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1.
Andrew Edwards Anthony M. J. Bull Andrew A. Amis 《Knee surgery, sports traumatology, arthroscopy》2008,16(1):29-36
The aim of this study was to describe the anatomical locations of the femoral attachments of the anteromedial (AM) and posterolateral
(PL) bundles of the anterior cruciate ligament (ACL). Twenty-two human cadaver knees with intact ACLs were used. The femoral
attachments of the two bundles were identified, marked and photographed. They were measured and described in terms of the
o’clock positions parallel to the femoral long axis and parallel to the roof of the intercondylar notch. The centres of the
bundles were also measured in a high–low and a superficial-deep manner referencing from the centre of the posterior femoral
condyle, and with respect to their positions within a measurement grid defined in this study. The bulk of the AM bundle was
attached between the 9.30 and 11.30 o’clock positions and the PL bundle between the 8.30 and 10 o’clock positions. The AM
and PL bundles were consistently found in specific zones of the measurement grid. Using the posterior condyle reference method,
the centre of the AM bundle was at 68 ± 7% (range 57–78) in a shallow–deep direction and 55 ± 5% (44–62) in a high–low direction.
The PL bundle was found at 56 ± 8% (40–73) in a shallow–deep direction, and 62 ± 7.0% (40–70) in a high–low direction. The
attachment was oriented at 37° to the femoral long axis. The results from this study could be used to guide ACL reconstruction
techniques. 相似文献
2.
目的 提高对膝关节前交叉韧带前内侧束和后外侧束的影像认识,并探讨其3.0T MR的理想常规成像显示平面.方法 回顾性分析149例正常膝关节的3.0TMR图像,采用x2分割法分析前交叉韧带、前内侧束和后外侧束双束结构及双束上、中、下各段在MR矢状面、冠状面、横断面各成像平面显示率的差异.结果 前交叉韧带前内侧束和后外侧束双束结构显示率,横断面(115/149,77.2%)与冠状面(103/149,69.1%)比较,×2=2.4606,P>0.0125;横断面、冠状面分别与矢状面(21/149,14.1%)比较,x2值分别为119.5138、92.8695,P值均<0.0125.前内侧束和后外侧束双束上段显示率,横断面( 104/149,69.8%)与冠状面(7/149,4.7%)、矢状面(0/149,0)及冠状面与矢状面分别比较,x2值分别为135.0813、159.7526、7.1684,P值均<0.0125.前内侧束和后外侧束双束中段显示率,横断面(108/149,72.5%)与冠状面(94/149,63.1%)比较,x2=3.0120,P>0.0125;横断面、冠状面分别与矢状面( 10/149,6.7%)比较,x2值分别为134.7454、104.2173,P值均<0.0125.前内侧束和后外侧束双束下段显示率,横断面(103/149,69.1%)与冠状面(110/149,73.8%)比较,x2=0.8065,P>0.0125;横断面、冠状面分别与矢状面(18/149,12.1%)比较,x2值分别为100.5300、115.9132,P值均<0.0125.前交叉韧带双束各段在MRI各序列上均呈低信号,形态、走行正常.结论 3.0TMR常规扫描平面能够在一定程度上显示前交叉韧带的双束结构,横断面和冠状面是较为理想的显像平面. 相似文献
3.
Mitsuhito Doi Masaaki Takahashi Masashi Abe Daisuke Suzuki Akira Nagano 《Knee surgery, sports traumatology, arthroscopy》2009,17(4):347-351
Recently, the femoral attachments of anteromedial and posterolateral bundles of anterior cruciate ligament (ACL) have been
extensively discussed, however, few publications have mentioned radiographic measurements of the tibial insertions of two
bundles. The aim of this study is to determine the radiographic measurements of the tibial sagital insertions for anteromedial
(AM) and posterolateral (PL) bundles of ACL. Thirty-one cadaveric proximal tibias were used. After identification of the AM
and PL bundles insertion sites on the tibia, the insertion center and the other anatomic landmarks were marked with a lead
pin, and lateral radiographs were taken. Sagital percentage is a percentage of the location of the insertion point calculated
from the anterior margin of the tibia in the anteroposterior direction. Anterior edge of ACL averaged 25.0%, center of AM
averaged 34.6%, center of PL averaged 38.4%, posterior edge of ACL averaged 50.2%. This study defines the radiographic location
of the tibial insertions of the anteromedial and posterolateral bundles of ACL. This contributes to more precise evaluation
of anatomical double bundle ACL reconstruction surgery postoperatively. 相似文献
4.
The role of the anteromedial and posterolateral bundles of the anterior cruciate ligament in anterior tibial translation and internal rotation 总被引:7,自引:0,他引:7
Zantop T Herbort M Raschke MJ Fu FH Petersen W 《The American journal of sports medicine》2007,35(2):223-227
BACKGROUND: A rupture of the entire fibers of the anterior cruciate ligament leads to knee instability due to increased anterior tibial translation and increased internal tibial rotation. The influence of isolated deficiency of the anteromedial or posterolateral bundle of the anterior cruciate ligament on the resulting knee kinematics have not yet been reported. HYPOTHESIS: Transection of the anteromedial bundle will lead to increased anterior tibial translation at 90 degrees. Transection of the posterolateral bundle will show an increased anterior tibial translation as well as a combined rotatory instability at 30 degrees. STUDY DESIGN: Controlled laboratory study. METHODS: Kinematics of the intact knee were determined in response to a 134-N anterior tibial load and a combined rotatory load of 10 N.m valgus and 4 N.m internal tibial rotation using a robotic/universal force moment sensor testing system. Subsequently, the fibers of the anteromedial and posterolateral bundle were resected in an alternating order and the new translation in response to the same external loading conditions measured. Statistical analysis was performed using a 2-way ANOVA test. RESULTS: Transection of the anteromedial bundle increased anterior tibial translation at 60 degrees and 90 degrees of knee flexion significantly. Isolated transsection of the posterolateral bundle increased anterior tibial translation in response to 134-N anterior load at 30 degrees of knee flexion significantly and resulted in a significant increase in combined rotation at 0 degrees and 30 degrees in response to a combined rotatory load compared with the intact knee and isolated resection of the anteromedial bundle. CONCLUSION: The anteromedial and posterolateral bundles stabilize the knee joint in response to anterior tibial loads and combined rotatory loads in a synergistic way. CLINICAL RELEVANCE: The results of the current study suggest that, from a biomechanical point of view, it may be beneficial to reconstruct both bundles of the anterior cruciate ligament to better restore normal anterior tibial translation and combined rotation. 相似文献
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M. Denti M.D. M. Bigoni G. Dodaro M. Monteleone A. Arosio 《Knee surgery, sports traumatology, arthroscopy》1995,3(2):75-77
This paper discusses the long-term results of the anterior cruciate ligament (ACL) reconstruction with the Leeds-Keio (LK) prosthetic ligament. For this type of reconstruction we used arthrotomy and an arthroscopy-assisted technique. The fixation was obtained with two bone plugs, and the distal portion was also attached with a staple. A postoperative protocol was used with a progressive range of motion and weight bearing after 50 days. We performed 50 LK operations in professional and amateur athletes aged 17–39 years with an isolated anterior instability. We reviewed at follow-up (5–7 years) 37 patients; 8 were lost, and 5 had a subsequent failure. At the Lysholm score the patients were classified: 19 excellent, 13 good, 3 fair, and 2 poor. At the IKDC grading the patients were classified as follows: 2 class A, 22 B, 8 C, and 5 D. The Lachman test was 1+ in 15 patients, 2+ in 7, 3+ in 2, and negative in 13: pivot shift was 1+ in 9, 2+ in 7, 3+ in 2, and negative in 25. Results of the KT 1000 test at 30 Ib side to side was <3 mm in 23 patients, 3–5 mm in 6, 6–10 mm in 6, and >10 mm in 2. In view of the results observed and the progressive deterioration over the years, this procedure should no longer be performed as an ACL substitute. 相似文献
8.
Mucoid degeneration of the anterior cruciate ligament (ACL) is a rare cause of knee pain. We report a case of a patient with
mucoid degeneration of the ACL, presenting with posterior knee pain and no history of a major knee trauma. On clinical examination,
the active range of motion showed a flexion deficit. The posterior knee pain was induced by passive hyperflexion of the knee.
There was no evidence of ligamentary instability. MRI showed a diffuse thickening of the ACL with a nodular mass on the femoral
insertion occupying the intercondylar notch, with increased signal intensity on both T1- and T2-weighted images. Arthroscopic
evaluation showed a diffuse hypertrophy of the ACL, throughout the entire length of the posterolateral bundle (PLB). A yellowish
homogenous mass on the femoral insertion of the ACL impinged on the posterior cruciate ligament (PCL) in flexion and occupied
the entire intercondylar notch. We performed an arthroscopic debridement of the hypertrophied tissues as precisely as possible.
This resulted in a nearly complete removal of the PLB and immediate relief of symptoms. Examination of knee stability after
debridement showed a stable ACL. Arthroscopic debridement of the mucoid degeneration of the ACL proved to be a safe and effective
method, without causing ligamentary instability in daily activities. 相似文献
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10.
Yoshinari Tanaka Yoshiki Shiozaki Yasukazu Yonetani Takashi Kanamoto Akira Tsujii Shuji Horibe 《Knee surgery, sports traumatology, arthroscopy》2011,19(1):54-59
Purpose
The purpose of this study was to evaluate the course of the anteromedial bundle (AMB) and the posterolateral bundle (PLB) of the anterior cruciate ligament (ACL) with magnetic resonance imaging (MRI) in order to clarify the relationship between the bundles and surrounding anatomic landmarks.Methods
Eighty-eight knees with intact ACLs were included in this study. MRI coronal oblique images were obtained with the knee in extension and used to assess the following characteristics of the AMB and PLB: (1) course of the ligament, (2) location of the tibial attachment, and (3) femoral attachment and geometry of the lateral femoral condyle inner wall.Results
In terms of the tibial attachment, the AMB was confluent with the apex of the medial intercondylar ridge (MIR) in all cases. Sixty-five PLBs (74%) inserted into the region between the apex and the slope of the MIR. The resident’s ridge was detected in 91% of the knees in the AMB image, whereas the ridge was clearly visualized in only 17% of the knees in the PLB image. A bony eminence was observed at the inner articular margin of the lateral femoral condyle in the PLB image.Conclusion
In terms of the tibial attachment, the AMB was confluent with the apex of the medial intercondylar ridge in all cases. Most of the PLBs attached to the region between the apex and the slope of the MIR. Because the bone tunnel location influences clearance between the grafts and the surrounding tissues, these results should be considered during anatomic double-bundle ACL reconstruction.Level of evidence
Study of nonconsecutive patients without a universally applied gold standard, Level III.11.
12.
K. F. Almqvist Pieter Willaert S. De Brabandere K. Criel R. Verdonk 《Knee surgery, sports traumatology, arthroscopy》2009,17(7):818-822
We retrospectively reviewed the long-term clinical outcome of unilateral arthroscopic anterior cruciate ligament (ACL) allograft
reconstruction. From October 1995 to December 1997, 64 arthroscopic ACL reconstructions were performed. Multiligamentous knee
injuries and ACL injuries in polytrauma patients were excluded and out of the remaining 60 patients 55 were available for
follow-up. Three patients had suffered a rerupture caused by major trauma. One patient had a rerupture without significant
trauma and one failure was caused by deep infection. These five patients were revised. Fifty patients (36 males, 14 females)
were included in the final follow-up. At the time of evaluation, the mean duration of follow-up was 10 years and 6 months.
All patients were examined by an independent examiner. Seven patients had an extension lag (<5°) and all patients had a knee
flexion of at least 120°, with a mean flexion of 135 ± 5° compared to 135 ± 8°. At the time of follow-up, the median IKDC
score was 97 (74–100). The Lysholm scoring scale had a median value of 95 (76–100). The median sports level on the Tegner
scale was 6 (4–9). The one-leg-hop test showed a mean value of 95 ± 5%. One patient did not perform the one-leg-hop test because
of recent surgery to the Achilles tendon. In conclusion, the tibialis anterior or tibialis posterior tendon allograft ACL
reconstruction produced good clinical results in the majority of patients at long-term follow-up. 相似文献
13.
Reconstruction of the anterior cruciate ligament (ACL) is currently a common procedure. We report a case of ACL reconstruction
using an autologous patellar tendon graft, where great infrapatellar heterotopic ossification occurred post-operatively. We
found no similar cases in the literature. We discuss about the probable origin. 相似文献
14.
A. Merter Ozenci Erkan Inanmaz Haluk Ozcanli Yetkin Soyuncu Nehir Samanci Tufan Dagseven Nilüfer Balci Semih Gur 《Knee surgery, sports traumatology, arthroscopy》2007,15(12):1432-1437
The aim of this study is to search if there is any proprioceptive difference between auto and allograft anterior cruciate
ligament (ACL) reconstructions, and also to determine if there is any relationship between instrumented anterior knee laxity
and proprioception after an ACL reconstruction. The following four groups were constituted for this purpose: group I, control
group; group II, autograft reconstructions; group III, allograft reconstructions and group IV, people with injured ACLs. Each
group consisted of 20 patients/volunteers. Two subgroups were constituted according to the findings of KT-1000 laxity testing
in group II and III; patients/volunteers found to have a laxity of 3 mm or less were enroled in the normal subgroup and those
with a laxity of more than 3 mm were enroled in the lax subgroup. Two proprioceptive tests were used: threshold to detect
passive motion (TDPM) and joint position sense (JPS) by using Cybex Norm dynamometer. Patients underwent ten tests and the
discrepancy in degrees was averaged for ten trials. Comparisons were made to evaluate the proprioceptive differences between
groups/subgroups; ANOVA and t test was used for comparisons where appropriate, and the significance was set at P < 0.05. There was a significant difference in degrees between patients with injured ACLs and the other three groups in TDPM
evaluations (injured: 1.93° vs. control: 1.03°, autograft: 1.01°, allograft: 0.96°; P < 0.001). Auto and allograft reconstructions were not different from each other and controls. Allo and autograft ACL reconstructions
are not different from each other according to proprioceptive measurements. Also, proprioception is not correlated to postoperative
anterior knee laxity; many variables involve joint proprioception and mostly the anterior knee laxity may not be the sole
determining element, and a lax ACL still may fulfill some of its afferent arc functions as long as it bridges the femur and
tibia. 相似文献
15.
目的研究前交叉韧带(ACL)中前内束(AMB)与后外束(PLB)在维持膝关节稳定性方面所起的不同作用。方法对12具新鲜冰冻尸体的膝关节标本在分别屈曲0°、15°、30°、60°及90°下对胫骨施加100N的前负荷及在0°、15°、30°下5Nm的胫骨内旋负荷,使两束韧带拉伸并带动电阻应变片形变引起阻值改变,从而引起输出电压值的变化。结果在对胫骨施加100N前负荷的条件下,AMB在屈膝60°和90°时的原位拉力显著>屈膝0°和15°时(P<0.05);而PLB在屈膝0°和15°时的原位拉力显著>屈膝30°、60°和90°时(P<0.05);在屈膝0°和15°时PLB的原位拉力显著>AMB(P<0.05);而在屈膝30°、60°和90°时AMB的原位拉力显著>PLB(P<0.05)。在对胫骨施加5Nm内旋负荷时,在屈膝15°和30°时AMB的原位拉力显著>PLB(P<0.05);在膝关节完全伸直位时二者无统计学差异(P>0.05)。结论虽然在ACL的双束中AMB起主要作用,但PLB的辅助作用仍不可忽视,其体现在膝关节接近伸直位维持前向和内旋稳定性方面。 相似文献
16.
Without an intact anterior cruciate ligament (ACL) to resist anterior tibial translation, it is commonly believed that ACL-deficient patients employ alterations in walking. Although there is no consensus in the literature about the specific kinematic and kinetic adaptations in these patients with ACL tears, the gait adaptation of quadriceps avoidance is perhaps the one most popularized. The purpose of our study was to determine whether quadriceps avoidance is common in patients with ACL-deficiency. We used a video-based motion analysis system and surface electromyography (EMG) to study 18 patients with ACL-deficiency. All patients demonstrated an internal knee extension moment during early mid-stance (similar to normal subjects). Quadriceps EMG activity was noted throughout most of stance. No patients demonstrated an internal knee flexion moment, a decreased internal knee extension moment or a decreased duration of quadriceps EMG activity during stance. The findings of this study would suggest that quadriceps avoidance as a gait adaptation in ACL-deficient patients may be less common than previously reported. 相似文献
17.
ObjectivesTo determine the relationship between knee flexion excursion symmetry and lower extremity kinematics, kinetics, and muscle, joint, and ligament forces in females 1–3 years after ACL reconstruction.DesignCross-sectional.SettingLaboratory.ParticipantsTwenty-one, college-aged females.Main outcome measuresLower extremity kinetics and kinematics, including estimated muscle, tibiofemoral, and ligament forces were assessed using 3D motion analysis and a musculoskeletal modeling approach. Participants demonstrating greater than 10% asymmetry in knee flexion excursion were classified as landing with an “extended knee”. Group and between-limb differences were compared.ResultsTen participants were classified as landing with an “extended knee” on the involved limb, while eleven exhibited a symmetric landing pattern. Participants landing with an “extended knee” demonstrated reduced knee extension moment and quadriceps force in the involved limb (p < 0.05).ConclusionsThese findings indicate that an “extended knee” landing pattern was associated with reduced knee extension moment and quadriceps muscle force in females 1–3 years after ACL reconstruction. This may represent an altered strategy that clinicians may choose to identify and address during rehabilitation. 相似文献
18.
We report a case of a mucoid degeneration of the anterior cruciate ligament (ACL) that produced osseous erosion of the medial aspect of the lateral femoral condyle. The MRI findings and differential diagnosis are discussed. 相似文献
19.
ObjectiveRegular quadriceps strength assessment is important following anterior cruciate ligament reconstruction (ACLR). The one-leg sit-to-stand (OLSTS) test potentially overcomes the barrier of accessibility to specialised testing equipment. However, feasibility and validity testing of OLSTS is lacking in the ACLR population. This study aims to examine the feasibility, correlates, and predictive validity of OLSTS with self-reported running and jumping difficulty in individuals post-ACLR.DesignRetrospective longitudinal study.Methods20 patients with primary unilateral ACLR were tested at 6-months and 1-year post-ACLR. Feasibility was assessed by the number of patients who had safely performed OLSTS at both timepoints. Cross-sectional gender-adjusted Spearman correlations of OLSTS with quadriceps strength, physical impairments, and psychological variables were measured at 6-months. Predictive validity was assessed via ordinal regression, quantifying the associations of OLSTS with self-reported running and jumping difficulty across time-points.ResultsAll patients understood the instructions to and were able to self-administer the OLSTS test safely. OLSTS is a valid measure of quadriceps strength (gender-adjusted Spearman's ρ = 0.53, P = 0.02). Knee pain (ρ = 0.44, P = 0.046) and readiness to return-to-sport (ρ = 0.55, P = 0.02) were additional correlates. Greater OLSTS performance was associated with greater odds of better self-reported running and jumping function (interquartile-range ORs, 12.0 [95% CI: 3.6–45] and 18.5 [95% CI: 5–67], respectively).ConclusionOLSTS is a feasible and valid test of quadriceps strength, demonstrating predictive validity with self-reported running and jumping post-ACLR. OLSTS potentially allows independent tracking of ACLR rehabilitation progress at home – an increasingly urgent necessity in the face of a global pandemic. 相似文献
20.
Koji Nishimoto Ryosuke Kuroda Kiyonori Mizuno Yuichi Hoshino Kouki Nagamune Seiji Kubo Masayoshi Yagi Motoi Yamaguchi Shinichi Yoshiya Masahiro Kurosaka 《Knee surgery, sports traumatology, arthroscopy》2009,17(3):270-276
The aim of this study is to investigate and compare the three dimensional bending angle of the graft at the femoral tunnel
aperture in the transtibial and the far anteromedial portal technique. Seven fresh-frozen human cadaveric knees were used.
Six degrees-of-freedom of knee kinematics and knee position data were measured using an electromagnetic device and the three
dimensional bending angles of the each graft at the femoral tunnel aperture were calculated by computer simulation. Additionally,
in order to assess the stress on the graft, the length change between the femoral and tibial attachment sites of the AM and
PL bundle were calculated. The maximum length of each bundle was detected at full extension of the knee. The relative change
of the length of the PL bundle in the range of 70°–0° of knee flexion was significantly larger than that of the AM bundle.
(P < 0.05) Maximum graft bending angles in both techniques were obtained at full extension where the graft was fully stretched.
The AM and PL graft bending angles in the transtibial technique were significantly larger than in the far anteromedial portal
technique at low flexion angle (AM: 0°–10°, PL: 0°–50°) (P < 0.01). This suggests use of the far anteromedial portal technique might result in lower stress on the graft at the femoral
tunnel aperture and therefore might reduce graft damage. 相似文献