Hsieh Y F, Draganich L F, Ho S H, Reider B
The University of Chicago, Department of Surgery, Illinois 60637, USA.
Am J Sports Med. 1998 Mar-Apr;26(2):201-9. doi: 10.1177/03635465980260020901.
Patellofemoral pain may be associated with anterior cruciate ligament deficiency or may occur after anterior cruciate ligament reconstruction. We investigated the effects of the removal and reconstruction of the anterior cruciate ligament on the kinematics of the tibiofemoral and patellofemoral joints during physiologic levels of quadriceps muscle loads in seven cadaveric knees. A bone-patellar tendon-bone graft was used for intraarticular reconstruction of the anterior cruciate ligament. The spatial positions of the tibiofemoral and patellofemoral joints were measured between 0 degrees and 90 degrees of knee flexion in 15 degrees increments with a six degree-of-freedom digitizing system. Excision of the anterior cruciate ligament resulted in statistically significant increases in anterior tibial translation between 0 degrees and 90 degrees and valgus tibial rotation between 30 degrees and 90 degrees; intraarticular reconstruction returned these to levels not significantly different from those of the intact knee. Excision of the anterior cruciate ligament resulted in significant increases in lateral patellar tilt, ranging from 6.3 degrees to 9.0 degrees between full extension and 90 degrees of knee flexion, and in lateral patellar shift, ranging from 2.9 mm at 15 degrees of knee flexion to 5.9 mm at 90 degrees; intraarticular reconstruction returned these to levels not significantly different from those of the intact knee. Neither removal nor reconstruction of the anterior cruciate ligament significantly affected tibial internal-external rotation, patellar flexion, patellar mediolateral rotation, patellar anteroposterior translation, or patellar proximodistal translation.
髌股疼痛可能与前交叉韧带损伤有关，或者在前交叉韧带重建术后出现。我们研究了前交叉韧带切除和重建对7具尸体膝关节在股四头肌生理负荷水平下胫股关节和髌股关节运动学的影响。采用骨-髌腱-骨移植物进行前交叉韧带的关节内重建。使用六自由度数字化系统，在膝关节从0度到90度屈曲过程中，以15度的增量测量胫股关节和髌股关节的空间位置。切除前交叉韧带导致在0度至90度之间胫骨前移以及在30度至90度之间胫骨外翻旋转有统计学意义的增加；关节内重建后这些指标恢复到与完整膝关节无显著差异的水平。切除前交叉韧带导致髌骨外侧倾斜显著增加，在膝关节完全伸展至90度屈曲之间为6.3度至9.0度，以及髌骨外侧移位显著增加，在膝关节15度屈曲时为2.9毫米，在90度屈曲时为5.9毫米；关节内重建后这些指标恢复到与完整膝关节无显著差异的水平。前交叉韧带的切除或重建均未显著影响胫骨内外旋转、髌骨屈曲、髌骨内外侧旋转、髌骨前后移位或髌骨远近端移位。
