The Anterolateral Capsule of the Knee Behaves Like a Sheet of Fibrous Tissue
The Anterolateral Capsule of the Knee Behaves Like a Sheet of Fibrous Tissue
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DOI：
10.1177/0363546516674477
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发表时间：
2017-03-01
影响因子：
4.8
通讯作者：
Debski, Richard E.
中科院分区：
文献类型：
--
作者：
Guenther, Daniel;Rahnemai-Azar, Amir A.;Debski, Richard E.
背景：膝关节前外侧关节囊的功能尚未明确定义。然而，与其他前外侧结构相比，关节囊的该区域对膝关节稳定性的贡献可以通过膝关节加载期间每个结构承载的相对力来确定。目的/假设：本研究的目的是确定完整和前交叉韧带（ACL）前外侧结构中的力，膝关节对胫骨前负荷和胫骨内扭矩的反应不足。据推测，前外侧关节囊不会像传统的韧带（即，传输力只沿着其纵轴）的功能。研究设计：对照实验室study.Methods：负载（134 N的前胫骨负载和7 Nm的内部胫骨扭矩）连续屈曲过程中施加到7个新鲜冷冻尸体膝关节在完整和ACL缺陷的状态，使用机器人测试系统。外侧副韧带（LCL）和前外侧囊与周围组织分离，并相互分离。这是通过进行3个垂直切口完成的：LCL外侧、LCL内侧和Gerdy结节外侧。LCL和前外侧关节囊的外侧壁与下方组织（即半月板）分离，使止点和起源保持完整。在前外侧关节囊，ACL，LCL的力分布，然后确定在30度，60度和90度的膝关节屈曲using the principle of superpositions.Results：在完整的膝关节，在ACL中的力响应于胫骨前负荷大于在其他结构（P < .001）。然而，在对内部胫骨扭矩的反应中，在ACL、LCL和关节囊分离后前外侧关节囊各区域之间传递的力之间没有发现显著差异。与其他结构相比，前外侧关节囊承受的力较小（类似于小50%）（P = 0.048）。对于ACL缺陷的膝关节，在胫骨前负荷下，前外侧关节囊各区域之间传递的力比前外侧关节囊中的力大434%（P <0.001），比屈曲30 °时LCL中的力大54%（P = 0.036）。在膝关节屈曲30 °、60 °或90 °时，胫骨内部扭矩的反应中，在前外侧关节囊和LCL的每个区域之间传递的力之间没有发现显著差异。在两种载荷条件下，在所有膝关节屈曲角度下，前外侧关节囊中的力均显著小于其他结构中的力（胫骨前向载荷P = 0.004，胫骨内扭矩P = 0.04）。前外侧囊在纵向方向上承载可忽略的力，并且关节囊区域之间传递的力与膝盖其他结构承受的力相似，这表明它不具有传统韧带的功能。因此，前外侧囊应被视为一片tissue.Clinical Relevance：前外侧囊的手术修复技术应恢复组织在囊相邻区域之间传递力的能力，而不是沿着其纵轴传递力。
Background: The function of the anterolateral capsule of the knee has not been clearly defined. However, the contribution of this region of the capsule to knee stability in comparison with other anterolateral structures can be determined by the relative force that each structure carries during loading of the knee.Purpose/Hypothesis: The purpose of this study was to determine the forces in the anterolateral structures of the intact and anterior cruciate ligament (ACL)-deficient knee in response to an anterior tibial load and internal tibial torque. It was hypothesized that the anterolateral capsule would not function like a traditional ligament (ie, transmitting forces only along its longitudinal axis).Study Design: Controlled laboratory study.Methods: Loads (134-N anterior tibial load and 7-Nm internal tibial torque) were applied continuously during flexion to 7 fresh-frozen cadaveric knees in the intact and ACL-deficient state using a robotic testing system. The lateral collateral ligament (LCL) and the anterolateral capsule were separated from the surrounding tissue and from each other. This was done by performing 3 vertical incisions: lateral to the LCL, medial to the LCL, and lateral to the Gerdy tubercle. Attachments of the LCL and anterolateral capsule were detached from the underlying tissue (ie, meniscus), leaving the insertions and origins intact. The force distribution in the anterolateral capsule, ACL, and LCL was then determined at 30 degrees, 60 degrees, and 90 degrees of knee flexion using the principle of superposition.Results: In the intact knee, the force in the ACL in response to an anterior tibial load was greater than that in the other structures (P < .001). However, in response to an internal tibial torque, no significant differences were found between the ACL, LCL, and forces transmitted between each region of the anterolateral capsule after capsule separation. The anterolateral capsule experienced smaller forces (similar to 50% less) compared with the other structures (P = .048). For the ACL-deficient knee in response to an anterior tibial load, the force transmitted between each region of the anterolateral capsule was 434% greater than was the force in the anterolateral capsule (P < .001) and 54% greater than the force in the LCL (P = .036) at 30 degrees of flexion. In response to an internal tibial torque at 30 degrees, 60 degrees, or 90 degrees of knee flexion, no significant differences were found between the force transmitted between each region of the anterolateral capsule and the LCL. The force in the anterolateral capsule was significantly smaller than that in the other structures at all knee flexion angles for both loading conditions (P = .004 for anterior tibial load and P = .04 for internal tibial torque).Conclusion: The anterolateral capsule carries negligible forces in the longitudinal direction, and the forces transmitted between regions of the capsule were similar to the forces carried by the other structures at the knee, suggesting that it does not function as a traditional ligament. Thus, the anterolateral capsule should be considered a sheet of tissue.Clinical Relevance: Surgical repair techniques for the anterolateral capsule should restore the ability of the tissue to transmit forces between adjacent regions of the capsule rather than along its longitudinal axis.