38(9):2684-2696. doi: 10.1016/j.arthro.2022.03.012. Epub 2022 Mar 22.
To compare the biomechanical effects of anterolateral structure reconstructions (ALSRs) with different tibial attachments on tibiofemoral kinematics and anterolateral structure (ALS) graft forces.
Eight cadaveric knees were tested in a customized knee testing system, using a novel pulley system to simulate more muscle tensions by loading the iliotibial band at 30 N and quadriceps at 10 N in all testing states. Anterior stability during anterior load and anterolateral rotatory stability during 2 simulated pivot-shift tests (PST1 and PST2) were evaluated in 5 states: intact, ALS-deficient (Def), ALSR-Ta (anterior tibial site), ALSR-Tm (middle tibial site), and ALSR-Tp (posterior tibial site). Tibiofemoral kinematics and resulting ALS graft forces against the applied loads were measured and compared in the corresponding states.
In anterior load, 3 ALSRs mitigated the anterior laxities of the ALS Def state at all degrees, which were close to intact state at 0° and 30° but showed significantly overconstraints at 60° and 90°. In both PSTs, all ALSRs significantly reduced the anterolateral rotatory instability of ALS Def, whereas the significant overconstraints were detected in ALSR-Ta and ALSR-Tm at greater knee flexion angles. All ALS grafts carried forces in resisting anterior and pivot-shift loads. Only ALS graft force in ALSR-Ta increased continuously with knee flexion angles. The ALS graft forces carried by ALSR-Ta were significantly larger than those by ALSR-Tp and ALSR-Tm when resisting anterior load and PSTs at greater knee flexion angles.
ALSRs with different tibial attachment sites similarly restored knee laxities close to the native tibiofemoral kinematics in an ALS-deficient knee, whereas the ALSR-Tp showed less propensity for overconstraining the knee at greater flexion angles. The ALS graft in ALSR-Ta carried more forces than those in ALSR-Tp and ALSR-Tm against simulated loads.
Altering the tibial attachment sites of ALSRs may not significantly affect tibiofemoral kinematics at most degrees whereas the posterior may have less overconstraints at greater flexion angles. However, ALS graft positioning at a more anterior tibial attachment site may carry more forces in resisting anterior and pivot-shift loads.
比较不同胫骨附着点的前外侧结构重建（ALSR）对胫股关节运动学和前外侧结构（ALS）移植物力的生物力学影响。
在定制的膝关节测试系统中测试了 8 个尸体膝关节，使用新型滑轮系统在所有测试状态下通过加载 30N 的阔筋膜张肌和 10N 的股四头肌来模拟更多的肌肉张力。在前负荷时评估前稳定性，在 2 个模拟枢轴移位试验（PST1 和 PST2）时评估前外侧旋转稳定性，共 5 种状态：完整、ALS 缺失（Def）、ALSR-Ta（胫骨前侧）、ALSR-Tm（胫骨中间）和 ALSR-Tp（胫骨后侧）。在相应状态下测量并比较前负荷和模拟枢轴移位试验时的胫股关节运动学和 ALS 移植物对施加负荷的力。
在前负荷时，3 种 ALSR 在所有角度都减轻了 ALS Def 状态的前松弛度，在 0°和 30°时接近完整状态，但在 60°和 90°时表现出明显的过度约束。在两个 PST 中，所有 ALSR 均显著降低了 ALS Def 的前外侧旋转不稳定性，而在更大的膝关节屈曲角度下，ALSR-Ta 和 ALSR-Tm 检测到明显的过度约束。所有 ALS 移植物都在抵抗前负荷和 PST 时产生力。只有 ALSR-Ta 的 ALS 移植物力随膝关节屈曲角度的增加而持续增加。当在更大的膝关节屈曲角度抵抗前负荷和 PST 时，ALSR-Ta 的 ALS 移植物力明显大于 ALSR-Tp 和 ALSR-Tm。
不同胫骨附着点的 ALSR 同样恢复了 ALS 缺失膝关节接近自然胫股关节运动学的膝关节松弛度，而 ALSR-Tp 在更大的膝关节屈曲角度下对膝关节的过度约束倾向较小。ALSR-Ta 中的 ALS 移植物在抵抗模拟负荷时比 ALSR-Tp 和 ALSR-Tm 产生更大的力。
改变 ALSR 的胫骨附着点可能不会在大多数角度显著影响胫股关节运动学，而后部在更大的膝关节屈曲角度下可能具有较小的过度约束。然而，ALS 移植物在前更靠前的胫骨附着点定位可能在抵抗前负荷和枢轴移位负荷时产生更大的力。
