Mostowy Marcin, Puzio Tomasz, Matera Katarzyna, Kozieł Michał, Stanek Jakub, Bawor Michalina, Grzelak Piotr, Domżalski Marcin E
Orthopedic and Trauma Department, Veteran's Memorial Teaching Hospital in Lodz, Medical University of Lodz, Lodz, Poland.
Department of Diagnostic Imaging, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland.
J Anat. 2024 Feb;244(2):325-332. doi: 10.1111/joa.13954. Epub 2023 Sep 22.
The first aim of this study was to compare the medial patellofemoral length between contracted and relaxed quadriceps muscle and second to assess the importance of the intermeshed vastus medialis oblique fibers. After a priori power analysis (α = 0.05, power [1-β] = 0.95), 35 healthy males aged 18-30 were prospectively examined with a 3.0-T magnetic resonance imaging (MRI) scanner in 10-15° of knee flexion. Two axial MRI sequences (25 s each) were made with relaxed and contracted quadriceps. Two blinded, independent raters measured twice medial patellofemoral ligament length (curved line) and attachment-to-attachment length (straight line). Mean medial patellofemoral ligament length and attachment-to-attachment length with relaxed quadriceps was: 65.5 mm (SD = 3.7), 59.7 mm (SD = 3.6), and after contraction, it increased to 68.7 mm (SD = 5.3), 61.2 mm (SD = 4.7); p < 0.01 and <0.001, respectively. Intraclass correlation coefficients for intra- and inter-rater reliabilities ranged from 0.55 (moderate) to 0.97 (excellent). Mean medial patellofemoral ligament length elongation after quadriceps contraction was significantly greater (3.2 mm, SD = 3.9) than mean attachment-to-attachment length elongation (1.6 mm, SD = 2.8); p < 0.001. Contraction of quadriceps muscle causes elongation of the medial patellofemoral ligament to the extent greater than the elongation of distance between its attachments. This confirms that medial patellofemoral ligament elongation after quadriceps contraction results not only from movement of its patellar attachment but also directly from intermeshed vastus medialis oblique fibers pulling medial patellofemoral ligament in a different direction creating a bow-like construct in agreement with the "pull-and-guide mechanism" proposed in the literature.
本研究的首要目的是比较股四头肌收缩和放松时髌股内侧长度，其次是评估相互交织的股内侧斜肌纤维的重要性。经过先验功效分析（α = 0.05，功效[1-β]= 0.95），对35名年龄在18 - 30岁的健康男性在膝关节屈曲10 - 15°时进行前瞻性3.0-T磁共振成像（MRI）扫描检查。在股四头肌放松和收缩状态下分别进行两个轴向MRI序列扫描（各25秒）。两名不知情的独立评估者对髌股内侧韧带长度（曲线）和附着点间长度（直线）各测量两次。股四头肌放松时髌股内侧韧带平均长度及附着点间长度分别为：65.5毫米（标准差 = 3.7），59.7毫米（标准差 = 3.6），收缩后分别增至68.7毫米（标准差 = 5.3），61.2毫米（标准差 = 4.7）；p值分别<0.01和<0.001。组内和组间评估者可靠性的组内相关系数范围为0.55（中等）至0.97（优秀）。股四头肌收缩后髌股内侧韧带平均长度伸长（3.2毫米，标准差 = 3.9）显著大于平均附着点间长度伸长（1.6毫米，标准差 = 2.8）；p<0.001。股四头肌收缩导致髌股内侧韧带伸长的程度大于其附着点间距离的伸长程度。这证实了股四头肌收缩后髌股内侧韧带伸长不仅源于其髌骨附着点的移动，还直接源于相互交织的股内侧斜肌纤维以不同方向牵拉髌股内侧韧带，形成一种与文献中提出的“牵拉引导机制”相符的弓形结构。
