Anterior cruciate ligament deficiency alters the in vivo motion of the tibiofemoral cartilage contact points in both the anteroposterior and mediolateral directions
Anterior cruciate ligament deficiency alters the in vivo motion of the tibiofemoral cartilage contact points in both the anteroposterior and mediolateral directions
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DOI：
10.2106/jbjs.e.00539
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发表时间：
2006-08-01
影响因子：
5.3
通讯作者：
Gill, Thomas J.
中科院分区：
文献类型：
--
作者：
Li, Guoan;Moses, Jeremy M.;Gill, Thomas J.
背景：量化前交叉韧带缺失对关节生物力学的影响，对于更好地了解前交叉韧带缺失膝关节退变的机制，提高前交叉韧带损伤的外科治疗水平具有重要意义。应用最新研制的双正交透视和磁共振成像技术，对9例单侧前交叉韧带断裂患者和正常对侧膝关节的前交叉韧带缺损区和健侧膝关节的胫股关节软骨接触点的位置变化进行了研究。对完整和前十字韧带缺失的膝关节进行磁共振成像，以建立膝关节骨和软骨表面的计算机模型。每个患者都进行单腿负重弓步运动，在完全伸展和屈曲150、300、600和900度时使用双透视系统记录图像。然后利用膝关节模型和透视图像再现每个屈曲角度下的活体膝关节位置。接触点定义为胫股关节软骨面相交区域的质心。结果：在前交叉韧带缺失和完整的膝关节中，接触点不仅在前后方向上移动，而且在内侧方向上移动。在前后方向上，前十字韧带缺陷膝关节的胫骨内侧间隙接触点在完全伸展和屈曲150度时比完整膝关节更靠后(p<；0.05)。胫骨外侧室接触点的前后运动无明显差异。在内侧向，在完全伸展和屈曲600度之间，胫骨内侧室的接触点向胫骨内侧棘侧移显著(p<；0.05)。在屈曲150和300度时，胫骨外侧室的接触点向外侧移位(p<；0.05)。结论：前交叉韧带损伤时，胫骨平台表面的接触点向后和向外侧移位。在内侧筋膜室，接触点向胫骨内侧棘移，这是慢性前十字韧带损伤患者观察到的退变区域。临床意义：这种活体测量技术可能有助于评估重建前交叉韧带以恢复正常胫股软骨接触生物力学的能力。观察到的胫股接触点的运动变化可能会改变软骨中的接触应力分布，使关节更容易发生退行性变化。
Background: Quantifying the effects of anterior cruciate ligament deficiency on joint biomechanics is critical in order to better understand the mechanisms of joint degeneration in anterior cruciate ligament-deficient knees and to improve the surgical treatment of anterior cruciate ligament injuries. We investigated the changes in position of the in vivo tibiofemoral articular cartilage contact points in anterior cruciate ligament-deficient and intact contralateral knees with use of a newly developed dual orthogonal fluoroscopic and magnetic resonance imaging technique.Methods: Nine patients with an anterior cruciate ligament rupture in one knee and a normal contralateral knee were recruited. Magnetic resonance images were acquired for both the intact and anterior cruciate ligament-deficient knees to construct computer knee models of the surfaces of the bone and cartilage. Each patient performed a single-leg weight-bearing lunge as images were recorded with use of a dual fluoroscopic system at full extension and at 150, 300, 600, and 900 of flexion. The in vivo knee position at each flexion angle was then reproduced with use of the knee models and fluoroscopic images. The contact points were defined as the centroids of the areas of intersection of the tibial and femoral articular cartilage surfaces.Results: The contact points moved not only in the anteroposterior direction but also in the mediolateral direction in both the anterior cruciate ligament-deficient and intact knees. In the anteroposterior direction, the contact points in the medial compartment of the tibia were more posterior in the anterior cruciate ligament-deficient knees than in the intact knees at full extension and 150 of flexion (p < 0.05). No significant differences were observed with regard to the anteroposterior motion of the contact points in the lateral compartment of the tibia. In the mediolateral direction, there was a significant lateral shift of the contact points in the medial compartment of the tibia toward the medial tibial spine between full extension and 600 of flexion (p < 0.05). The contact points in the lateral compartment of the tibia shifted laterally, away from the lateral tibial spine, at 150 and 300 of flexion (p < 0.05).Conclusions: In the presence of anterior cruciate ligament injury, the contact points shift both posteriorly and laterally on the surface of the tibial plateau. In the medial compartment, the contact points shift toward the medial tibial spine, a region where degeneration is observed in patients with chronic anterior cruciate ligament injuries. Clinical Relevance: This in vivo measurement technique may be useful for assessing the ability of an anterior cruciate ligament reconstruction to restore normal tibiofemoral cartilage contact biomechanics. The observed altered motions of the tibiofemoral contact points might change contact stress distributions in the cartilage and predispose the joint to degenerative changes.