Navigated knee kinematics after cutting of the ACL and its secondary restraint
Navigated knee kinematics after cutting of the ACL and its secondary restraint
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DOI：
10.1007/s00167-011-1640-8
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发表时间：
2012-05-01
影响因子：
3.8
通讯作者：
D'Arrigo, C.
中科院分区：
文献类型：
--
作者：
Monaco, E.;Ferretti, A.;D'Arrigo, C.
本研究的目的是评估前交叉韧带切断后膝关节的运动学变化，并使用导航系统评估前交叉韧带和其中一种辅助约束在控制膝关节稳定性方面的作用。在不同的不稳定条件下评价膝关节的运动学：ACL完整、后外侧（PL）束分离后、前内侧（AM）束分离后和外侧囊韧带（LCL）损伤后。在10个新鲜冷冻尸体膝关节上，通过使用手动最大载荷，用计算机导航系统测量胫骨前平移和旋转。在屈曲30 A度、60 A度和90 A度下评估前向平移;在0A度、15 A度、30 A度、45 A度、60 A度和90 A度下旋转。切断AM束显著增加了30 A度和60 A度的前后（AP）平移（P = 0.01），但没有增加膝关节的旋转。切割LCL增加了60 A °时的前向平移（P = 0.04）和30 A度、45 A度和60 A度旋转在本研究的测试条件下，PL束不影响膝关节的前向平移和旋转; AM束是前平移的主要限制，但不影响膝关节旋转，而LCL的病变增加了胫骨旋转，可能与枢轴移位有关因此，在ACL手术时评估和修复膝关节前外侧结构的相关病变更为正确和生物力学有效。
The purpose of this study is to evaluate the kinematics changes of the knee after cutting of the ACL with or without injury of the anterolateral structures.In this study, the role of the ACL and one of the secondary restraints in controlling knee stability using a navigation system was evaluated. The kinematics of the knee was evaluated in different conditions of instability: ACL intact, after dissection of the posterolateral (PL) bundle, after dissection of the anteromedial (AM) bundle, and after lesion of the lateral capsular ligament (LCL). Anterior tibial translation and rotation were measured with a computer navigation system in 10 fresh-frozen cadaveric knees by use of a manual maximum load. Anterior translation was evaluated at 30A degrees, 60A degrees, and 90A degrees of flexion; rotation at 0A degrees, 15A degrees, 30A degrees, 45A degrees, 60A degrees, and 90A degrees.Cutting the PL bundle does not increase anterior translation and rotation of the knee. Cutting the AM bundle significantly increased the anteroposterior (AP) translation at 30A degrees and 60A degrees (P = 0.01), but does not increase rotation of the knee. Cutting the LCL increased anterior translation at 60A degrees (P = 0.04) and rotation at 30A degrees, 45A degrees, and 60A degrees (P = 0.03).Within the testing conditions of this study, the PL bundle does not affect anterior translation and rotation of the knee; the AM bundle is the primary restraint of the anterior translation but does not affect rotation of the knee while the lesion of the LCL increases tibial rotation and could be related to the pivot shift phenomenon, so it is more correct and biomechanical valid to assess and repair the associated lesion of the antero-lateral structure of the knee at the time of ACL surgery.