Sullivan D, Levy I M, Sheskier S, Torzilli P A, Warren R F
J Bone Joint Surg Am. 1984 Jul;66(6):930-6. doi: 10.2106/00004623-198466060-00015.
We investigated the motion of cadaver knees before and after section of the medial structures and anterior cruciate ligament. The knees were tested using a 5-degrees-of-freedom in vitro knee-testing apparatus that measured anterior-posterior, medial-hateral, and axial displacement as well as internal-external and valgus-varus rotation. The fiexion angle could be varied but was fixed for each individual test. A 125-newton anterior-posterior force was applied perpendicular to the tibial shaft and the resulting motion of the knee was measured. In five knees the anterior cruciate ligament was cut first, followed by progressive cuts of the structures on the medial side (superficial medial collateral ligament, deep medial ligament, oblique fibers of the superficial medial ligament, and the posteromedial part of the capsule). Conversely, in five knees the medial structures were progressively cut first, followed by section of the anterior cruciate ligament. Tests were performed after each cut. With an intact anterior cruciate ligament, progressive cutting of the medial side had no effect on anterior and posterior displacements. When section of the medial structures followed cutting of the anterior cruciate ligament, anterior displacement exceeded that seen after isolated section of the anterior cruciate ligament. The anterior and posterior load-tests were repeated with the tibia fixed in 5 degrees of internal and 5 degrees of external rotation. Fixed external notation had no effect on anterior and posterior displacements. Fixed internal rotation significantly decreased anterior displacement only when both the anterior cruciate ligament and the medial structures were cut. The amounts of tibial rotation and tibial torque resulting from the applied anterior and posterior forces were low compared with our previous results, and we attributed this to decreased constraints on motion of the knee in the current testing apparatus.
Athletic injuries of the knee frequently involve both the anterior cruciate ligament and the medial side of the knee. Clinical studies have demonstrated that combined injuries of the anterior cruciate and medial collateral ligaments often cannot be successfully managed conservatively. Our in vitro findings support the clinical data and suggest that injuries to the medial structures further compromise anterior stability when they accompany anterior cruciate injuries.
我们研究了尸体膝关节在内侧结构和前交叉韧带切断前后的运动情况。使用一个五自由度的体外膝关节测试装置对膝关节进行测试，该装置可测量前后、内外侧和轴向位移以及内外旋和内翻-外翻旋转。屈曲角度可以变化，但在每个单独测试中是固定的。垂直于胫骨干施加125牛顿的前后力，并测量膝关节的相应运动。在五个膝关节中，先切断前交叉韧带，然后逐步切断内侧结构（浅层内侧副韧带、深层内侧韧带、浅层内侧韧带的斜纤维以及关节囊的后内侧部分）。相反，在另外五个膝关节中，先逐步切断内侧结构，然后切断前交叉韧带。每次切断后进行测试。在前交叉韧带完整时，逐步切断内侧结构对前后位移没有影响。当内侧结构切断在切断前交叉韧带之后时，前位移超过单独切断前交叉韧带后的位移。在胫骨固定于5度内旋和5度外旋的情况下重复进行前后负荷测试。固定外旋对前后位移没有影响。仅当前交叉韧带和内侧结构都被切断时，固定内旋才会显著降低前位移。与我们之前的结果相比，由施加的前后力产生的胫骨旋转量和胫骨扭矩较低，我们将此归因于当前测试装置中膝关节运动的约束减少。
膝关节的运动损伤经常涉及前交叉韧带和膝关节内侧。临床研究表明，前交叉韧带和内侧副韧带的联合损伤通常无法通过保守治疗成功处理。我们的体外研究结果支持临床数据，并表明当内侧结构损伤伴随前交叉韧带损伤时，会进一步损害前稳定性。
