Anterior cruciate ligament (ACL) repair using cortical or anchor fixation with suture tape augmentation vs ACL reconstruction: A comparative biomechanical analysis

BackgroundThe purpose was to compare knee kinematics in a cadaveric model of anterior cruciate ligament (ACL) repair using an adjustable-loop femoral cortical suspensory (AL-CSF) or independent bundle suture anchor fixation (IB-SAF) with suture tape augmentation to a bone-patellar tendon-bone (BPTB) ACL reconstruction.MethodsTwenty-seven cadaveric knees were randomly assigned to one of three surgical techniques: (1) ACL repair using the AL-CSF technique with suture tape augmentation, (2) ACL repair using the IB-SAF technique with suture tape augmentation, (3) ACL reconstruction using a BPTB autograft. Each specimen underwent three conditions according to the state of the ACL (native, proximal transection, repair/reconstruction) with each condition tested at four different angles of knee flexion (0°, 30°, 60°, 90°). Anterior tibial translation (ATT) and internal tibial rotation (ITR) were evaluated using 3-dimensional motion tracking software.ResultsACL transection resulted in a significant increase in ATT and ITR when compared to the native state (P < 0.001, respectively). ACL repair with the AL-CSF or IB-SAF technique as well as BPTB reconstruction restored native ATT and ITR at all tested angles of knee flexion, while showing significantly less ATT at 0°, 30°, 60°, and 90° as well as significantly less ITR at 30°, 60°, and 90° of knee flexion when compared to the ACL-deficient state. There were no significant differences in ATT and ITR between the three techniques utilized.ConclusionACL repair using the AL-CSF or IB-SAF technique with suture tape augmentation as well as BPTB ACL reconstruction each restored native anteroposterior and rotational laxity, without significant differences in knee kinematics between the three techniques utilized.Level of EvidenceControlled Laboratory Study.     

Anterior cruciate ligament repair versus reconstruction: A kinematic analysis

BackgroundThe purpose of this study was to compare the biomechanical properties of an anterior cruciate ligament (ACL) anatomic repair of a true femoral avulsion to an anatomic ACL reconstruction. It was hypothesized that the ACL repair and ACL reconstruction would have comparable biomechanical behavior when compared to the native knee.MethodsTen paired fresh-frozen cadaveric knees (n = 20) were used to investigate knee kinematics when an anterior drawer force, varus, valgus, internal, and external rotational moment were applied at 0, 15, 30, 45, 60, and 90 degrees of flexion. Displacement and rotation were recorded in the following conditions: ACL-intact, ACL-deficient, and ACL-repaired vs reconstructed.ResultsSectioning of the ACL significantly increased anterior tibial translation (0°, 15°, 30° and 45°) compared to the intact state. The mean anterior displacement difference from intact was lower in the ACL-repaired knees compared to reconstructed knees at 30° and 90°. There were no significant differences between conditions in varus, valgus, internal, or external rotations.ConclusionACL repair and ACL reconstruction procedures restored knee anterior tibial translation in matched paired specimens. There were no differences in valgus, varus, internal, or external rotation. Although, ACL-repaired knees (avulsion model) demonstrated less anterior tibial translation when compared to ACL-reconstructed knees, this difference was less than one millimeter. Based on the findings of this study, repair and reconstruction procedures both restored anterior tibial translation in matched-pair specimens. This suggests that the initial functionality of both techniques is similar and that further clinical studies are needed to compare the long-term stability.     

The effect of ACL deficiency on the end-to-end distances of the tibiofemoral ACL attachment during in vivo dynamic activity

Purpose

To evaluate the effect of ACL deficiency on the in vivo changes in end-to-end distances and to determine appropriate graft fixation angles for commonly used tunnel positions in contemporary ACL reconstruction techniques.

Magnetic resonance imaging study of alteration of tibiofemoral joint articulation after posterior cruciate ligament injury

Cadaveric studies have shown that the posterior cruciate ligament (PCL) is an important constraint to posterior translation of the tibia. Arthroscopic studies have shown that chronic PCL injuries predispose to articular cartilage lesions in the medial compartment and the patellofemoral joint. The aim of the present study was to investigate sagittal plane articulation of the tibiofemoral joint of subjects with an isolated PCL injury.Magnetic resonance was used to generate sagittal images of 10 healthy knees and 10 knees with isolated PCL injuries. The subjects performed a supine leg press against a 150 N load. Images were generated at 15° intervals as the knee flexed from 0 to 90°. The tibiofemoral contact and the flexion facet centre (FFC) were measured from the posterior tibial cortex.The contact pattern and FFC was significantly more anterior in the injured knee from 45 to 90° of knee flexion in the medial compartment compared to the healthy knee. The greatest difference between the mean TFC points of both groups occurred at 75 and 90°, the difference being 4 mm and 5 mm respectively. The greatest difference between the mean FFC of both groups occurred at 75° of flexion, which was 3 mm. There was no significant difference in the contact pattern and FFC between the injured and healthy knees in the lateral compartment.Our findings show that there is a significant difference in the medial compartment sagittal plane articulation of the tibiofemoral joint in subjects with an isolated PCL injury.     

Tibial displacement and rotation during seated knee extension and wall squatting: A comparative study of tibiofemoral kinematics between chronic unilateral anterior cruciate ligament deficient and healthy knees

BackgroundFollowing anterior cruciate ligament (ACL) rupture, the knee becomes unstable with alterations in joint kinematics including anterior tibial displacement (ATD), and internal tibial rotation. Therapeutic exercises that promote faulty kinematics should be discouraged, especially early post-reconstruction, to avoid graft stretching and possibly longer-term osteoarthritis. Our study aimed to compare ATD and tibial rotation during two commonly prescribed exercises, namely: open kinetic chain (OKC) seated extension and closed kinetic chain (CKC) single leg wall squatting in ACL-deficient and healthy knees.MethodsEight ACL-deficient patients and eight healthy subjects matched for age, gender and sports history were assessed using Qualisys 3D-Motion Analysis System to track 17 infrared markers while performing a seated knee extension with 3 kg weight and a unilateral wall squat. We developed a model to measure joint kinematics through 70° of knee flexion and extension. ANOVA and paired t-tests compared relative ATD and tibial rotation between exercises and groups at 10° increments of flexion and extension.ResultsWe found increased ATD in the wall squat compared to the seated extension (p = 0.049). There was no difference in ATD between the healthy and ACL-deficient knees but overall the tibia was significantly more internally rotated (p = 0.003) in ACL-deficient knees, irrespective of the exercise, possibly interfering with the screw-home mechanism.ConclusionsCKC exercises, in particular wall squats, are not necessarily safer for patients with ACL-deficiency and possibly ACL-reconstruction; although generalization should only be made with appropriate caution. Clinicians require a detailed knowledge of the effect of exercise on knee joint kinematics.     

Fiber orientation of anterior cruciate ligament: An experimental morphological and functional study,part I

The anterior cruciate ligament (ACL) is divided morphologically as well as functionally into anteromedial and posterolateral bundles. The changes in distance between femoral and tibial attachment sites of both bundles were measured throughout the full range of motion in ten formalin-carbol preserved cadaveric knees. The femoro-tibial distance (and thus the length) of the anteromedial bundle remains nearly the same throughout the full range of motion. The femoro-tibial distance for the posterolateral bundle decreases with flexion; thus it becomes increasingly slack from 0° to 90° of flexion. For a truly functional replacement of the ACL, in which the roll-glide motion of the knee joint is regained, isometric reconstruction of the anteromedial bundle is necessary. By utilizing the described method of intraoperative measurement, isometric positioning of the graft may be achieved. © 1993 Wiley-Liss, Inc.     

In-situ mechanical behavior and slackness of the anterior cruciate ligament at multiple knee flexion angles

In this study the in-situ tensile behavior and slackness of the anterior cruciate ligament (ACL) was evaluated at various knee flexion angles. In four cadaveric knees the ACL was released at the tibial insertion, after which it was re-connected to a tensiometer. After pre-tensioning (10 N) the ACL in full-extension, the knee was flexed from 0° to 150° at 15° increments, during which the ACL tension was measured. At each angle the ACL was subsequently elongated and shortened under displacement control, while measuring the ACL tension. In this manner, the pre-tension or the slackness, and the mechanical response of the ACL were measured. All ACL's displayed a higher tension at low (0°–60°) and high (120°–150°) flexion angles. The ACL slackness depended on flexion angle, with the highest slackness found at 75°–90°. Additionally, the ACL stiffness also varied with flexion angle, with the ACL behaving stiffer at low and high flexion angels. In general, the ACL was stiffest at 150°, and most compliant at 90°. The results of this study contribute to understanding the mechanical behavior of the ACL in-situ, and may help tuning and validating computational knee models studying ACL function.     

In vivo weight-bearing kinematics with medial rotation knee arthroplasty

Knee arthroplasties are designed to accommodate flexion, axial rotation and anteroposterior (AP) translation. Axial rotation during extension varies, with some rotating platform devices allowing unrestricted rotation while some conforming fixed-bearing designs almost none. The purpose of this study was to examine in vivo kinematics of a fixed-bearing medial rotation-type arthroplasty (MRK) during weight-bearing activities. Fifteen knees with a medial pivot TKA design were studied during step and pivot activities using lateral fluoroscopy and model-image registration. Average knee kinematics during the step activity showed little AP translation or rotation from 0°–100° flexion. During the pivot activity, the mean tibial internal rotation in individual knees was 7° (3°–19°). Mean condylar translations for individual knees were 3 mm medially and 5 mm laterally. The medial pivot prosthesis design provides anteroposterior stability during demanding activities, and exhibits a medial pivot motion pattern when subjected to twisting.     

Weight-bearing flexion angle correlates significantly with severity of knee osteoarthritis

This study evaluated flexion angles and mechanical loads at the knee during weight-bearing deep flexion in patients with knee osteoarthritis (OA). Thirty-eight knees of 26 patients (mean age, 73 years; range, 58–81 years) with medial knee OA and 16 knees of 8 healthy volunteers (mean age, 63.4 years; range, 60–65 years) were enrolled. Patients were subdivided into two groups based on Kellgren and Lawrence OA grade: moderate OA (grade 2, 17 knees) or severe OA (grade 3 or 4, 21 knees). Motion analysis was performed while rising from maximal knee flexion with one leg for each subject. Maximum knee flexion angles and net quadriceps moments in the weight-bearing motion were compared among the two OA groups and healthy subjects. Mean maximum flexion angle in patients was 91 ± 9°. Angles were about 30% smaller than passive range of motion (ROM). Mean angles in healthy subjects, moderate OA and severe OA were 102.7 ± 5.0°, 95.6 ± 7.7° and 86.5 ± 7.2°, respectively, and net quadriceps moments during motion were 5.5 ± 1.2%BWHt, 4.5 ± 1.7%BWHt and 3.9 ± 1.3%BWHt, respectively. Angles and moments were significantly lower in OA patients than in healthy subjects. Maximum flexion angles during weight-bearing rising correlated significantly with HSS score (r = 0.63; 95% confidence interval, 0.40–0.78) and were significantly lower in severe OA patients compared to moderate OA. This measurement may offer an important clinical index for knee OA.     

Risk factors for residual anterolateral rotational instability after double bundle anterior cruciate ligament reconstruction: Evaluation by quantitative assessment of the pivot shift phenomenon using triaxial accelerometer

BackgroundExact knowledge of risk factors for residual anterolateral rotatinoal instability (ALRI) after anterior cruciate ligament (ACL) reconstruction is limited. The purpose of this study was to analyse possible risk factors for ALRI after ACL reconstruction.MethodsQuantitative assessment of the pivot shift phenomenon by measuring tibial acceleration was performed in 46 patients during primary double-bundle ACL reconstructions. The absolute value of the acceleration of the injured knee after provisional fixation of the ACL grafts (‘absolute residual acceleration’) and the subtraction of the acceleration of the uninjured knee from absolute residual acceleration (‘relative residual acceleration’) were defined as indicators for residual ALRI. The associations between these indicators and nine candidate risk factors were analysed using univariate and multiple regression analyses.ResultsMultiple regression analysis revealed that absolute residual acceleration was positively associated with both preoperative acceleration difference between injured and uninjured knees (β = 0.469, P < 0.001) and tibial acceleration of the uninjured knee (β = 0.597, P < 0.001). Relative residual acceleration was also positively associated with preoperative acceleration difference between injured and uninjured knees (β = 0.446, P < 0.001), but was negatively associated with tibial acceleration of the uninjured knee (β = − 0.763, P < 0.001).ConclusionsPatients with larger preoperative side-to-side difference of the pivot shift phenomenon have higher risk for both absolute and relative residual ALRIs after ACL reconstruction, whereas patients with larger pivot shift phenomenon in their uninjured knees are at higher risk for absolute residual ALRI but not for relative residual ALRI.     

AM bundle controls the anterior–posterior and rotational stability to a greater extent than the PL bundle — A cadaver study

BackgroundThe purpose of this study was to evaluate the influence of both bundles of the anterior cruciate ligament (ACL) on knee stability, anterior–posterior translation (APT) and internal (IR) and external (ER) rotation in cadaveric knees using a computer navigation system.MethodsThe APT, IR, and ER of the knees were recorded in the intact condition, the anterolateral bundle (AM) or the posterolateral bundle (PL) deficit condition and in the ACL-deficient condition. The KT-1000 arthrometer was used for APT evaluation. The measurement of rotational movements was done using a rollimeter. All tests were performed at 30°, 60° and 90° of flexion.ResultsAt 30° of flexion: In the intact knee APT was 5.8 mm, IR 12.1°, ER 10.1°. After the AM was cut, the APT increased to 9.1 mm, IR to 13.9° and ER to 12.6°. After the PL was cut, the APT was 6.4 mm, IR 13.1° and ER 10.6°. After the AM and PL were cut, the APT was 10.8 mm, IR 15.7° and the ER was 12.9° on average.ConclusionsThe AM has a greater impact on the APT than the PL in all knee joint flexion angles. The PL does not resist the rotational stability more than the AM. The rotational stability is better controlled by both bundles of ACL as compared to one bundle of the ACL.Clinical RelevanceThis study acknowledges the fact that the both bundles of the ACL are importants for AP and rotational stability of the knee joint.     

Maximal peak torque as a predictor of angle-specific torques of hamstring and quadriceps muscles in man

Summary This study assessed the relationship between the isokinetic peak torque (PT) (speed of movement 1.05 and 3.14 rads^–1) and the angle-specific torques (ASTs) at 0.26 and 1.31 rad of knee flexion in multiple contractions of the quadriceps and hamstrings in 70 individuals with a chronic anterior cruciate ligament (ACL) insufficiency and 78 individuals with a chronic medial collateral ligament (MCL) insufficiency in one knee. At every test speed, the Pearson product moment correlation coefficients (r) between the PT and ASTs were highly significant (P<0.001) in the uninjured knees (r=0.61–0.93) as well as in the knees with ACL (r=0.61–0.87) and MCL (r=0.74–0.91) insufficiency. In addition, in both groups the majority of the correlation coefficients exceeded 0.80, which is generally regarded as the threshold for the relationship to be considered clinically significant. Furthermore, using regression analysis, both extremities showed completely non-systematic distribution of the residuals. It is concluded that in healthy knees or knees with ACL or MCL insufficiency, the predictability of ASTs from PT was good, and, therefore, that AST analyses may offer little additional information about thigh muscle function to that obtained from a simpler and more commonly used measurement, the PT analysis.     

Estimation of Ligament Loading and Anterior Tibial Translation in Healthy and ACL-Deficient Knees During Gait and the Influence of Increasing Tibial Slope Using EMG-Driven Approach

The purpose of this study was to develop a biomechanical model to estimate anterior tibial translation (ATT), anterior shear forces, and ligament loading in the healthy and anterior cruciate ligament (ACL)-deficient knee joint during gait. This model used electromyography (EMG), joint position, and force plate data as inputs to calculate ligament loading during stance phase. First, an EMG-driven model was used to calculate forces for the major muscles crossing the knee joint. The calculated muscle forces were used as inputs to a knee model that incorporated a knee–ligament model in order to solve for ATT and ligament forces. The model took advantage of using EMGs as inputs, and could account for the abnormal muscle activation patterns of ACL-deficient gait. We validated our model by comparing the calculated results with previous in vitro, in vivo, and numerical studies of healthy and ACL-deficient knees, and this gave us confidence on the accuracy of our model calculations. Our model predicted that ATT increased throughout stance phase for the ACL-deficient knee compared with the healthy knee. The medial collateral ligament functioned as the main passive restraint to anterior shear force in the ACL-deficient knee. Although strong co-contraction of knee flexors was found to help restrain ATT in the ACL-deficient knee, it did not counteract the effect of ACL rupture. Posterior inclination angle of the tibial plateau was found to be a crucial parameter in determining knee mechanics, and increasing the tibial slope inclination in our model would increase the resulting ATT and ligament forces in both healthy and ACL-deficient knees.     

Kinematic and Kinetic Interactions During Normal and ACL-Deficient Gait: A Longitudinal In Vivo Study

The interactions between different tissues within the knee joint and between different kinematic DOF and joint flexion during normal gait were investigated. These interactions change following ACL transection, in both short (4 weeks) and long (20 weeks) term. Ten skeletally mature sheep were used in control (N = 5) and experimental (N = 5) groups. The 6-DOF stifle joint motion was first measured during normal gait. The control group were then euthanized and mounted on a unique robotic testing platform for kinetic measurements. The experimental group underwent ACL transection surgery, and kinematics measurements were repeated 4 and 20 weeks post-operatively. The experimental group were then euthanized and underwent kinetic assessment using the robotic system. Results indicated significant couplings between joint flexion vs. abduction and internal tibial rotation, as well as medial, anterior, and superior tibial translations during both normal and ACL-deficient gait. Distinct kinetic interactions were also observed between different tissues within the knee joint. Direct relationships were found between ACL vs. LM/MM, and PCL vs. MCL loads during normal gait; inverse relationships were detected between ACL vs. PCL and PCL vs. LM/MM loads. These kinetic interaction patterns were considerably altered by ACL injury. Significant inter-subject variability in joint kinematics and tissue loading patterns during gait was also observed. This study provides further understanding of the in vivo function of different tissues within the knee joint and their couplings with joint kinematics during normal gait and over time following ACL transection.     

Effect of voluntary soft tissue tension and articular conformity after total knee arthroplasty on in vivo anteroposterior displacement

The in vivo relationship between the degree of voluntary soft tissue tension and articular conformity after total knee arthroplasty (TKA) and anteroposterior (AP) displacement was simultaneously investigated by analyzing LCS prostheses (posterior cruciate ligament-sacrificing rotating platform design) in 20 knees from 20 patients. AP displacement was measured using the KT-2000 arthrometer, at 30° and 75° flexion, while patients were conscious and under anesthesia; 30° flexion was regarded as high conformity and 75° as low conformity. Mean displacements at 30° and 75° were 5.1 mm and 7.0 mm, respectively, in conscious patients, and 6.7 mm and 7.7 mm, respectively, in patients under anesthesia. AP displacement was significantly associated with soft tissue tension (p = 0.026) and conformity (p = 0.001). No interaction was observed between the two variables (p = 0.193). Surgeons should recognize that AP displacement is greater in anesthetized patients than in conscious patients, regardless of the degree of conformity, and that higher conformity shows less displacement, regardless of the degree of soft tissue tension. These results may help surgeons to determine the intra-operative AP displacement required for proper postoperative displacement in the current prosthetic design.     

Anterior cruciate ligament graft forces are sensitive to fixation angle and tunnel position within the native femoral footprint during passive flexion

BackgroundAnterior cruciate ligament (ACL) graft position within the anatomic femoral footprint of the native ACL and the flexion angle at which the graft is fixed (i.e., fixation angle) are important considerations in ACL reconstruction surgery. However, their combined effect on ACL graft force remains less well understood.HypothesisDuring passive flexion, grafts placed high within the femoral footprint carry lower forces than grafts placed low within the femoral footprint (i.e., high and low grafts, respectively). Forces carried by high grafts are independent of fixation angle. All reconstructions impart higher forces on the graft than those carried by the native ACL.Study DesignControlled laboratory study.MethodsFive fresh-frozen cadaveric knees were mounted to a robotic manipulator and flexed from full extension to 90° of flexion. The ACL was sectioned and ACL force was calculated via superposition. ACL reconstructions were then performed using a patellar tendon autograft. For each knee, four different reconstruction permutations were tested: high and low femoral graft positions fixed at 15° and at 30° of flexion. Graft forces were calculated from full extension to 90° of flexion for each combination of femoral graft position and fixation angle again via superposition. Native ACL and ACL graft forces were compared through early flexion (by averaging tissue force from 0 to 30° of flexion) and in 5° increments from full extension to 90° of flexion.ResultsWhen fixed at 30° of flexion, high grafts carried less force than low grafts through early flexion bearing a respective 64 ± 19 N and 88 ± 11 N (p = 0.02). Increasing fixation angle from 15° to 30° caused graft forces through early flexion to increase 40 ± 13 N in low grafts and 23 ± 6 N in high grafts (p < 0.001). Low grafts fixed at 30° of flexion differed most from the native ACL, carrying 67 ± 9 N more force through early flexion (p < 0.001).ConclusionACL grafts placed high within the femoral footprint and fixed at a lower flexion angle carried less force through passive flexion compared to grafts placed lower within the femoral footprint and fixed at a higher flexion angle. At the prescribed pretensions, all grafts carried higher forces than the native ACL through passive flexion.Clinical RelevanceBoth fixation angle and femoral graft location within the anatomic ACL footprint influence graft forces and, therefore, should be considered when performing ACL reconstruction.     

Gait speed is more challenging than cognitive load on the stride-to-stride variability in individuals with anterior cruciate ligament deficiency

Background

Several investigations have studied gait variability of individuals with anterior cruciate ligament (ACL) deficiency; however, the effect of dual-tasking on the gait variability of these individuals remained unclear. The aim of the present study was to determine the effect of gait speed and dual-tasking on knee flexion–extension variability in subjects with and without ACL deficiency.

Measuring patellar height using the lateral active flexion radiograph: Effect of total knee implant design

Patellar position during knee flexion was studied in 41 patients with bicruciate substituting (BCS), 41 patients with posterior cruciate retaining (CR) and 41 patients with posterior stabilized (PS) TKA's. The perpendicular height of the patella above the tibial tubercle was compared to the length of the patellar tendon on maximum flexion lateral radiographs. BCS knees had greater active flexion compared to PS and CR knees (BCS = 124 ± 9.8, PS = 112 ± 9.5, CR = 110 ± 10.9). In flexion, apparent patella infera (API) or the height of the patella above the tibial tubercle was 3.5% lower than the patellar tendon length for BCS knees, 1.7% lower in PS knees and 0.5% lower in CR knees. API in PS and BCS knees correlated with active knee flexion, but not in CR knees. Our findings indicate that an apparent inferior position of the patella occurs in BCS knees during deep flexion which is not caused by significant patellar ligament shortening or joint line elevation, but associated with normal posterior rollback of the femur.     

Loss of neuromuscular control related to motion in the acutely ACL-injured knee: an experimental study

Ligamentomuscular and muscular stretch reflexes are known to contribute to knee joint stability. After anterior cruciate ligament (ACL) injury, a more intense and adjusted muscular response is required to maintain joint stability, but this neuromuscular control of the knee has not been clearly proved. The aim of the study is to record electromyography (EMG) signal and muscular fibre length variations in quadriceps and hamstrings of the knee with and without ACL, and to analyze and integrate the ligament strain and the muscular reaction to forced anterior tibial translation (ATT). In 17 knees from 12 cats, EMG electrodes and ultrasonomicrometry crystals were inserted into four main periarticular muscles, with strain gauges on periarticular ligament insertions. Their output signal was compared before and after ACL surgical section in series of ATT (at 90 degrees and 30 degrees knee flexion), and also during knee flexion and extension. Linear regression analysis was performed between the EMG signal and muscular fibre length variations, and between the EMG signal and the strain on ligament insertions, in the search of this reflex neuromuscular response. In the ACL deficient knees, the studied muscles showed a poor adjustment to motion of EMG firing, inversely to controls. The muscle stretch reflexes showed poorer correlation with post-peak EMG activity than the ligaments. ATT control depended mainly on hamstrings activity in control knees, whereas in unstable knees, quadriceps activity was associated with more tibial translation. Acute ACL-deficient knees showed poor neuromuscular control with weak ligamentomuscular reflexes and no muscular stretch reflexes, suggesting the ineffectiveness of acute muscular reaction to provide early mechanical knee stabilization after injury.     

基于2D/3D配准技术的正常膝关节运动还原在体稳定性参数研究

目的应用2D/3D图像配准技术进行运动还原以获得正常膝关节韧带的在体稳定性参数。方法在生理负重下利用两台C型臂X线机采集8名志愿者健、膝关节屈曲0°、15°、30°、60°和90°时的两幅相互垂直的X线影像(2D),与由CT重建的三维图像在虚拟X线投射系统进行2D/3D图像配准,还原膝关节不同角度时的股骨和胫骨相对3D位置关系,并通过韧带止点还原的方法对ACL、PCL、MCL、LCL进行韧带长度分析。结果随屈曲角度的增大,ACL长度逐渐缩短,从0(°27.73±1.34)mm至90(°23.34±1.48)mm;PCL长度逐渐增加,从0(°26.5±1.65)mm至90(°33.80±1.97)mm;MCL长度逐渐减小,从0°(38.17±1.40)mm至90°时(35.98±1.50)mm。LCL长度同样逐渐减小,从0°(52.56±1.64)mm至90°(50.22±1.41)mm。差异均有统计学意义(P0.05)。结论基于2D/3D图像配准技术可获得正常膝关节生理屈曲过程中韧带长度的变化规律。