Tsuda Takashi, Hino Kazunori, Kutsuna Tatsuhiko, Watamori Kunihiko, Kinoshita Tomofumi, Horita Yusuke, Takao Masaki
Department of Orthopaedic Surgery, Ehime University, Graduate School of Medici`ne, Shitsukawa, Toon City, Ehime 791-0295, Japan.
Department of Joint Reconstruction, Ehime University, Graduate School of Medicine, Shitsukawa, Toon City, Ehime 791-0295, Japan.
J ISAKOS. 2025 Aug;13:100913. doi: 10.1016/j.jisako.2025.100913. Epub 2025 Jun 18.
INTRODUCTION/OBJECTIVES: The specific contributions of the soft tissue attachments along the tibial rim remain poorly understood, while the importance of medial stability in the knee joint has been widely emphasized. This study aimed to evaluate the effect of releasing individual anteromedial stabilizers by replicating the soft tissue release typically performed in total knee arthroplasty.
Eight cadaveric knees were evaluated. Passive stress in each direction with six degrees of freedom was applied to the knees under image-free navigation monitoring. Measurements were taken following the sequential release of soft tissue structures: normal; anterior and posterior cruciate ligament resection; removal of the medial meniscus with 1 cm of anteromedial meniscotibial ligament release; 3 cm of anteromedial joint capsule release; and tibial attachment release of the deep collateral ligament. The entire section was performed sequentially on the identical cadaver knee.
Anterior translation exhibited a statistically significant increase following dissection of the medial meniscus and 1 cm of the meniscotibial ligament at an intermediate flexion angle compared with the previous section. External laxity statistically significantly increased following dissection of the medial meniscus and 1 cm of the meniscotibial ligament overall flexion angle. Moreover, further external rotational laxity was observed following 3-cm anteromedial joint capsule release and subsequent deep collateral ligament release throughout an extensive flexion angle. Due to the dissection of each medial structure, gradual increases in external rotation laxity were observed in all sections, with statistically significant differences. Following deep collateral ligament dissection, laxity in each of the six degrees of freedom increased by approximately 20-30 % compared with the values observed after anterior and posterior cruciate ligament dissection.
Structures attaching to the anteromedial rim of the tibia serve as critical secondary stabilizers during midflexion in cruciate-deficient knees, with the anteromedial joint capsule sleeve and deep medial collateral ligament contributing to rotational stability despite the presence of an intact superficial medial collateral ligament.
V.
引言/目的：沿胫骨边缘的软组织附着的具体作用仍知之甚少，而膝关节内侧稳定性的重要性已得到广泛强调。本研究旨在通过复制全膝关节置换术中通常进行的软组织松解来评估松解单个前内侧稳定结构的效果。
对8个尸体膝关节进行评估。在无图像导航监测下，对膝关节施加六个自由度的每个方向的被动应力。在依次松解软组织结构后进行测量：正常状态；切除前后交叉韧带；切除内侧半月板并松解1厘米的前内侧半月板胫骨韧带；松解3厘米的前内侧关节囊；以及松解深层副韧带的胫骨附着点。整个操作在同一具尸体膝关节上依次进行。
与上一阶段相比，在中间屈曲角度下，切除内侧半月板和1厘米半月板胫骨韧带后，前向平移在统计学上有显著增加。在内侧半月板和1厘米半月板胫骨韧带切除后，在整个屈曲角度下，外侧松弛度在统计学上有显著增加。此外，在3厘米前内侧关节囊松解及随后在广泛的屈曲角度下松解深层副韧带后，观察到进一步的外侧旋转松弛。由于每个内侧结构的松解，在所有阶段均观察到外侧旋转松弛逐渐增加，且有统计学显著差异。在深层副韧带松解后，六个自由度中的每一个的松弛度与前后交叉韧带松解后观察到的值相比增加了约20% - 30%。
附着于胫骨前内侧边缘的结构在交叉韧带缺失的膝关节中屈曲中期作为关键的二级稳定结构，尽管存在完整的浅层内侧副韧带，但前内侧关节囊袖和深层内侧副韧带仍有助于旋转稳定性。
V级
