Witzel U
Forschungsgruppe für Biomechanik Institut, Ruhr-Universität Bochum.
Polim Med. 1993;23(1-2):19-37.
The capsular and ligamentous structures as control system of a healthy knee-joint supported by the muscular system are responsible for the rolling and gliding motion of the femoral condyles on the tibial plateau. Both the condyles and the tibial plateau have individually developed but to each other adjusted shapes and fine structures thereby. These structures consist of hyaline cartilage at their three-dimensional surfaces and of closely packed fibrils (lamina splendens) as the final gliding zone for tensile load. The orientation of the collagenous fibres can be made visible by split lines. The chondral surfaces are indirectly in contact to each other and orthogonally stressed at the particular point of contact. The indirect contact of the cartilaginous surfaces happens under interposition of the menisci. The meniscus serves to reduce and equalize the surface pressure by its own projected surface on the one hand and by maintaining of a hydraulic pressure of the synovial fluid on the other hand. Deviations of the condylar position as a result on ligamentous instabilities or ruptures with a following occurring loss of congruence, meniscal lesions or traumatic ruptures lead to a rapid discharge of the synovial fluid under load. The result is a hydraulic head loss with direct contact of the chondral surfaces under stress leading to arthrotic deformations. Severe arthrotic deformations or very much every meniscectomy produce intraarticular lumped loads resulting in a hyper-physiologic chondral pressure and malnutrition thereby. Further on there develop subchondral stress concentrations (caused by the lumped loads) leading to osseous damages, too. MR-pictures can make visible these damages. Chondromalacia, fissure or even chondrolysis are arthroscopically detectable sometimes. As after-effects of deficient knee ligaments occur pathological deviations of the femoral condyles and resulting destructions of the articular surfaces under stress enormously intensified by strongly dynamic stress after ruptures of the cruciate ligaments with a too late muscular compensation. The reconstruction of cruciate ligaments is consequently required from biomechanical view to preserve the physiological position of the articular surfaces.(ABSTRACT TRUNCATED AT 400 WORDS)
由肌肉系统支撑的健康膝关节的关节囊和韧带结构作为控制系统，负责股骨髁在胫骨平台上的滚动和滑动运动。髁和胫骨平台都各自发育出相互适配的形状和精细结构。这些结构在其三维表面由透明软骨组成，并由紧密排列的纤维（亮层）作为拉伸负荷的最终滑动区域。胶原纤维的取向可通过分裂线显现。软骨表面相互间接接触，并在特定接触点受到正交应力。软骨表面的间接接触是在半月板的介入下发生的。半月板一方面通过自身的投影表面来减少和平衡表面压力，另一方面通过维持滑液的液压来实现。由于韧带不稳定或断裂导致髁位置偏差，进而出现一致性丧失、半月板损伤或创伤性破裂，会导致负荷下滑液迅速排出。结果是液压头损失，应力下软骨表面直接接触，导致关节变形。严重的关节变形或几乎每次半月板切除术都会产生关节内集中负荷，从而导致软骨压力过高和营养不良。此外，还会出现软骨下应力集中（由集中负荷引起），也会导致骨质损伤。磁共振成像（MR）图片可以显示这些损伤。软骨软化、裂隙甚至软骨溶解有时可通过关节镜检测到。由于膝关节韧带缺陷的后遗症，会出现股骨髁的病理性偏差，以及在交叉韧带断裂后肌肉补偿过晚时，应力下关节面的破坏会因强烈的动态应力而极大加剧。因此，从生物力学角度来看，需要重建交叉韧带以保持关节面的生理位置。（摘要截于400字）
