膝关节交叉韧带撕裂的MRI与关节镜对照研究

目的 研究膝关节交叉韧带撕裂的MRI表现及诊断价值。方法 对196例膝关节病变患者进行前瞻性研究,以关节镜结果作为金标准,分析交叉韧带损伤的MRI表现,将部分撕裂按其损伤程度分为完整和完全撕裂,比较无或单个韧带损伤与多个韧带同时损伤时的MRI诊断准确性。结果 关节镜下确诊55例患者共65条交叉韧带损伤,MRI诊断前交叉韧带完全撕裂的敏感性、特异性和准确性分别为94.1％、98.1％、97.4％。多条韧带同时损伤时,MRI诊断韧带撕裂的敏感性、特异性和准确性分别为88.0％、94.3％、91.7％,与无或单个韧带损伤时比较,其特异性和准确性有显著性差异(P<0.05)。 结论 MRI是诊断急性完全性交叉韧带撕裂的理想检查方法。把韧带撕裂分为低度损伤与高度损伤后,其诊断敏感性可得到提高,对于临床及关节镜手术有指导意义。而慢性损伤或多个支持结构同时损伤时,其诊断准确性降低。     

前交叉韧带重建修复运动性膝关节损伤：临床现状与未来

背景：膝关节交叉韧带损伤后自愈能力较差,治疗上以移植物植入重建交叉韧带为主。目的：总结膝关节前交叉韧带的功能、结构,力学特点,及其缺损后人工韧带重建研究的进展,为人工韧带的临床应用提供依据。方法：作者应用计算机检索数据库,检索关键词“人工合成材料;膝交叉韧带,韧带修复,运动,韧带重建。选择的文献内容与材料学特点、生物相容性及其膝关节韧带损伤相关领域的文章,共引用25篇文献,重点讨论重建膝关节交叉韧带的性能,及其生物材料的种类。结果与结论：前交叉韧带重建作为治疗前交叉韧带损伤的有效治疗手段,近年来发展快速。目前国内外修复前交叉韧带损伤可供选择的移植物有自体组织替代物、同种异体韧带、生物组织工程韧带以及人工韧带等。人工合成材料与组织工程韧带近几年研究较多,生物型人工韧带对膝关节韧带损伤的修复取得了很好的效果。分子生物学技术以及基因学和细胞学在韧带中的运用,为未来膝关节韧带损伤的康复及治疗提供新的研究方向。     

Ultrasound Appearances of Complications After Arthroscopic Anterior Cruciate Ligament Reconstruction

Anterior cruciate ligament tears are among the most frequent knee injuries. Surgical treatment is mandatory in active athletes to prevent meniscal tears and early joint degenerative changes. Anterior cruciate ligament arthroscopic reconstruction (ACLAR) is considered the preferred procedure, allowing a successful functional restoration and a prompt return to sports practice. Postsurgical complications are infrequent and are mainly assessed clinically and by magnetic resonance imaging. Although ultrasound can only evaluate the outer aspect of the knee, it can detect several ACLAR complications. The aim of this pictorial essay is to present the ultrasound appearances of a wide spectrum of ACLAR complications.     

Second time around: evaluating the postoperative anterior cruciate ligament

Anterior cruciate ligament (ACL) injuries are especially common in the younger athletic population. In 1998, more than 100,000 ACL reconstructions were performed. MR imaging examination has proved to be valuable in imaging and evaluating ACL reconstructions. This article reviews different surgical reconstruction procedures, indications for postoperative MR imaging, and the MR imaging appearance seen in routine ACL reconstructions and in complications associated with ACL reconstructions.     

Komplexe Bandläsion des Kniegelenks

Combined injuries of the main knee ligaments have a broad spectrum, ranging from typical combinations like anterior cruciate ligament (ACL) and medial collateral ligament (MCL) ruptures up to knee luxations with severe combinations of both cruciate ligaments and at least one collateral ligament. Isolated injuries of the MCL and the posterior cruciate ligament (PCL) can be treated conservatively. Indications for surgical repair are mainly combined injuries of cruciate ligaments and ruptures of the lateral structures. Knee luxations are often complex injuries with neurovascular complications. Careful and early detection of these complications can avoid endangering the extremity and therefore prevent massive damage to the patient. Surgical repair of ligament injuries is superior to conservative treatment.     

前交叉韧带重建移植材料的研究与进展

背景：膝关节前交叉韧带重建效果受多种因素影响,包括移植物的选择。目的：对用于前交叉韧带重建的移植材料的种类、材料性质、相关实验、临床应用等方面的研究进行回顾分析。方法：由第一作者检索1985/2009PubMed数据及万方数据库有关前交叉韧带重建的移植材料如自体韧带、同种异体韧带、人工韧带、组织工程韧带、异种韧带等方面的文献。结果与结论：目前国内外修复前交叉韧带损伤可供选择的移植物有自体组织替代物、同种异体韧带、人工韧带、生物组织工程韧带等。此外还有一些其他生物材料如异种韧带等,目前还处于实验探索及研究阶段。人工合成材料与组织工程韧带近几年研究较多,但其制作工艺复杂,价格昂贵,很难满足临床移植的需要。随着越来越多去抗原处理技术的出现,有效去除异种韧带的免疫原性,提高其组织相容性已不是没有可能,在此基础上异种韧带来源广泛,获取方便、价格低廉、适用性广等优势得以凸显。     

膝关节韧带损伤及伴发半月板损伤的MRI分析

目的：探讨膝关节单发韧带损伤、多发韧带损伤及二者伴发半月板损伤的特点,比较分析MRI诊断单发韧带损伤、多发韧带损伤及伴发半月板损伤的准确性。方法对187例经临床手术证实为膝关节韧带损伤的MRI病例资料进行回顾性分析。结果187例病例中,单发韧带损伤103例,多发韧带损伤84例;单发韧带损伤组中,前交叉韧带（ACL）损伤38例,内侧副韧带（MCL）损伤36例,后交叉韧带（PCL）损伤14例,内侧髌股韧带（MPFL）损伤10例,髌韧带（PT）损伤3例,外侧副韧带（LCL）损伤2例,伴发内侧半月板（MM）损伤35例,伴发外侧半月板（LM）损伤23例;多发韧带损伤组中, ACL、MCL联合损伤37例,ACL、PCL联合损伤21例,ACL、PCL、MCL联合损伤10例,MPFL、MCL联合损伤8例,MPFL、MCL、ACL联合损伤4例,ACL、PT联合损伤2例,ACL、PCL、LCL联合损伤2例,伴发MM损伤43例,伴发LM损伤35例;单发韧带组与多发韧带组中,MRI诊断韧带损伤的敏感性、特异性、准确性分别为90.3%、97.7%、96.4%和81.5%、88.4%、85.9%,二者比较差异均有统计学意义（P＜0.05）;二者伴发MM、LM损伤的发生率分别为34%、22.3%和51.2%、41.7%,二者比较差异有统计学意义（P＜0.05）,MRI诊断二者间伴发MM损伤的敏感性、特异性、准确性分别为88.6%、89.7%、89.3%和76.7%、65.9%、71.4%,二者比较特异性、准确性差异有显著统计学意义（P＜0.01）,而敏感性差异无统计学意义（P＞0.05）,MRI诊断二者间伴发LM损伤的敏感性、特异性、准确性分别为87%、93.8%、92.2%和85.7%、77.6%、77.4%,二者比较特异性、准确性差异有统计学意义（P＜0.05）,而敏感性差异无统计学意义（P＞0.05）。结论单发韧带损伤以ACL损伤最为多见,其次为MCL;多发韧带损伤以ACL、MCL联合损伤最为常见,其次为ACL、PCL联合损伤,再次为ACL、PCL、MCL联合损伤;MRI诊断多发韧带损伤的敏感性、特异性、准确性均较单发韧带损伤下降;多发韧带损伤较单发韧带损伤更易伴发 MM、LM损伤;多发韧带组与单发韧带组比较,虽然MRI诊断伴发MM、LM损伤敏感性无明显差异,但特异性、准确性均较单发韧带组明显降低。     

On the coupling between anterior and posterior cruciate ligaments,and knee joint response under anterior femoral drawer in flexion: a finite element study

OBJECTIVE: To investigate the extent of coupling between the anterior and posterior cruciate ligaments as well as the role of the posterior cruciate ligament in the knee joint response under anterior femoral force at different flexion angles. DESIGN: A developed finite element model of the tibiofemoral joint is used to perform non-linear elastostatic analyses. BACKGROUND: The structural properties of the posterior cruciate ligament subsequent to an injury (either left untreated or replaced by a graft) would likely change, an event that alters the function of not only the ligament itself but also the other intact cruciate ligament and the entire joint. METHODS: The model consists of two bony structures and their articular cartilage layers, menisci and four principal ligaments. Under 100 N anterior femoral load at different flexion angles from 0 degrees to 90 degrees, kinematics, forces in ligaments and contact forces in the fully unconstrained joint were computed in intact cases and following alterations in joint ligaments. RESULTS: Collateral ligaments were the primary structures to resist the force at full extension under 100 N anterior femoral load with a moderate contribution from the posterior cruciate ligament. With joint flexion up to 90 degrees, however, force in the posterior cruciate ligament substantially increased whereas that in collateral ligaments diminished. CONCLUSIONS: A remarkable coupling was found between the posterior cruciate ligament and the anterior cruciate ligament in flexion; a structural alteration in one of them significantly influenced the mechanical role of both ligaments and not just the one affected. A tauter or stiffer ligament increased the force in both ligaments while an excessive laxity or rupture in one diminished forces in both. RELEVANCE: Alterations in ligament stiffness or initial tautness during reconstruction surgery or following injuries markedly influence the normal role of both cruciate ligaments. Consideration of cruciate ligaments coupled together rather than in isolation should be the rule in the management of ligament injuries towards a successful long-term outcome.     

重建前交叉韧带移植物生长的MR信号改变初步研究

目的探讨术后生长良好的重建前交叉韧带(ACL)移植物MR信号改变过程。方法选取48例ACL重建患者,Lysholm平均积分由术前54分升至术后83.5分,总结其术后4～22个月重建ACL移植物的MR信号改变。扫描序列包括SE T_1WI、GE T_2WI和STIR序列。结果 4～9个月内大部分重建ACL信号增高,术后12～22个月大部分重建ACL信号降低,与正常韧带相仿。结论生长良好的重建ACL移植物,术后MR信号呈现由高到低的变化过程,1年后信号与正常韧带相仿。     

运动性膝关节损伤重建交叉韧带的生物材料：选择与优劣分析

目的：分析不同生物材料对膝关节运动损伤后交叉韧带重建的优势和缺陷,为膝关节运动损伤后交叉韧带重建与生物材料的选择临床应用提供理论依据。方法：由作者应用计算机检索维普数据库中与人工合成膝关节韧带有关的文献,检索时限为1987-01/2010-09。检索关键词：膝交叉韧带,运动,韧带修复,韧带重建,人工合成材料。纳入选取针对性强,相关度高的文献。排除较陈旧的文献及重复性研究。对16条文献资料进行分析。结果：膝关节交叉韧带的重建修复材料主要有包括自体移植物、同种异体移植物和人工韧带。三种材料在临床应用中都存在各自的优势和缺陷及适用范围。结论：膝关节运动损伤膝关节交叉韧带的重建在材料选择方面,应该从个体化的、不同年龄、不同受伤机制、不同术后要求方面进行最佳材料的选择。     

人工韧带修复膝关节交叉韧带损伤

背景：以往治疗膝关节交叉韧带损伤的主要手段是移植重建,最常用的移植材料为自体的骨髌腱骨、半腱肌腱和股薄肌腱。但由于此类移植物存在取材区并发症及韧带化过程中的各种问题,近年来人工韧带的研究受到重视。目的：认识膝关节交叉韧带的结构及血供特点,以及膝关节交叉韧带损伤后人工韧带重建治疗机制与临床应用特点。方法：①分析膝关节前、后交叉韧带的组织结构,功能学特点以及血供差异。②分析膝关节前、后交叉韧带损伤的类型及生物力学机制。③分析修复膝关节交叉韧带损伤的材料学分类及特点。④分析人工韧带修复后影响关节稳定性的因素。结果与结论：修复膝关节前、后交叉韧带损伤时,择合适的重建物,使重建时过程简化,操作简单,能的双重建。应首先考虑到前、后交叉韧带的功能及血供情况,选重建材料的组织相容性较好,达到修复后的解剖与功     

Effects of the posterior cruciate ligament reconstruction on the biomechanics of the knee joint: a finite element analysis

BACKGROUND: Previous experimental studies have been conducted to evaluate the biomechanical effects of posterior cruciate ligament reconstruction; but no consensus has been reached on the preferred method of reconstruction. METHODS: The 3D finite element mesh of a knee joint was reconstructed from computed tomography and magnetic resonance images. The ligaments were considered as hyperelastic materials. The tibiofemoral and patellofemoral joints were modeled with large sliding contact elements. The 3D model was used to simulate knee flexion from 0 degrees to 90 degrees in four cases: a knee with a "native" posterior cruciate ligament, a resected posterior cruciate ligament, a reconstructed single graft posterior cruciate ligament, and a reconstructed double graft posterior cruciate ligament. FINDINGS: A resected posterior cruciate ligament induced high compressive forces in the medial tibiofemoral and patellofemoral compartments. The pressures generated in the tibiofemoral and patellofemoral compartments were nearly the same for the two reconstruction techniques (single graft and double graft). The single graft resulted in lower tensile stresses inside the graft than for the double graft. INTERPRETATION: Firstly, a resected posterior cruciate ligament should be replaced to avoid excessive compressive forces, which are a source of cartilage degeneration. Secondly, the two types of posterior cruciate ligament reconstruction techniques partially restored the biomechanics of the knee in flexion, e.g. contact pressures were restored for pure flexion of the knee. The reconstruction techniques therefore partially restore the biomechanics of the knee in flexion. A double graft reconstruction is subjected to the highest tensile stresses.     

Biomechanical evaluation of intra-articular and extra-articular procedures in anterior cruciate ligament reconstruction: a finite element analysis

BACKGROUND: Intra-articular techniques (single and double bundles) are the most widely used procedures for the anterior cruciate ligament reconstruction. Lemaire introduced in 1967 the extra-articular techniques, and combined intra-articular and extra-articular reconstruction, to better restore the stability of the knee. However, the effectiveness of these procedures (intra-articular, extra-articular combined or not with intra-articular) seems to be controversial. METHODS: In the present study, we developed numerical models of a knee joint to evaluate the effects of these different procedures on the kinematics and biomechanics of the knee during an internal rotation test. Six cases were simulated: intact anterior cruciate ligament, intra-articular reconstructed anterior cruciate ligament (single and double bundles), extra-articular reconstructed anterior cruciate ligament alone, and combination of extra- and intra-articular reconstructions. The loading condition was an internal tibial torque of 2 N m at 0 degrees, 15 degrees, 30 degrees and 45 degrees of knee flexion. Internal rotation of the tibia and forces within the grafts and the ligaments were calculated. FINDINGS: This study showed that both single and double bundles intra-articular reconstructions restore similar internal rotation control and biomechanics of the soft structures as the intact anterior cruciate ligament situation. On the other hand, our results indicate that extra-articular reconstruction reduces appreciably the internal rotation and modifies the charges distribution in the soft structures when compared to the intact anterior cruciate ligament. INTERPRETATION: The extra-articular procedure alters the kinematics of the knee, which might overconstraint the ligaments and the femorotibial joints, leading to the failure of the anterior cruciate ligament reconstruction.     

人工合成材料在膝交叉韧带损伤修复中的应用

目的:通过对人工合成材料重建膝交叉韧带研究进展的研究和临床实验观察,着重探讨其重建后在损伤修复中的应用前景.方法:由第一作者应用计算机检索维普数据库与人工合成材料重建膝交叉韧带有关的文献,检索时限为1993-01/2009-10.检索关键词:膝关节交叉韧带;人工韧带:移植重建.纳入标准:①人工合成材料在膝交叉韧带损伤修复中应用等相关文献.②LARS人工韧带重建膝前、后交叉韧带的实验研究与临床应用相关的文章.排除标准:③排除较陈旧的理论观点以及一些重复性研究.对资料进行初审,并查看每篇文献后的引文.结果:计算机初检到105篇文献,阅读标题和摘要进行初筛,排除研究目的与本文无关的文献40篇,内容重复性研究44篇,共21篇文献符合标准.膝关节前交叉韧带断裂是一种严重的膝关节损伤,可导致膝关节不稳,并可继发关节内主要结构损伤,严重影响关节功能.对于要求锻炼的年轻患者,特别是运动员前交叉韧带损伤,LARS人工韧带是理想移植材料.目前为止,LARS人工韧带的并发症报道比例较小,特别是没有滑膜炎的报道,被认为是安全的移植材料.结论:人工韧带为前、后交叉韧带重建的确提供了一种选择,但仍存在不足之处,还不是最理想的移植物,也不能完全代替交叉韧带.     

Preliminary comparison of the rupture of human and rabbit anterior cruciate ligaments

Objective. This study was aimed at examining ruptures of the human anterior cruciate ligaments by scanning electron microscopy and video imaging and comparing the appearance of the rupture surfaces with those from rabbit anterior cruciate ligaments.

Design. The specimens were tested to failure as femur-anterior cruciate ligament–tibia complexes using an Instron 8511 materials testing machine.

Background. Rupture of the anterior cruciate ligament is a major clinical problem, leading to instability of the knee joint. Due to the frequency and potential severity of the injuries, a need still exists for information on the biomechanical properties of ligaments under loading conditions, which occur at the time of trauma.

Methods. Four human femur-anterior cruciate ligament–tibia complexes were loaded to failure at a displacement rate of 0.008 m/s. Video recordings of the tests were used to study the progress of the ruptures and to compare the modes of failure of the ligaments. Scanning electron microscopy was employed to study the appearance of collagen fibres at the rupture surfaces.

Results. The modes of failure of the rabbit anterior cruciate ligament and appearance of the rupture surfaces were similar to those of the human anterior cruciate ligaments.

Conclusion. The rabbit anterior cruciate ligament provides a model for investigating failure of the human ligament during trauma.Relevance

The results will be of significance since most studies on ligaments are carried out on animal models with the intention of applying the deductions from the results to human ligaments. Examining the appearance of collagen fibres at these surfaces may help us to understand more about what actually happens during and after ligament rupture.     

Magnetic resonance imaging of autologous chondrocyte implantation

There is now over 10 years experience with autologous chondrocyte implantation (ACI) for the management of full-thickness chondral injuries in the knee. This article briefly reviews the surgical procedure, the time lines of graft maturation, and patient rehabilitation in the context of postoperative magnetic resonance imaging (MRI) assessment. The normal and abnormal appearances of ACI repair cartilage on MR images are described, with an emphasis on the MR appearances of the complications that may occur after this procedure, and the usefulness of MR imaging for the surgeon.     

前交叉韧带重建移植材料的研究与进展

背景:膝关节前交叉韧带重建效果受多种因素影响,包括移植物的选择.目的:对用于前交叉韧带重建的移植材料的种类、材料性质、相关实验、临床应用等方面的研究进行回顾分析.方法:由第一作者检索1985/2009 PubMed数据及万方数据库有关前交叉韧带重建的移植材料如自体韧带、同种异体韧带、人工韧带、组织工程韧带、异种韧带等方面的文献.结果与结论:目前国内外修复前交叉韧带损伤可供选择的移植物有自体组织替代物、同种异体韧带、人工韧带、生物组织工程韧带等.此外还有一些其他生物材料如异种韧带等,目前还处于实验探索及研究阶段.人工合成材料与组织工程韧带近几年研究较多,但其制作工艺复杂,价格昂贵,很难满足临床移植的需要.随着越来越多去抗原处理技术的出现,有效去除异种韧带的免疫原性,提高其组织相容性已不是没有可能,在此基础上异种韧带来源广泛,获取方便、价格低廉、适用性广等优势得以凸显.     

关节镜下LARS人工韧带在重建前交叉韧带中的临床应用

目的探讨在关节镜下运用韧带增强重建系统（LARS）人工韧带重建前交叉韧带的手术方法和临床疗效。方法 2007年6月起运用法国LARS人工韧带治疗前交叉韧带断裂14例。等距点建立胫骨和股骨骨道,置入韧带后游离纤维位于关节腔内,挤压螺钉固定。结果经平均18个月随访,术后Lysholm评分平均92分,优9例,良5例,优良率为100%。术后无感染、无韧带断裂,无膝关节疼痛。结论运用＂LARS人工韧带＂重建前交叉韧带可达到解剖重建,可有效恢复膝关节稳定性;关节镜下手术拥有创伤小、康复快、疗效好等微创特点。     

膝关节交叉韧带重建与生物材料的选择:在跆拳道运动中的特点

背景:膝关节交叉韧带的重建与人工韧带的选择有密切的关系.目的:通过检索相关文献,综述跆拳道运动员膝关节交叉韧带损伤的原因、膝关节交叉韧带重建和人工生物材料的选择问题,探讨人工韧带的重建、功能恢复及其临床效果的关系.方法:应用网络http://www.highwire.org/, http://www.chkd.cnki.net/index.htm/, 检索1999-01/2009-10的相关文献,检索词"Sport Training Dept, anterior cruciate ligament, ACL", 限定文章语言种类为English;并用检索词"跆拳道,膝关节前交叉韧带",限定文章语言种类为中文,检索相关的博士硕士论文,以及相关的中英文会议论文集.另外手工查找膝关节前交叉韧带有关的资料和书籍.排除实验设计不合理的文章及观点模糊的综述.结果与结论:①膝关节损伤是跆拳道运动常见的伤病,膝关节交叉韧带的重建,人工韧带的选择很关键.采用何种材料主要考虑一定形态、大小的移植物的强度、移植物的愈合过程、供区的损坏程度以及移植后能否建立与正常韧带组织相似的附着点.②人工合成材料重建交叉韧带的应用成败主要取决于其组成材料.材料的生物性、机械性是否能与正常韧带生物相容性和生物力学匹配制约着手术的成败.采用理想的生物材料修复韧带,可避免因自体取材的附加损伤.③人工合成材料重建交叉韧带的特点:可避免取材部位的并发症;关节镜下手术操作简便,手术时间短,创伤小;术中即刻获得足够抗拉强度;术后能够早期活动,恢复快;并发症少.临床上近期效果满意,远期效果还需进一步观察证实.     

Bildgebung postarthroskopischer Komplikationen nach Knieverletzungen

The most common joint injuries in professional and recreational sports participants and also in the total population are knee injuries. Arthroscopy is indicated if this modality will improve the patient outcome and potential long-term complications can be avoided. Although uncommon, complications following arthroscopy are mostly evaluated by magnetic resonance imaging (MRI). For planning further therapy strategies following postarthroscopic complications, e.g. if anterior cruciate ligament (ACL) reconstruction is required, digital radiographs and computed tomography (CT) are helpful. This article provides an overview of the different procedures for surgical treatment which are a prerequisite for the analysis of postarthroscopic images. In addition typical complications after treatment of meniscal and chondral injuries as well as after ACL reconstruction are described and typical signs in MRI, radiography and CT are explained in detail.