Direct Anterior Cruciate Ligament Insertion to the Femur Assessed by Histology and 3-Dimensional Volume-Rendered Computed Tomography
Direct Anterior Cruciate Ligament Insertion to the Femur Assessed by Histology and 3-Dimensional Volume-Rendered Computed Tomography
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DOI：
10.1016/j.arthro.2010.01.023
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发表时间：
2010-09-01
影响因子：
4.7
通讯作者：
Nakamura, Norimasa
中科院分区：
文献类型：
--
作者：
Iwahashi, Takehiko;Shino, Konsei;Nakamura, Norimasa
目的：本研究的目的是组织学上确定股前交叉韧带（ACL）的直接和间接止点。此外，我们通过使用三维（3D）体积渲染（VR）计算机断层扫描（CT）模型定量测量股骨直接止点面积。方法：利用8个完整的尸体膝关节，在平行于髁间切迹顶部的3个斜轴面和矢状面对包括前交叉韧带附件的股骨外侧髁进行组织学检查。在切片前，对这些膝关节进行CT以获得股骨的3D VR图像。一旦在每个组织学切片上确定了ACL的直接插入，将相应的图像叠加在相应的CT图像上。结果：在股骨外侧髁关节软骨后内侧缘与关节软骨缘前7 ~ 10 mm的线状骨嵴之间的区域，显微镜下发现了致密胶原纤维通过纤维软骨层与骨连接的直接前交叉韧带插入。仔细比较组织学分析和3D VR CT模型显示，前交叉韧带直接插入正好与线状骨脊后面的月牙形空心吻合。直接插入长度为17.4 +/- 0.9 mm（平均+/- SD），宽度为8.0 +/- 0.5 mm，面积为128.3 +/- 10.5 mm。结论：前交叉韧带的直接止点位于股骨外侧髁股骨脊与关节软骨缘之间的凹陷处。它长17.4 +/- 0.9毫米，宽8.0 +/- 0.5毫米，面积128.3 +/- 10.5毫米。临床意义：三维虚拟现实CT描绘前交叉韧带股骨直接插入点可用于规划准确的股骨隧道定位解剖前交叉韧带重建的有用工具。
Purpose: The purpose of this study was to histologically identify the direct and indirect insertion of the femoral anterior cruciate ligament (ACL) insertion. Furthermore, we quantitatively measured the direct femoral insertion area by use of the 3-dimensional (3D) volume-rendered (VR) computed tomography (CT) model. Methods: By use of 8 intact cadaveric knees, the lateral femoral condyle including the ACL attachment was sectioned for histologic examination in 3 oblique-axial planes parallel to the roof of the intercondylar notch and in the sagittal planes. Before sectioning, these knees had been subjected to CT to obtain 3D VR images of the femur. Once the direct insertion of the ACL was identified on each histologic section, the corresponding image was superimposed on the corresponding CT image. Results: The direct ACL insertion, in which dense collagen fibers were connected to the bone by the fibrocartilaginous layer, was microscopically identified at the region between the posteromedial articular cartilage margin of the lateral femoral condyle and the linear bony ridge 7 to 10 mm anterior to the articular cartilage margin. Meticulous comparison of histologic analysis and the 3D VR CT model showed that the ACL direct insertion coincided with a crescent-shaped hollow just behind the linear bony ridge. The direct insertion measured 17.4 +/- 0.9 mm (mean +/- SD) in length, 8.0 +/- 0.5 mm in width, and 128.3 +/- 10.5 mm(2) in area. Conclusions: The direct insertion of the ACL is located in the depression between the resident's ridge and the articular cartilage margin on the lateral femoral condyle. It measured 17.4 +/- 0.9 mm in length, 8.0 +/- 0.5 mm in width, and 128.3 +/- 10.5 mm(2) in area. Clinical Relevance: Delineation of the ACL femoral direct insertion by 3D VR CT could be a useful tool for planning of accurate femoral tunnel positioning in anatomic ACL reconstruction.