背景:前交叉韧带(ACL)重建仍然与再断裂和持续旋转不稳定的风险相关。额外的关节外前外侧稳定手术稳定胫骨内旋并导致较低的ACL失败率和改善的膝关节稳定性。然而,缺乏胫骨外旋额外稳定的数据,并且前内侧稳定程序的重要性没有得到很好的评估。这项研究的目的是研究关节外内侧稳定手术对胫骨外部旋转的稳定和保护ACL免受这些旋转力的影响。
方法:将胫骨的内部和外部旋转应用于具有解剖ACL的有限元(FE)模型,后交叉韧带(PCL),外侧副韧带(LCL),内侧副韧带(MCL)和完整的内侧和外侧半月板。五个额外的解剖结构(前内侧稳定/前内侧韧带,AML,内侧副韧带增强,sMCL,后斜韧带,POL,前外侧韧带,All,和pop肌腱,PLT)分别添加到FE模型中,然后合并。测量并确定了每种情况下所有结构内的力历史。
结果:前内侧稳定或假想的AML是胫骨外旋的主要次要稳定物(ACL力减少的90%)。AML在胫骨外部旋转中将ACL上的负载减少了9%,这是通过增强sMCL(-1%)无法实现的。AML对胫骨内旋无影响(1%)。在与所有其他结构(AML,All,PLT,POL)胫骨外旋时ACL上的负荷减少了10%。
结论:这项研究表明,额外的前内侧稳定程序可确保胫骨的外部旋转,并且在这些外部旋转力期间对ACL具有最大的保护作用。
BACKGROUND: Anterior cruciate ligament (ACL) reconstruction remains associated with the risk of re-rupture and persisting rotational instability. Additional extraarticular anterolateral stabilization procedures stabilize the tibial internal rotation and lead to lower ACL failure rate and improved knee stability. However, data for additional stabilization of tibial external rotation is lacking and the importance of an anteromedial stabilization procedure is less well evaluated. Aim of this
study is to investigate the influence of an extraarticular anteromedial stabilization procedure for the stabilization of the tibial external rotation and protection of the ACL from these rotational forces.
METHODS: Internal and external rotations of the tibia were applied to a finite element (FE) model with anatomical ACL, posterior cruciate ligament (PCL), lateral collateral ligament (LCL), medial collateral ligament (MCL) and intact medial and lateral meniscus. Five additional anatomic structures (Anteromedial stabilization/anteromedial ligament, AML, augmented superficial medial collateral ligament, sMCL, posterior oblique ligament, POL, anterolateral ligament, ALL, and popliteal tendon, PLT) were added to the FE model separately and then combined. The force histories within all structures were measured and determined for each case.
RESULTS: The anteromedial stabilization or imaginary AML was the main secondary stabilizer of tibial external rotation (90% of overall ACL force reduction). The AML reduced the load on the ACL by 9% in tibial external rotation which could not be achieved by an augmented sMCL (-1%). The AML had no influence in tibial internal rotation (-1%). In the combined measurements with all additional structures (AML, ALL, PLT, POL) the load on the ACL was reduced by 10% in tibial external rotation.
CONCLUSIONS: This
study showed that an additional anteromedial stabilization procedure secures the tibial external rotation and has the most protective effect on the ACL during these external rotational forces.