Harman M K, Markovich G D, Banks S A, Hodge W A
Orthopaedic Research Laboratory, Good Samaritan Medical Center, West Palm Beach, FL 33402, USA.
Clin Orthop Relat Res. 1998 Jul(352):149-58.
The size and location of articular cartilage wear was assessed on 106 varus and 37 valgus osteoarthritic tibial plateaus resected during total knee arthroplasty. Anterior cruciate ligament integrity was assessed intraoperatively, and calibrated digital images were used to measure the wear patterns. Complete anterior cruciate ligament deficiency was seen in 25% of the varus and 24% of the valgus knees. Wear patterns on anterior cruciate ligament intact and attenuated varus tibial plateaus occurred in the middle to anterior aspect of the medial plateau. Anterior cruciate ligament deficient varus plateaus had significantly larger wear areas located more posterior on the medial plateau. In contrast, anterior cruciate ligament intact and deficient valgus tibial plateaus had wear located posterior to the center of the lateral plateau. Anterior cruciate ligament integrity is a discrete feature of advanced osteoarthritis that strongly influences the articular wear patterns. The anterior cruciate ligament deficient wear patterns show a wear mechanism that is consistent with the posterior femoral subluxation and posterior tibiofemoral contact observed after acute anterior cruciate ligament rupture. These observations provide insight into the altered knee mechanics that exist in osteoarthritic knees and the resulting mechanical factors that contribute to degenerative changes.
在全膝关节置换术中，对106例内翻和37例外翻骨关节炎胫骨平台切除标本的关节软骨磨损大小和位置进行了评估。术中评估前交叉韧带的完整性，并使用校准后的数字图像测量磨损模式。25%的内翻膝关节和24%的外翻膝关节存在完全性前交叉韧带缺失。前交叉韧带完整和松弛的内翻胫骨平台磨损模式出现在内侧平台的中前部。前交叉韧带缺失的内翻平台在内侧平台更靠后的位置有明显更大的磨损区域。相比之下，前交叉韧带完整和缺失的外翻胫骨平台磨损位于外侧平台中心后方。前交叉韧带的完整性是晚期骨关节炎的一个独立特征，对关节磨损模式有强烈影响。前交叉韧带缺失的磨损模式显示出一种与急性前交叉韧带断裂后观察到的股骨后脱位和胫股后接触相一致的磨损机制。这些观察结果有助于深入了解骨关节炎膝关节中存在的改变的膝关节力学以及导致退行性变化的机械因素。
