关节镜诊治股骨髁间窝撞击前交叉韧带

目的 :分析股骨髁间窝与前交叉韧带撞击对伸膝关节功能的影响。方法 :回顾本院骨科 1995年 3月～2 0 0 3年 1月 8例有股骨髁间窝与前交叉韧带撞击现象患者的关节镜下诊治及患者的恢复情况。结果 :8例患者的股骨髁间窝扩大后 ,疼痛均减轻或消失 ,伸膝范围加大。结论 :股骨髁间窝撞击前交叉韧带是引起屈膝畸形及伸膝疼痛不可忽视的原因之一 ,关节镜在诊断与治疗此病方面有其独特的优点。     

关节镜术诊断与治疗退行性股骨髁间窝前交叉韧带撞击症

目的 报道退行性股骨髁间窝前交叉韧带撞击症１６膝。作者对镜在本病诊断中的优点、分型及治疗方法进行探讨。方法 所有病人均合并骨性关节炎,主要表现为膝关节前部或定位不确定的钝痛、渐进性关节伸屈障碍和反复关节积液。关节镜术野良好,可动态检查前交叉韧带在运动中所受阻碍的情况,提高本病诊断率并有助于分型,关节镜下可将本病分为三型：磨损型、挤夹型、混合型。治疗采用关节镜下股骨髁间窝扩大成形术加镜下关节清理术。     

股骨髁间前交叉韧带撞击症

股骨髁间前交叉韧带撞击症薛庆云黄公怡股骨髁间前交叉韧带撞击症是指在膝关节屈伸活动的正常范围内发生的股骨髁间窝与前交叉韧带撞击、磨损，产生前交叉韧带损伤的一种病理现象。１９７７年Ｎｏｒｗｏｄ和Ｃｒｏｓ［１］研究发现，在膝关节最大伸直位时膝关节前交叉韧带...     

前交叉韧带断裂后股骨髁间窝变化的影像学研究

目的探讨前交叉韧带（ACL）断裂后会否引起患侧股骨髁间窝增生致狭窄。方法收集2008年10月～2008年12月进行关节镜下治疗单侧膝关节ACL断裂患者共216例,对其中35例健侧膝关节X线检查无退变的患者进行研究。术前记录患膝ACL断裂的病程,拍摄双侧膝关节髁间窝位X线片,测量其宽度,并对患侧膝关节进行IKDC、Lvsholm及Tegner评分。结果本组患者的髁间窝宽度差值（健侧－患侧）为（2．62±1．38）ml／1,患膝ACL断裂病程为（24．71±15．20）个月,两者呈正相关,并有统计学意义：患侧膝关节的IKDC、Lysholm及Tegner评分分别为（69．31±5．17）、（72．34±6．17）及（4．66±0．54）,此三者与髁问窝宽度差值问的相关性无统计学意义。结论影像学测量观察表明,ACL断裂后可继发患侧膝关节股骨髁间窝狭窄,其狭窄程度随病程的延长进一步加重。     

评价成人前交叉韧带损伤与髁间窝形态的关系:一项高分辨率MRI研究

[目的]分析髁间窝形态与前交叉韧带(anterior cruciate ligament,ACL)损伤风险的关系。[方法]回顾兰州大学第二医院2013年6月~2015年1月期间收治的150例符合纳入标准的ACL损伤患者作为病例组,平均年龄36.3岁(18~60岁),男女比例为1.4:1。对照组为按照年龄、性别与病例组1:1配对的参加体检的健康人群,共150例。分别在膝关节高分辨率MRI冠状位和轴位扫描图像上测量髁间窝宽度、股骨双髁宽度,统计髁间窝分型,计算髁间窝宽度指数(notch width index,NWI)。[结果]髁间窝宽度、NWI单变量Logistic回归分析结果:轴位髁间窝宽度[OR=0.865,95%CI(0.784,0.955),P=0.004]和冠状位髁间窝宽度[OR=0.879,95%CI(0.813,0.851),P=0.001]是ACL损伤的危险因素,轴位NWI[OR=0.000 02,95%CI(0.000,0.008),P=0.002]和冠状位NWI[OR=0.000 2,95%CI(0.000,0.010),P=0.001]是ACL损伤的高度危险因素。对病例组和对照组髁间窝分型的χ2检验结果显示:在男性女性合并的总体中两组分型无差异(P=0.792),但在女性中两组分型有显著性差异(P=0.025)。[结论]髁间窝宽度和NWI是ACL损伤的危险因素,其中NWI是高危因素;病例组和对照组的髁间窝分型在总体中无差异,但在女性中A型髁间窝可增加ACL损伤的风险。     

股骨髁间窝的应用解剖及临床意义

本文对股骨髁间窝的形态、测量方法、股骨髁间窝与前交叉韧带的关系等方面进行综述,并讨论了面临的一些问题和前景。     

股骨髁间窝前交叉韧带撞击现象

本科自１９９２年至今发现膝关节股骨髁间窝前交叉韧带撞击现象２４例，主要病因为股骨髁间窝狭窄、骨赘增生或前交叉韧带胫骨嵴止点升高，造成股骨髁间窝出口前缘于伸膝时磨擦撞击前交叉韧带并产生相应临床症状。其典型表现为膝关节前部钝痛、反复膝关节积液和伸膝活动受限，关节镜及手术中发现为股骨髁间窝前内缘和前交叉韧带在接近胫骨止点的部分的前侧的磨损。伸膝位检查可证实上述部位发生撞击和磨擦现象，其中２０例病人接受股骨髁间窝成形手术。     

股骨髁间窝的应用解剖及其临床研究

目的 探讨如何完善髌韧带中1／3重建前叉韧带术式，防止重建韧带撞 现象的发生。方法 测量42例和73例正常干、湿性股骨髁间窝标本的横径、纵径及其相关值；通过对湿性膝关节标本股骨髁间窝与前交叉韧带和重建韧带解剖关系的观测，确定膝关节伸展时髁间窝与韧带发生撞击的部位，在髌韧带中1／3重建前叉韧带的模拟和临床手术中， 切除股骨髁间窝前外侧壁及顶部部分骨质，加宽加深髁间窝，保持重建韧带与其有5mm间距。结果 临床应用19例中随访1年以上者11例，无1例出现重建韧带撞击现象，膝关节稳定性恢复良好。结论 股骨髁间窝扩大成形能有效地防止髁间窝对髌韧带的撞击，保证其顺利地替代前叉韧带的功能。     

前交叉韧带

前交叉韧带（ anterior cruciate ligament, ACL）实质部是既有弹性又有刚性的致密结缔组织,位于关节内,却被滑膜包绕,是关节内滑膜外结构。韧带起于股骨外侧髁后内侧一个半圆形的区域内,向前内下走行,穿过髁间窝止于胫骨前部到髁间棘之间。长度约30～38mm,宽度约10～12mm。     

股骨髁间窝的影像学测量及其临床意义

目的:观测股骨髁间窝的形态及大小,以及与前交叉韧带损伤、性别、身高、体重的关系.方法:采用屈膝45.后前位投照法对62个正常人膝关节行股骨髁间窝穿通位摄片.在肌腱沟水平测量股骨髁间窝宽度及股骨髁宽并计算股骨髁间窝宽度指数.结果:正常髁间窝形状呈倒“U”形.62个髁间窝宽为(18.9±4.8)mm,男为(19.8±3.8)mm,女为(18.3±5.3)mm,(t=1.29,P＞ 0.05).髁间窝指数平均为0.24±0.05.髁间窝指数与身高(r=-0.11)、体重(r=-0.13)、年龄(r=-0.28)不相关.结论:屈膝45.髁间窝穿通位像可完整显示髁间窝的形态与宽度.该测量可为临床上股骨髁间窝相关疾病的诊断和治疗提供放射学基础.术前对髁间窝进行影像学测量有着重要临床意义.     

Radiological Evaluation of Femoral Intercondylar Notch and Tibial Intercondylar Eminence Morphometries in Anterior Cruciate Ligament Pathologies Using Magnetic Resonance Imaging

PurposeTo determine the relationship between femoral–tibial morphometries and anterior cruciate ligament (ACL) pathologies using magnetic resonance imaging (MRI). MethodsWe retrospectively evaluated 455 patients (211 females and 244 males) who underwent knee MRI with suspected ACL pathology. Imaging findings were classified as normal ACL (n = 119), degeneration of the ACL (n = 116), partial ACL tear (n = 103), and complete ACL tear (n = 117). In all groups, the femoral intercondylar notch width (INW), intercondylar distance (CD), notch width index (NWI), and intercondylar notch angle (INA), the angles between the tibial plateau and tibial spines (MPA and LPA), intercondylar eminence peak angle (IEA), and tibial slope angles (MSA and LSA) were measured. ResultsFemoral INW and NWI were significantly lower in patients with ACL pathology (p < 0.05). They were also lower in patients with tear compared to degeneration. The INA was significantly smaller in patients with ACL pathology (p < 0.001) and the significance continued in both genders. The LSA was only increased in patients with complete tear (p < 0.01) and the difference seems existing in both genders. It was also found that the LPA and IEA demonstrated significant increases in patients with ACL pathology (p < 0.01 and < 0.05, respectively) and the significance in LPA continued in both genders. Significant differences between males and females were found for the INW and CD in all 4 groups (p < 0.001). In addition, the INA, LPA and LSA were independent predictors in determining the risk of ACL pathology.ConclusionThe ACL pathologies are associated with femoral–tibial morphometries and these associations exist in both genders.Supplementary InformationThe online version contains supplementary material available at 10.1007/s43465-021-00490-7.     

Prediction of Chronicity of Anterior Cruciate Ligament Tear Using MRI Findings

Background

The estimation of anterior cruciate ligament (ACL) tear is required in certain cases involving legal and financial administration, such as the worker''s compensation and/or insurance. The aim of this study is to propose and evaluate a quantitative evaluation instrument to estimate the chronicity of the ACL tear, based on the four magnetic resonance imaging (MRI) findings.

Methods

One hundred and fifty one cases of complete ACL tear confirmed by arthroscopy were divided into 4 groups according to the time from ACL injury to MRI acquisition: acute (< 6 weeks), subacute (6 weeks to 3 months), intermediate (3 months to 1 year), and chronic (> 1 year). The four MRI findings including ACL morphology, joint effusion, posterior cruciate ligament angle, and bone bruise were analyzed for temporal changes among the 4 groups. Binary logistic regression equations were formulated using the MRI findings to estimate the chronicity of ACL tear in a quantitative manner, and the accuracy of the formulated regression equations was evaluated.

Results

The four MRI findings showed substantial temporal correlation with the time-limits of ACL injury to be included in the estimation model. Three predictive binary logistic equations estimated the probability of the ACL injury for the three cutoff time-limits of 6 weeks, 3 months, and 1 year with accuracies of 82.1%, 89.4%, and 89.4%, respectively.

Conclusions

A series of predictive logistic equations were formulated to estimate the chronicity of ACL tear using 4 MRI findings with chronological significance.     

Factors Affecting the Femoral Cartilage Thickness After Anterior Cruciate Ligament Reconstruction

BackgroundThis study aimed to evaluate the changes in the distal femoral cartilage thickness in patients that underwent anterior cruciate ligament reconstruction (ACLR) and to analyze their association with concomitant meniscal surgery, knee muscle strength, kinesophobia, and physical activity level.MethodsThe demographic characteristics and surgical data of 47 male patients that underwent unilateral ACLR (mean, 27.55 ± 5.63; range, 18–40 years) were evaluated. The patients were assessed in three groups depending on surgery: isolated ACLR (n = 15), ACLR + partial medial meniscus resection (ACLR&M) (n = 16), and ACLR + medial meniscus repair (ACLR&MR) (n = 16). The medial (MCCT), intercondylar (ICCT), and lateral (LCCT) femoral cartilage thicknesses on both limbs were measured using ultrasonography. The extensor and flexor muscles strength of the knees was assessed using an isokinetic dynamometer at 60°/s. The physical activity level was evaluated by the International Physical Activity Questionnaire (IPAQ) short form and Tegner Activity Scale (TAS). The fear of movement was assessed by the Tampa Scale for Kinesiophobia Questionnaire (TSKQ).ResultsThe postoperative mean follow-up duration was 32.24 ± 9.17 months. MCCT and LCCT were significantly decreased in the ACLR&M group (p < 0.001 and p = 0.019, respectively). MCCT, ICCT and LCCT were significantly decreased in the ACLR&MR group (p = 0.017, p = 0.011, and p = 0.004, respectively). No significant change was found in the ACLR group. Cartilage thickness changes were not significantly correlated with the knee muscle strength, IPAQ, TAS and TSKQ scores in all groups (p > 0.05).ConclusionThe results showed partial meniscectomy and meniscus repair at the time of ACLR as important risk factors for decreased chondral thickness.     

Hybrid Anterior Cruciate Ligament Reconstruction: Introduction of a New Technique for Anatomic Anterior Cruciate Ligament Reconstruction

Recently, anatomic or double-bundle reconstruction of the anterior cruciate ligament (ACL) has been presented in an effort to more accurately restore the native anatomy. These techniques create 2 tunnels in both the femur and tibia to reproduce the bundles of the ACL. However, the increased number of tunnels, particularly on the femoral side, has raised some concerns among authors and surgeons. We describe a technique to reconstruct the 2 distinct bundles of the ACL by using a single femoral tunnel and 2 tibial tunnels, the “hybrid” ACL reconstruction. The femoral tunnel is drilled through an anteromedial arthroscopy portal, which allows placement in a more anatomic position. Fixation in the femur is achieved with a novel device that separates a soft-tissue graft into 2 independently functioning bundles. Once fixed in the femur, the anteromedial and posterolateral bundles of the graft are passed through respective tunnels at the anatomic footprint on the tibia. These bundles are independently tensioned, which creates a reconconstruction that is similar to the native ACL. The technique presented provides surgeons with an alternative to other double-bundle techniques involving 4 tunnels.     

Anteromedial Portal Technique for Creating the Anterior Cruciate Ligament Femoral Tunnel

There has been a renewed focus on anterior cruciate ligament (ACL) insertional anatomy and its biomechanics. It has been postulated that traditional single-bundle transtibial reconstructions have placed grafts in a less anatomic location relative to the true ACL insertion site. In traditional transtibial techniques, the femoral tunnel is predetermined by the position of the tibial tunnel. It is our belief that achieving the most anatomic position for the graft requires the femoral and tibial tunnels to be drilled independently. Use of the anteromedial portal technique provides us with more flexibility in accurately placing the femoral tunnel in the true ACL insertion site as compared with the transtibial technique. Advantages include anatomic tunnel placement, easy preservation of any remaining ACL fibers when performing ACL augmentation procedures, and flexibility in performing either single- or double-bundle reconstructions in primary or revision settings. This technique is not limited by the choice of graft or fixation and offers the advantage of true parallel screw placement through the same portal as that used for tunnel drilling in the case of interference fixation.