Jonsson H, Kärrholm J
Department of Orthopaedics, University Hospital of Northern Sweden, Umeå.
J Orthop Res. 1994 Nov;12(6):769-79. doi: 10.1002/jor.1100120604.
The three-dimensional motions of the knee were analysed during closed kinetic chain knee extension in 13 patients with unilateral chronic injury of the anterior cruciate ligament. The patients ascended a platform, and serial stereophotogrammetric roentgenograms were exposed from about 100 degrees of flexion to full extension. From a position of about 100 degrees of knee flexion and 20 degrees of internal rotation, the tibia rotated externally during the extension. Almost no tibial adduction or abduction was observed. The tibial intercondylar eminence translated laterally, distally, and anteriorly relative to the femur. In knees with absence of the anterior cruciate ligament, the intercondylar eminence had a more posterior position compared with the contralateral normal knees. The proximal tibia was used as a fixed reference segment to evaluate the anteroposterior translations of a central point in the femoral condyles. The femoral point was more anteriorly displaced in the injured than in the contralateral knees. This difference might reflect increased activity of the hamstrings in the injured knees, because it was most pronounced at 80 degrees of flexion and decreased with increasing extension. In the sagittal plane, the mean helical axis was positioned close to the femoral insertion of the ligament at 80 degrees of flexion and was displaced distally and anteriorly during extension. In the frontal plane, the axis had a transverse direction at 80 degrees of flexion. At close to full extension, the axis was positioned distally in the lateral condyle and proximally in the medial condyle. In the horizontal plane, the helical axes ran slightly more anteriorly in the medial than in the lateral femoral condyle but changed inclination at close to full extension and became almost parallel to the transverse axis.
对13例单侧前交叉韧带慢性损伤患者在闭链膝关节伸展过程中的膝关节三维运动进行了分析。患者登上一个平台，从大约100度屈曲到完全伸展期间拍摄连续的立体摄影X线片。从膝关节屈曲约100度和内旋20度的位置开始，在伸展过程中胫骨向外旋转。几乎未观察到胫骨内收或外展。胫骨髁间隆起相对于股骨向外侧、远侧和前方移位。在前交叉韧带缺失的膝关节中，髁间隆起相对于对侧正常膝关节具有更靠后的位置。以近端胫骨作为固定参考节段来评估股骨髁中央一点的前后移位。损伤侧的股骨点比双侧膝关节中的对侧更向前移位。这种差异可能反映了损伤膝关节中腘绳肌活动增加，因为这种差异在屈曲80度时最为明显，并随着伸展增加而减小。在矢状面，平均螺旋轴在屈曲80度时靠近韧带的股骨附着点，并在伸展过程中向远侧和前方移位。在额状面，该轴在屈曲80度时呈横向。接近完全伸展时，该轴位于外侧髁的远侧和内侧髁的近侧。在水平面，螺旋轴在内侧股骨髁比外侧股骨髁稍向前走行，但在接近完全伸展时改变倾斜度并变得几乎与横轴平行。
