Anterior cruciate ligament anatomy and function relating to anatomical reconstruction
Anterior cruciate ligament anatomy and function relating to anatomical reconstruction
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DOI：
10.1007/s00167-006-0076-z
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发表时间：
2006-10-01
影响因子：
3.8
通讯作者：
Fu, Freddie H.
中科院分区：
文献类型：
--
作者：
Zantop, Thore;Petersen, Wolf;Fu, Freddie H.
最近，对重建前交叉韧带（ACL）的前内侧束（AM）和后外侧束（PL）的外科技术的兴趣有所增加。这篇综述的重点是前交叉韧带的结构和力学特性，以及前交叉韧带的股骨起源、中间物质和胫骨止点的解剖细节。AM和PL束的术语是根据胫骨插入和膝关节屈曲的功能张力模式来选择的。接近延长AM是适度松散和PL是紧的。当膝关节屈曲时，前交叉韧带的股骨连接变得更加水平，导致AM束收紧，PM束松弛。ACL被描述为抑制胫骨前移位和胫骨内旋。旋转组件可以用PL包表示。股骨起始点呈椭圆形，AM中心靠近过顶位置，PL中心靠近前、下软骨边缘。前交叉韧带的胫骨和股骨插入物比中间物大3.5倍以上，隧道放置更具挑战性，因为潜在移植物的大小有限，隧道位置放置的选择。重建时，使用骨-髌腱-骨（BPTB）和四肢腿筋移植物。据报道，10毫米宽的BPTB或四肢腿筋移植物的结构特性与原生ACL相当。
Recently, the interest in surgical techniques that reconstruct the anteromedial (AM) and the posterolateral (PL) bundles of the anterior cruciate ligament (ACL) has risen. This review focuses on the structural as well as the mechanical properties of the ACL and the anatomical details of the femoral origin, midsubstance, and tibial insertion of AM and PL bundles of the ACL. The terminology of AM and PL bundles is chosen according to the tibial insertion and determined by their functional tensioning pattern throughout knee flexion. Close to extension the AM is moderately loose and the PL is tight. As the knee is flexed, the femoral attachment of the ACL becomes more horizontally oriented, causing the AM bundle to tighten and the PM bundle to loosen up. The ACL has been described to be restraint to anterior tibial displacement and internal tibial rotation. The rotational component might be represented by the PL bundle. The femoral origin has an oval shape with the center of the AM close to over-the-top position and the center of the PL close to the anterior and inferior cartilage margin. Tibial and femoral insertions of the ACL are over 3.5 times larger when compared to the midsubstance and tunnel placement is more challenging because of the limited size of potential grafts selection of tunnel site placement. For reconstruction, both bone-patellar tendon-bone (BPTB) and quadrupled hamstring grafts are used. Structural properties of a 10 mm wide BPTB or quadrupled hamstring graft have been reported to be comparable with those of the native ACL.