Radiographic Identification of the Primary Medial Knee Structures
Radiographic Identification of the Primary Medial Knee Structures
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DOI：
10.2106/jbjs.h.00909
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发表时间：
2009-03-01
影响因子：
5.3
通讯作者：
Engebretsen, Lars
中科院分区：
文献类型：
--
作者：
Wijdicks, Coen A.;Griffith, Chad J.;Engebretsen, Lars
背景：在解剖修复或重建过程中，膝关节内侧附着部位的影像学标志是未知的。如果确定，它们可以帮助术前评估结构位置，并允许术后评估重建隧道的放置。方法：将不透射线标记物植入11例新鲜冷冻非配对尸体膝关节标本的浅内侧副韧带的股骨和胫骨附着体以及髌股后斜韧带和髌股内侧韧带的股骨附着体。拍摄了正位片和侧位片。在侧位x线片上投影的参考线相交形成的象限内评估结构。定量测量由三名独立审查员进行。使用类内相关系数确定观察者内重复性和观察者间可靠性。结果：观察者内重现性和观察者间信度的总体类内相关系数分别为0.996和0.994。在正位x线片上，髌股内侧浅副韧带、后斜韧带和髌股内侧韧带的附着部位距股关节线分别为30.5 +/- 2.4mm、34.8 +/- 2.7 mm和42.3 +/- 2.1 mm。在股外侧x线片上，浅内侧副韧带的附着点距内侧上髁6.0±0.8 mm，位于前远端象限。后斜韧带附着于距腓肠肌结节7.7±1.9 mm处，位于后远端象限。髌股内侧韧带附着于距内收肌结节8.9±2.0 mm处，位于前近端象限。在胫骨侧位片上，内侧浅副韧带的胫骨近端和远端附着体距胫骨倾斜度分别为15.9 +/- 5.2和66.1 +/- 3.6 mm。结论：主要膝关节内侧结构的附着位置可以定性和定量地与骨标记和x线投影相关，检查人员之间的一致。临床意义：本研究通过影像学标记确定膝关节内侧结构附着部位，从而对主要膝关节内侧结构的手术修复和重建进行可靠的术前和术后评估。
Background: Radiographic landmarks for medial knee attachment sites during anatomic repairs or reconstructions are unknown. If identified, they could assist in the preoperative evaluation of structure location and allow for postoperative assessment of reconstruction tunnel placement.Methods: Radiopaque markers were implanted into the femoral and tibial attachments of the superficial medial collateral ligament and the femoral attachments of the posterior oblique and medial patellofemoral ligaments of eleven fresh-frozen, nonpaired cadaveric knee specimens. Both anteroposterior and lateral radiographs were made. Structures were assessed within quadrants formed by the intersection of reference lines projected on the lateral radiographs. Quantitative measurements were performed by three independent examiners. Intraobserver reproducibility and interobserver reliability were determined with use of intraclass correlation coefficients.Results: The overall intraclass correlation coefficients for intraobserver reproducibility and interobserver reliability were 0.996 and 0.994, respectively. On the anteroposterior radiographs, the attachment sites of the superficial medial collateral ligament, posterior oblique ligament, and medial patellofemoral ligament were 30.5 +/- 2.4mm, 34.8 +/- 2.7 mm, and 42.3 +/- 2.1 mm from the femoral joint line, respectively. On the lateral femoral radiographs, the attachment of the superficial medial collateral ligament was 6.0 +/- 0.8 mm from the medial epicondyle and was located in the anterodistal quadrant. The attachment of the posterior oblique ligament was 7.7 +/- 1.9 mm from the gastrocnemius tubercle and was located in the posterodistal quadrant. The attachment of the medial patellofemoral ligament was 8.9 +/- 2.0 mm from the adductor tubercle and was located in the anteroproximal quadrant. On the lateral tibial radiographs, the proximal and distal tibial attachments of the superficial medial collateral ligament were 15.9 +/- 5.2 and 66.1 +/- 3.6 mm distal to the tibial inclination, respectively.Conclusions: The attachment locations of the main medial knee structures can be qualitatively and quantitatively correlated to osseous landmarks and projected radiographic lines, with close agreement among examiners.Clinical Relevance: The present study identifies medial knee structure attachment sites with use of radiographic landmarks and thus allows for reliable preoperative and postoperative assessments of surgical repairs and reconstructions of the main medial knee structures.