Combined knee loading states that generate high anterior cruciate ligament forces
Combined knee loading states that generate high anterior cruciate ligament forces
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DOI：
10.1002/jor.1100130618
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发表时间：
1995-11-01
影响因子：
2.8
通讯作者：
Slauterbeck, JL
中科院分区：
文献类型：
--
作者：
Markolf, KL;Burchfield, DI;Slauterbeck, JL
前交叉韧带损伤经常发生在膝关节负荷的联合机制下。这项体外研究旨在测量各个负载状态的双重组合下的韧带力水平，并确定哪些组合产生高力。当膝关节在恒定的胫骨负载下从90度屈曲被动伸展到5度过伸时记录合力。各个负载状态为 100 N 的胫骨前力、10 Nm 的内翻和外翻力矩以及 10 Nm 的内部和外部胫骨扭矩。胫骨前直力是最直接的加载机制；平均韧带力大约等于屈曲 30 度时施加的胫骨前力，以及完全伸展时施加的胫骨力的 150%。将胫骨内扭矩添加到由前胫骨力加载的膝盖上，会在完全伸展和过度伸展时产生力的急剧增加。这种载荷组合产生了研究中记录的最高韧带力，并且就韧带潜在损伤而言是最危险的。与此形成鲜明对比的是，向由前胫骨力加载的膝盖添加外部胫骨扭矩，显着降低了膝盖弯曲位置的力；当屈曲接近 90 度时，前十字韧带完全卸载。向由前胫骨力加载的膝关节添加内翻力矩会增加伸展和过度伸展的力，而添加外翻力矩会增加弯曲位置的力。这些组合负载状态也可能增加受伤的风险。胫骨内扭矩是膝关节伸展时前十字韧带的重要加载机制。与胫骨内扭矩结合应用的内翻或外翻力矩造成韧带损伤的总体风险与单独使用胫骨内扭矩的风险相似。胫骨外扭矩是产生前十字韧带力的相对不重要的机制。
Injuries to the anterior cruciate ligament frequently occur under combined mechanisms of knee loading. This in vitro study was designed to measure levels of ligament force under dual combinations of individual loading states and to determine which combinations generated high force. Resultant force was recorded as the knee was extended passively from 90 degrees of flexion to 5 degrees of hyperextension under constant tibial loadings. The individual loading states were 100 N of anterior tibial force, 10 Nm of varus and valgus moment, and 10 Nm of internal and external tibial torque. Straight anterior tibial force was the most direct loading mechanism; the mean ligament force was approximately equal to applied anterior tibial force near 30 degrees of flexion and to 150% of applied tibial force at full extension. The addition of internal tibial torque to a knee loaded by anterior tibial force produced dramatic increases of force at full extension and hyperextension. This loading combination produced the highest ligament forces recorded in the study and is the most dangerous in terms of potential injury to the ligament. In direct contrast, the addition of external tibial torque to a knee loaded by anterior tibial force decreased the force dramatically for flexed positions of the knee; at close to 90 degrees of flexion, the anterior cruciate ligament became completely unloaded. The addition of varus moment to a knee loaded by anterior tibial force increased the force in extension and hyperextension, whereas the addition of valgus moment increased the force at flexed positions. These states of combined loading also could present an increased risk for injury. Internal tibial torque is an important loading mechanism of the anterior cruciate ligament for an extended knee. The overall risk of injury to the ligament from varus or valgus moment applied in combination with internal tibial torque is similar to the risk from internal tibial torque alone. External tibial torque was a relatively unimportant mechanism for generating anterior cruciate ligament force.