■外科医生利用股骨远端内收肌结节作为解剖标志,在内侧髌股韧带(MPFL)和内侧股四头肌腱股韧带(MQTFL)重建髌股不稳定过程中确定移植锚的放置。在骨骼不成熟的人群中,它相对于physis的位置还没有很好的定义。
■在骨骼未成熟的个体中确定内收肌结节相对于股骨远端的位置,并了解接受MPFL和MQTFL重建的儿科患者的最佳移植物锚钉位置。
■描述性实验室研究。
■37例男性尸体标本的薄层计算机断层扫描(年龄,4-16年)是从新墨西哥州死者图像数据库中获得的。在受过研究训练的肌肉骨骼放射科医生的指导下,创建了识别内收肌结节的测量协议。通过利用轴向,日冕,和膝盖计算机断层扫描的矢状视图,识别了内收肌肌腱,并在股骨远端插入(内收肌结节)。测量了在近端-远端方向上从内收肌大腱插入的中点相对于physis的距离。还评估了中点肌腱插入相对于股骨后皮质线的前后距离。
■在30个标本中,大内收肌肌腱的中点在physis处。一个8岁的尸体标本在physis远端插入了1.1mm。在所有≥15岁的标本中(n=6),内收肌大肌肌腱的插入距离为2.73mm。内收肌结节的位置总是在后面(平均,5.1mm)相对于股骨后皮质线。
■男性儿科患者内收肌结节的位置可能位于或远端。因此,这项研究的结果与之前提出更近端的研究直接冲突.
■在骨骼未成熟患者中进行MPFL和MQTFL重建期间,最佳的移植物锚钉放置可能具有挑战性,因为先前研究中报道了内侧髌股复合体起源相对于physis的变异性。这项研究表明,远端而不是近端移植物锚钉的放置可能会更好地帮助恢复髌股等轴测量。
The adductor tubercle of the distal femur is utilized by surgeons as an anatomic landmark to identify graft anchor placement during medial patellofemoral ligament (MPFL) and medial quadriceps tendon femoral ligament (MQTFL) reconstruction for patellofemoral instability. In the skeletally immature population, its location relative to the physis has not been well defined.
To identify the location of the adductor tubercle relative to the distal femoral physis in skeletally immature individuals and gain insight regarding optimal graft anchor placement for pediatric patients undergoing MPFL and MQTFL reconstruction.
Descriptive laboratory study.
Thin-cut computed tomography scans of 37 male cadaveric specimens (age, 4-16 years) were obtained from the New Mexico Decedent Image Database. A measurement protocol to identify the adductor tubercle was created with guidance from a fellowship-trained musculoskeletal radiologist. By utilizing axial, coronal, and sagittal views of knee computed tomography scans, the adductor magnus tendon was identified and followed distally to its insertion (adductor tubercle) on the distal femur. Distance from the midpoint of the adductor magnus tendon insertion relative to the physis in the proximal-distal orientation was measured. The anterior-posterior distance of the midpoint tendon insertion relative to the posterior femoral cortex line was also evaluated.
The midpoint of the adductor magnus tendon was at the physis in 30 specimens. One 8-year-old cadaveric specimen had an insertion 1.1 mm distal to the physis. In all specimens ≥15 years old (n = 6), the adductor magnus tendon insertion was distal to the physis with a mean distance of 2.73 mm. The location of the adductor tubercle was always posterior (mean, 5.1 mm) with respect to the posterior femoral cortex line.
The location of the adductor tubercle in male pediatric patients is likely at or distal to the physis. Thus, the findings of this study directly conflict with previous studies that suggested a more proximal location.
Optimal graft anchor placement during MPFL and MQTFL reconstruction in the skeletally immature patient can be challenging because of the variability reported in previous studies of the medial patellofemoral complex origin relative to the physis. This study suggests that distal-rather than proximal-graft anchor placement might better help restore patellofemoral isometry.