The effect of femoral tunnel placement on ACL graft orientation and length during in vivo knee flexion
The effect of femoral tunnel placement on ACL graft orientation and length during in vivo knee flexion
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DOI：
10.1016/j.jbiomech.2011.04.030
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发表时间：
2011-07-07
影响因子：
2.4
通讯作者：
DeFrate, Louis E.
中科院分区：
文献类型：
--
作者：
Abebe, Ermias S.;Kim, Jong-Pil;DeFrate, Louis E.
解剖学上放置的移植物被认为能更紧密地恢复前交叉韧带的功能。本研究测量了负重屈曲时股骨隧道放置对移植物方向和长度的影响。使用MR对12名患者的双侧膝关节进行成像，其中12名患者将移植物放置在前交叉韧带前近端边缘附近，10名患者将移植物放置在前交叉韧带中心附近。这些图像用于创建重建的完整对侧膝关节的3D模型，包括天然前交叉韧带和移植物的附着点。接下来，患者在进行准静态弓步时使用双平面透视成像。这些模型被配准到透视图像上，以再现活体膝盖的运动。根据附着点在模型上的相对运动，测量移植物和天然前交叉韧带的长度和方向。在矢状面和冠状面上，放置在股骨前近端的移植物在矢状面和冠状面上都比原始前交叉韧带更长、更垂直，而解剖放置的移植物更接近于模拟前交叉韧带的运动。在完全伸展时，前近侧移植物在矢状面上的垂直角度比原始前交叉韧带高12.3+/-5.2度(平均和95%可信区间)，而解剖位置的移植物垂直角度降低了2.9+/-3.7度。移植物放置在前近端比天然前交叉韧带长6+/-2 mm，而解剖放置的移植物最多长2+/-2 mm。总之，移植物在解剖学上更接近于恢复了原始的前交叉韧带的长度和方向。因此，解剖移植物更有可能恢复完整的膝关节运动学。(C)2011爱思唯尔有限公司。保留所有权利。
Anatomically placed grafts are believed to more closely restore the function of the ACL. This study measured the effect of femoral tunnel placement on graft orientation and length during weight-bearing flexion. Both knees of twelve patients where the graft was placed near the anteroproximal border of the ACL and ten where the graft was placed near the center of the ACL were imaged using MR. These images were used to create 3D models of the reconstructed and intact contralateral knees, including the attachment sites of the native ACL and graft. Next, patients were imaged using biplanar fluoroscopy while performing a quasi-static lunge. The models were registered to the fluoroscopic images to reproduce in vivo knee motion. From the relative motion of the attachment sites on the models, the length and orientation of the graft and native ACL were measured. Grafts placed anteroproximally on the femur were longer and more vertical than the native ACL in both the sagittal and coronal planes, while anatomically placed grafts more closely mimicked ACL motion. In full extension, the grafts placed anteroproximally were 12.3 +/- 5.2 degrees (mean and 95%CI) more vertical than the native ACL in the sagittal plane, whereas the grafts placed anatomically were 2.9 +/- 3.7 degrees less vertical. Grafts placed anteroproximally were up to 6 +/- 2 mm longer than the native ACL, while the anatomically placed grafts were a maximum of 2 +/- 2 mm longer. In conclusion, grafts placed anatomically more closely restored native ACL length and orientation. As a result, anatomic grafts are more likely to restore intact knee kinematics. (C) 2011 Elsevier Ltd. All rights reserved.