膝关节对吻性骨挫伤在急性前交叉韧带损伤中的临床意义

目的探讨急性膝关节损伤出现股骨外侧髁与胫骨外侧平台后缘对吻性骨挫伤时与前交叉韧带(ACL)损伤的关系及其临床意义。方法分析50例膝关节损伤伴有股骨外侧髁与胫骨外侧平台后缘对吻性骨挫伤的MRI图像,分析股骨外侧髁与胫骨外侧平台后缘对吻性骨挫伤与前交叉韧带损伤之间的关系。结果在50例有股骨外侧髁与胫骨外侧平台后缘对吻性骨挫伤的膝关节损伤患者中,前交叉韧带损伤50例,其中断裂38例,损伤率达100%,断裂率达76%。结论在急性膝关节外伤时,股骨外侧髁与胫骨外侧平台后缘对吻性骨挫伤的出现对前交叉韧带损伤的诊断及临床诊治有重要意义。     

前交叉韧带重建中不同入路制备股骨骨道的对比研究

目的:比较改良经胫骨隧道(TT)入路和前内侧(AM)入路两种方法解剖位重建前交叉韧带(ACL)术后,股骨隧道的定位情况及临床疗效。方法:回顾性分析2016年1月～2017年12月我科收治的42例单侧前交叉韧带损伤患者的临床资料。其中24例采用改良TT入路技术重建ACL,18例采用AM入路技术重建ACL。术后1周内行膝关节CT平扫+三维重建评估股骨骨道位置,术后3个月时扫描MRI并测量JGS、JGC角;术前及术后12个月评估患者国际膝关节文献委员会(IKDC)评分、Lysholm评分、膝关节前方松弛度及轴移试验结果。结果:术前两组患者性别、年龄、病程、IKDC评分、Lysholm评分、膝关节前方松弛度、轴移试验阴性率,差异均无统计学意义(P>0.05)。末次随访时,两组患者IKDC评分、Lysholm评分,前方松弛度,轴移试验阴性率相较术前均显著改善,差异具有统计学意义(P<0.05);组间比较,差异无统计学意义(P>0.05)。CT三维重建分析显示,两组股骨骨道内口位置无明显差异(P>0.05),MRI测量JGS、JGC角,组间无明显差异(P>0.05)。结论:采用改良经胫骨隧道入路和前内侧入路重建ACL,均可获得良好的股骨解剖中心隧道定位,骨道位置无明显差异,术后早期疗效令人满意。     

股骨髁间窝宽度和前交叉韧带胫骨端左右径相关性及其与前交叉韧带损伤的关系

目的:探讨股骨髁间窝宽度与前交叉韧带(ACL)胫骨端左右径之间的相关性及其与ACL损伤的关系,为ACL重建术提供解剖依据。方法:选取在本院接受膝关节镜检的患者,ACL损伤组17人,ACL完整组20人,搜集其性别、年龄、是否为运动员、受伤至手术时间等信息。术中在关节镜下测量ACL胫骨端左右径和髁间窝上1/3、下1/3及基底部宽度。分别比较ACL损伤组和ACL完整组、男性和女性患者、ACL损伤组男性和ACL完整组男性、ACL完整组女性和ACL完整组男性患者之间测量指标有无统计学差异,并分别分析髁间窝宽度与ACL胫骨端左右径之间有无相关性。结果:(1)各组别患者的髁间窝宽度、ACL胫骨端左右径绝对值比较均无统计学差异。(2)ACL损伤组患者髁间窝宽度与ACL胫骨端左右径不具有相关性,而ACL完整组患者具有中等程度相关性;单独分析男性患者,发现ACL完整组男性患者患者髁间窝宽度与ACL胫骨端左右径具有高度相关性,而ACL损伤组男性患者不具有相关性,提示髁间窝宽度与ACL胫骨端左右径不匹配可能是非接触性ACL损伤发生的危险因素之一。(3)全体男性患者的髁间窝宽度与ACL胫骨端左右径具有中等程度相关性,而全体女性患者则不具有相关性;去掉ACL损伤患者,发现ACL完整组男性患者髁间窝宽度与ACL胫骨端左右径具有高度相关性,而ACL完整组女性患者则不具有相关性,提示髁间窝宽度与ACL胫骨端左右径不匹配可能是女性非接触性ACL损伤发生率高于男性的原因之一。结论:ACL胫骨端左右径相对于髁间窝宽度太宽或太窄可能是ACL损伤的危险因素,也可能是女性ACL损伤发生率高于男性的原因之一。     

健康老年妇女近段股骨骨密度和结构的定量CT研究

目的 采用定量CT(QCT)和双能X线吸收测量(DXA)仪对健康老年妇女近段股骨骨密度(BMD)和骨结构进行研究,并对2种测量方法的结果进行比较.方法 对66名65岁以上健康妇女左侧髋关节进行DXA测量,计算出股骨颈和粗隆区BMD;对其双侧近段股骨进行QCT测量,计算出股骨颈、粗隆区和整体股骨ROI的皮质骨、松质骨和总体骨的BMD和体积;并将QCT三维图像模拟DXA的平面投影计算出模拟DXA股骨颈BMD和模拟DXA股骨粗隆区BMD.对所获数据进行配对t检验或非参数秩和检验,并用Pearson法分析DXA和QCT相对应ROI的相关性.结果 用QCT可以对股骨近段不同ROI(股骨颈、粗隆区和整体股骨区)及不同骨成分(皮质骨、松质骨和总体骨)的BMD及体积等参数进行精确的定量分析.除右侧股骨颈皮质骨BMD[(0.52±0.04)g/cm3]、股骨粗隆区皮质骨BMD[(0.49±0.03)g/cm3]、股骨粗隆区综合骨BMD[(0.22±0.04)g/cm3]大于左侧相应参数[分别为[(0.51±0.04)、(0.48±0.03)、(0.21±0.04)g/cm3],差异均有统计学意义(P值均<0.05),但差别均<3.3%;而模拟DXA股骨颈BMD、模拟DXA股骨粗隆区BMD、股骨颈皮质骨体积、股骨颈松质骨BMD、股骨颈松质骨体积、股骨颈综合骨BMD、股骨颈综合骨体积、股骨粗隆区皮质骨体积、股骨粗隆区松质骨BMD、股骨粗隆区松质骨体积、股骨粗隆区综合骨体积左侧参数分别为(0.52±0.10)g/cm2、(0.78±0.13)g/cm2、5.80 cm3、(0.06±0.03)g/cm3、(5.19±1.40)cm3、(0.25±0.04)g/cm3、15.66 cm3、(21.74±3.43)cm3、(0.08±0.03)g/cm3、(34.27±6.09)cm3、(76.12±11.11)cm3,右侧分别为(0.52±0.10)g/cm2、(0.78±0.13)g/cm2、6.01 cm3、(0.06±0.02)g/cm3、(5.17±1.27)cm3、(0.25±0.04)g/cm3、15.62 cm3、(22.12±3.60)cm3、(0.09±0.03)g/cm3、(34.17±5.94)cm3、(76.53±10.71)cm3,差异均无统计学意义(P值均>0.05).左右两侧近段股骨QCT各相对应参数之间的r值范围在0.656～0.955,均具有相关性(P<0.05).QCT模拟DXA股骨颈和粗隆区BMD与真正DXA测量的相应值之间r值分别为0.685和0.855,具有相关性(P<0.05).结论 利用QCT技术可以对老年妇女近段股骨不同区域和不同成分的BMD和结构进行精确定量分析,QCT是骨质疏松研究中非常有用的测量技术.     

三维重建CT与X线测量前交叉韧带重建后骨道位置对比研究

目的:探讨三维重建CT(3D-CT)和X线测量前交叉韧带(ACL)重建后骨道位置的准确性。方法:2005年5月至10月,15例ACL损伤患者采用单切口股骨和胫骨单骨道方法重建ACL。术后采用3D-CT观察骨道口与临近骨性解剖标志;观察Endobutton、Endopearl、骨块、可吸收界面挤压螺钉和骨道位置,以及重建后ACL是否与髁间窝撞击。分别使用X线和3D-CT测量骨道位置,胫骨骨道位置测量采用Klos推荐的方法,股骨骨道测量采用Bernard的"四格法"。结果:3D-CT可直观地观察到ACL重建后骨道及相关情况。3D-CT测量胫骨骨道内口位置为43.53%±2.16%(30.0%~59.1%),X线测量胫骨骨道内口位置为41%±6.25%(25%~62%),两种测量结果差异有统计学意义(P<0.05)。3D-CT测量股骨骨道内口位置为37%±4.56%(23.3%~48.1%),X线测量股骨骨道内口位置为34%±7.31%(21%~54%),两种测量结果差异有统计学意义(P<0.05)。提示:3D-CT与X线骨道位置测量结果有差异。     

前交叉韧带起止点X线下定位的研究

目的研究X线下前交叉韧带(anterior cruciate ligament,ACL)起止点印迹在股骨髁及胫骨平台上的定位,为术中重建ACL制备骨隧道时提供参考依据。方法采集12例正常国人膝关节标本,制作标本后分别在股骨髁及胫骨平台将ACL起止点边缘用金属丝标记,标记后摄标准的正侧位膝关节标本x线片,使用X-Caliper测量仪在CR片上精确测量ACL股骨髁和胫骨平台止点的几何中心与CR片骨性标记之间的距离。结果ACL股骨侧止点中心在股骨干力学轴与其平行线之间(65．3±1．1)%处,在Blumensaat线及其平行线之间(78．1±1．0)%处。胫骨侧止点中心在正位片上位于胫骨平台(47．1±2．6)%处,在侧位片位于(43．9±1．7)%处。结论股骨干力学轴和Blumensaat线及与其平行的股骨髁切线结合更方便定位ACL股骨侧标记；X线下胫骨平台定位更为准确。     

膝关节三维CT重建评估住院医师嵴发生率

目的:探讨关节镜下前交叉韧带(ACL)重建术中使用住院医师嵴作为股骨端定位骨性标志的临床可行性。方法:对2011年~2015年间在我院行膝关节CT三维重建的患者中,选取80例,年龄4~81岁,男性53人,女性27人,依照年龄分为4组,A组(4~12岁)、B组(13~30岁)、C组(31~45岁)、D组(45~81岁),其中B组和C组为我科前交叉韧带断裂拟手术患者,各组20例。分析每组膝关节髁间窝外侧嵴(1ateral intercondylar ridge)即住院医师嵴(resident ridge)三维CT重建之发生率及镜下观察结果。结果:4组患者住院医师嵴发生率:A组0%,B组15%,C组15%,D组45%,组间比较差异有统计学意义(P<0.05),住院医师嵴的发生率与患者的性别无相关性(P>0.05),与年龄有相关性(P<0.05)。B组和C组全部患者在关节镜下采用股骨外侧髁内侧壁后1/3定位ACL股骨止点足印区的原则,行有限髁间窝清理后,结果显示,术前三维CT重建证实存在住院医师嵴的患者,术中却未被发现,但在2组患者均能发现位于股骨外髁内侧壁股骨止点足印区内有一条白色致密纤维切迹。住院医师嵴和白色致密纤维切迹无相关性(P>0.05)。结论:住院医师嵴的发生率与患者的性别无相关性,与年龄有相关性,可能与前交叉韧带股骨止点前界受到应力的持续刺激有关,还需进一步研究证实。关节镜下前交叉韧带重建术中,使用住院医师嵴作为股骨端个体化骨性定位标志尚需临床进一步研究。在B组和C组患者术中确认的白色致密纤维切迹,即ACL股骨足印区致密纤维切迹,可以作为ACL重建术中股骨隧道的个体化非骨性定位参考。     

定量CT与双能X线吸收测定仪测量腰椎各椎体间骨密度差异性研究

目的探讨L2～L4椎体的骨密度变化趋势,并比较定量CT(QCT)与双能X线骨密度仪(DXA)测量结果的差异。资料与方法从多中心合作数据库中选择11443名志愿者数据进行L2～L4椎体骨密度(BMD)分析,其中11081名志愿者选用DXA检测椎体BMD值,男性2158名,女性8923名;362名志愿者选用QCT检测椎体中间松质骨BMD值,男性170名,女性192名,比较二者测量各腰椎BMD的差异。结果 DXA测量椎体间BMD值差异有统计学意义(男性:F=74.450,P<0.05;女性:F=605.388,P<0.05),从L2～L4呈增加趋势;QCT测量椎体间BMD值差异无统计学意义(男性:F=1.291,P>0.05;女性:F=1.653,P>0.05)。结论 QCT是真正意义上的体积骨密度测量技术,能更准确地测量骨密度。     

双能X线骨密度仪测定股骨假体周围骨密度水平对患者术后治疗效果的评估

【摘要】目的：探讨双能X线骨密度仪测定股骨假体周围骨密度(BMD)水平对患者术后治疗效果的影响。方法：选取2019年10月-2021年4月本院收治的148例髋关节置换术患者为研究对象,据患者术后12个月的髋关节功能Harris评分将其分为疗效良好组102例(≥80分)、疗效不良组46例(＜80分)。采用双能X线骨密度仪对两组患者置换术后1个月和术后12个月的股骨假体周围BMD进行检测,计算并比较两组患者的BMD变化率,分析BMD变化率与Harris评分变化值之间的相关性。结果：两组患者术后1个月和术后12个月ROI2～ROI6的BMD差异无统计学意义(P＞0.05);疗效不良组术后12个月ROI1的BMD相较于术后1个月和疗效良好组的术后12个月显著升高(P＜0.05);两组患者术后12个月的ROI7的BMD相较于术后1个月均明显下降,但疗效不良组下降程度更低(P＜0.05)。疗效良好组ROI1、ROI5以及ROI6的骨量升高率低于疗效不良组,ROI2、ROI3、ROI4、ROI7的骨量降低率均低于疗效不良组(P＜0.05）。术后1个月的Harris评分（54.67±5.12）分,术后12个月（80.58±8.46）分,差异有统计学意义（P＜0.05）。Pearson相关性分析显示,Harris评分变化值与ROI2～6的骨密度变化率无相关性（P>0.05）,而与ROI1的骨密度变化率呈负相关性,与ROI7的骨密度变化率呈正相关性（P<0.05）。结论：髋关节置换术患者手术后股骨假体周围BMD的变化程度越低则术后疗效越佳。     

Hefti中高等级运动项目优秀青少年运动员前交叉韧带初次损伤与膝关节解剖结构的相关性分析

目的：针对Hefti中高等级运动项目优秀青少年运动员,进行前交叉韧带（ACL）初次损伤与膝关节解剖结构的相关性分析研究。方法：回顾性研究。连续选取2016年至2021年收治的ACL首次损伤的Hefti中高等级运动项目青少年运动员21例（研究组）,男8例、女13例,年龄16.47±1.40岁（14～18岁）,按年龄和性别1:1匹配健康青少年运动员21例（对照组）。利用磁共振测量胫骨平台后倾角（PTS）、髁间窝宽度、股骨髁形态、髁间棘高度、半月板-胫骨平台角（MBA）等指标,比较两组人群的膝关节形态差异,并分析前交叉韧带初次损伤的膝关节解剖风险因素。结果：ACL损伤的青少年运动员的外侧软组织PTS显著大于对照组（2.64°±5.59°vs-1.1°±2.64°,P<0.05）,髁间窝宽度（1.61±0.19 cm vs 1.79±0.23 cm）、髁间窝宽度指数（NWI）(0.23±0.02 vs 0.25±0.02)和内侧MBA(24.9°±3.87°vs 28.1°±4.02°)小于对照组（P<0.05）。外侧软组织PTS、髁间窝宽度和内侧MBA为ACL损伤的独立风险因素。...     

Deep lateral femoral sulcus: study of 124 patients with anterior cruciate ligament tear

Abnormal deepening of the lateral femoral sulcus has been proposed as a potential indirect sign allowing the diagnosis of an anterior cruciate ligament (ACL) tear on conventional lateral knee radiographs. We studied a large group of patients with proven ACL tears during the acute injury and at 5-year follow-up to determine (a) the normal range of the depth of this sulcus and (b) the sensitivity, specificity, and positive predictive value of a deepened lateral sulcus. One hundred fifty patients with suspected ACL tears after sustaining unilateral injuries to their knees were referred to a specialty clinic for further evaluation. The injury was based on the presence of hemarthrosis, pathologic joint motion, and/or instability of the tibiofemoral joint. From this group, 124 patients were diagnosed with complete ACL tears (112 cases confirmed by arthroscopy, 12 cases diagnosed by the presence of pathologic motion with a KT-1000 arthrometer). Conventional radiographs of the injured knee were obtained in all 150 patients at the time of the acute injury. Five years later, radiographs of both the injured knee and the uninjured contralateral knee were evaluated. The lateral femoral condylopatellar sulcus, or notch, was measured on the acute injury and 5-year follow-up radiographs, and this measurement was compared to that on radiographs of the uninjured contralateral knee. The depth of the lateral sulcus consistently was noted to be similar in both knees in a given patient. Two groups of patients were identified: one group consisted of 124 patients with torn ACLs with a mean notch depth on the injured side of 0.57 mm [range, 0.0–3.3 mm; standard deviation (SD), 0.57 mm] and on the uninjured contralateral side of 0.43 mm (range, 0.0–2.0 mm; SD, 0.42 mm); and a second group consisted of those 26 injured patients with intact ACLs with a mean notch depth on the injured side of 0.31 mm (range, 0.0–1.0 mm; SD, 0.35 mm) and on the uninjured contralateral side of 0.27 mm (range, 0.0–0.8 mm; SD, 0.26 mm). Four of the 124 patients with a proven ACL tear had lateral notch measurements greater than 2.0 mm in depth. No patient with an intact ACL demonstrated a lateral sulcus that exceeded 2.0 mm in depth. A depth greater than 2.0 mm had a specificity of 100%, sensitivity of 3.2%, accuracy of 60%, and a positive predictive value of 100% for complete ACL tear. This work was supported in part by Veterans Affairs Grant SA 206.     

Bone mineral assessments in the calcaneus after anterior cruciate ligament injury An investigation of 92 male patients before and two years after reconstruction or revision surgery

The aim of this study was to assess the Bone Mineral Areal mass (BMA) in the calcaneus of male patients with unilateral anterior cruciate ligament (ACL) injury before and after reconstruction and to assess whether the BMA ratio or the BMA of the injured and uninjured side correlated with the level of activity, functional performance or the time period between the injury and the reconstruction. Ninety-two male patients with unilateral ACL injury were included in the study. The BMA was analysed immediately prior to surgery: a median of 11 (2–192) months after the injury in 30 patients aged 26 (15–41) years scheduled for primary ACL reconstruction (Group A). Forty-nine patients aged 29 (18–49) years had their BMA analysed a median of 24 (23–29) months after the primary ACL reconstruction (Group B). Thirteen patients aged 27 (21–39) years had their BMA analysed a median of 24 (20–45) months after ACL revision surgery (Group C). The median BMA ratio (injured side/uninjured side) was 96 (88–105)% in Group A, 96 (86–118)% in Group B and 95 (83–111)% in Group C. In all three groups, the median BMA value in the calcaneus was significantly lower on the injured side compared with the uninjured side (p=0.001, p=0.0003, p=0.01 in Groups A, B and C, respectively). The time period between the injury and the reconstruction neither correlated with the BMA ratio nor the BMA of the injured or the uninjured side in Group A. The level of activity as measured by the Tegner activity level and the functional performance as measured by the one-leg-hop quotient did not correlate with the BMA ratio in any of the groups. In the 49 patients with a primary ACL reconstruction (Group B), the post-operative Tegner activity level correlated with the BMA, on both the injured and uninjured side (P=0.0003, P=0.0005, respectively), when the BMA was assessed two years after the index operation. Male patients with unilateral ACL injury had a significantly lower BMA in the calcaneus on the injured side compared with the uninjured side before primary reconstruction, two years after primary reconstruction and two years after revision surgery. The time period between the injury and the index operation did not correlate with the BMA. A high level of activity correlated with the BMA on both the injured and the uninjured side two years after primary reconstruction.     

Intercondylar roof impingement pressure after anterior cruciate ligament reconstruction in a porcine model

Anterior cruciate ligament (ACL) graft impingement against the intercondylar roof has been postulated, but not thoroughly investigated. The roof impingement pressure changes with different tibial and femoral tunnel positions in ACL reconstruction. Anterior tibial translation is also affected by the tunnel positions of ACL reconstruction. The study design included a controlled laboratory study. In 15 pig knees, the impingement pressure between ACL and intercondylar roof was measured using pressure sensitive film before and after ACL single bundle reconstruction. ACL reconstructions were performed in each knee with two different tibial and femoral tunnel position combinations: (1) tibial antero-medial (AM) tunnel to femoral AM tunnel (AM to AM) and (2) tibial postero-lateral (PL) tunnel to femoral High-AM tunnel (PL to High-AM). Anterior tibial translation (ATT) was evaluated after each ACL reconstruction using robotic/universal force-moment sensor testing system. Neither the AM to AM nor the PL to High-AM ACL reconstruction groups showed significant difference when compared with intact ACL in roof impingement pressure. The AM to AM group had a significantly higher failure load than PL to High-AM group. This study showed how different tunnel placements affect the ACL-roof impingement pressure and anterior-posterior laxity in ACL reconstruction. Anatomical ACL reconstruction does not cause roof impingement and it has a biomechanical advantage in ATT when compared with non-anatomical ACL reconstructions in the pig knee. There is no intercondylar roof impingement after anatomical single bundle ACL reconstruction.     

Tunnel widening following anterior cruciate ligament reconstruction using hamstring autograft: a comparison between double cross-pin and suspensory graft fixation

Femoral and tibial tunnel widening following ACL reconstruction using hamstring autograft has been described. Greater tunnel widening has been reported with suspensory fixation systems. We hypothesized that greater tunnel widening will be observed in patients whose hamstring autograft was fixated using a cortical, suspensory system, compared to double cross-pin fixation on the femur. We performed clinical and radiographic evaluation on 46 patients at minimum 2 years after primary ACL reconstruction. We measured subjective and objective outcomes including KT-1000 and AP, lateral radiographs. A musculoskeletal radiologist, independent of the surgical team, measured tunnel width, while correcting for magnification, at the widest point and at 1 cm away from tibial and femoral tunnel apertures. Patients in the suspensory graft fixation group exhibited significantly greater absolute change and greater percent change in femoral tunnel diameter compared to patients with double cross-pin fixation (P ≤ 0.05). This difference was noted on both AP and lateral radiographs and at both measurement sites. There was no significant difference between groups for tibial tunnel widening, IKDC subjective scores or KT-1000 side to side differences. There was significantly more femoral tunnel widening associated with the use of the endobutton suspensory fixation system compared to the use of double cross-pins for fixation within the tunnel.     

Gamma loop dysfunction in the quadriceps femoris of patients who underwent anterior cruciate ligament reconstruction remains bilaterally

Purpose of this study was to investigate the effects of anterior cruciate ligament (ACL) repair on the gamma loop of the bilateral quadriceps femoris (QF). Maximal voluntary contraction (MVC) of knee extension and integrated electromyogram (I-EMG) of vastus medialis (VM), vastus lateralis (VL), and rectus femoris (RF) were examined in uninjured and injured limbs of 18 patients and 10 normal subjects, before and after 20-min vibration applied to the QF. Mean percentage changes were calculated as: (pre-vibration value-post-vibration value)/pre-vibration value x 100. Patients were divided into two groups: short-term-group (tested /=18 months after ACL repair, n=10). Mean percentage changes of the four groups were compared with those of controls. Results indicated that changes of MVC and I-EMG on the uninjured and injured sides in short-term-group in response to vibration were significantly different from those of controls. There were no significant differences between uninjured sides in long-term and control groups. MVC and I-EMG of VM and RF of injured side in patients in the long-term-group in response to vibration were not different from those of controls. From these results, we concluded that this abnormality of the gamma loop in both injured and uninjured sides did not recover despite ACL reconstruction. However, the abnormality in uninjured side might recover >/=18 months after repair.     

Evaluation of the tunnel placement in the anatomical double-bundle ACL reconstruction: a cadaver study

The objective of this study was to investigate the accurate AM and PL tunnel positions in an anatomical double-bundle ACL reconstruction using human cadaver knees with an intact ACL. Fifteen fresh-frozen non-paired adult human knees with a median age of 60 were used. AM and PL bundles were identified by the difference in tension patterns. First, the center of femoral PL and AM bundles were marked with a K-wire and cut from the femoral insertion site. Next, each bundle was divided at the tibial side, and the center of each AM and PL tibial insertion was again marked with a K-wire. Tunnel placement was evaluated using a C-arm radiographic device. For the femoral side assessment, Bernard and Hertel’s technique was used. For the tibial side assessment, Staubli’s technique was used. After radiographic evaluations, all tibias’ soft tissues were removed with a 10% NaOH solution, and tunnel placements were evaluated. In the radiographic evaluation, the center of the femoral AM tunnel was placed at 15% in a shallow–deep direction and at 26% in a high–low direction. The center of the PL bundle was found at 32% in a shallow–deep direction and 52% in a high–low direction. On the tibial side, the center of the AM tunnel was placed at 31% from the anterior edge of the tibia, and the PL tunnel at 50%. The ACL tibial footprint was placed close to the center of the tibia and was oriented sagittally. AM and PL tunnels can be placed in the ACL insertions without any coalition. The native ACL insertion site has morphological variety in both the femoral and tibial sides. This study showed, anatomically and radiologically, the AM and PL tunnel positions in an anatomical ACL reconstruction. We believe that this study will contribute to an accurate tunnel placement during ACL reconstruction surgery and provide reference data for postoperative radiographic evaluation.     

Relationship between quadriceps femoris muscle volume and muscle torque at least 18 months after anterior cruciate ligament reconstruction

The purpose of this study was to evaluate motor unit recruitment in the quadriceps femoris (QF) after anterior cruciate ligament (ACL) rupture and repair. Subjects included 24 patients at ≥18 months after ACL reconstruction and 22 control subjects with no history of knee injury. A series of cross-sectional magnetic resonance images were obtained to compare the QF of patients' injured side with that of their uninjured sides and that of uninjured control subjects. Muscle torque per muscle volume was calculated as isokinetic peak torque divided by QF muscle volume (cm(3) ). The mean muscle torque per unit volume of the injured side of patients was not significantly different from that of the uninjured side or control subjects (one-way ANOVA) Results of the present study were contrary to the results of a previous study that evaluated patients at ≤12 months after ACL reconstruction. The present study found that high-threshold motor unit recruitment was restored at ≥18 months after ACL reconstruction. Thus, clinicians must develop techniques that increase the recruitment of high-threshold motor units in the QF from the period immediately after the injury until approximately 18 months after ACL reconstruction.     

陈旧性膝关节运动损伤者股四头肌随意动员能力下降

目的:观察陈旧性膝关节运动损伤股四头肌随意动员能力的变化。方法:60名天津体育学院学生,自愿参加测试,根据其是否有陈旧性膝关节运动损伤分为2组,损伤组(有训练史)30人,对照组(无训练史)30人。应用股四头肌随意动员能力评定系统测定分析股四头肌最大随意等长肌力(MVC)、随意动员能力(MA)和力量上升速率(RFD)。结果:对照组两侧股四头肌MVC、MA和RFD无显著差异(P>0.05),损伤组两侧股四头肌MVC无显著性差异(P>0.05)。对照组右侧股四头肌MVC、RFD值显著低于损伤组未损伤侧(P<0.05,P<0.01),损伤组膝关节损伤侧MA、RFD值显著低于未损伤侧(P<0.05,P<0.01)。结论:即使陈旧性膝关节运动损伤者股四头肌肌肉力量已恢复到未损伤侧水平,其随意动员能力和力量上升速率依然较低,膝关节神经肌肉控制仍较差,这可能是影响陈旧性膝关节运动损伤功能状态的主要因素之一。股四头肌随意动员能力评价系统可检测这一变化。     

慢性膝关节前交叉韧带损伤患者步态的运动学分析

目的:探讨慢性膝关节前交叉韧带(ACL)损伤患者下肢关节运动学变化特点。方法:30名慢性ACL损伤患者为损伤组,30名健康人为对照组,利用三维运动分析系统对实验对象进行步态分析,比较两组的时间距离指标;比较两组在预承重期髋、膝关节最大屈曲角度和踝关节最大跖屈角度,以及膝关节最大外旋角度。结果:同对照组比较,损伤组步频、步速显著减小,步态周期时间显著增加(P<0.05)。在预承重期,损伤组最大屈髋角度同对照组相比无明显差异,最大屈膝角度显著小于对照组(P<0.05),最大跖屈角度显著小于对照组(P<0.05),最大胫骨外旋角度显著大于对照组(P<0.05)。结论:慢性ACL损伤患者行走时步态出现膝关节屈曲、踝关节跖屈角度的改变,同时,膝关节旋转角度也发生改变。     

Tunnel placement in anterior cruciate ligament (ACL) reconstruction: quality control in a teaching hospital

Correct placement of the femoral and tibial bone tunnels is decisive for a successful anterior cruciate ligament (ACL) reconstruction. Our method of tunnel placement was evaluated as part of quality control at a teaching hospital. The emphasis was placed mainly on investigating the influence of surgical experience on tunnel placement, and the effect of tunnel position on the clinical outcome. Seventeen surgeons with different levels of experience (between 0 and >150 ACL reconstructions) performed endoscopic ACL repair in uniform technique from August 2000 to August 2003 on 50 patients (18 women, 32 men, age range 18–43 years). The patients were available to clinical and radiological follow-up after an average of 19 months. The clinical outcome was classified according to the International Knee Documentation Committee (IKDC) standard evaluation form. The femoral tunnel was evaluated according to the quadrant method of Bernard and Hertel; the position of the tibial bone tunnel was assessed according to the criteria of Stäubli and Rauschnig. The IKDC score revealed 47 (94%) patients with a normal (A) or nearly normal (B) knee joint at follow-up. According to the quadrant method, the femoral canal was situated on average at 29% in the saggital plane. The tibial tunnel was situated on average at 43% of the a.p. diameter of the tibial condyle. Statistical analysis of our data showed no significant correlation between tunnel placement and surgical expertise. However, a highly significant correlation was found (α<0.01) between the femoral position of the tunnel in the sagittal plane and the IKDC score. The more anterior the femoral canal, the poorer the IKDC score. The method of tunnel placement in ACL reconstruction being investigated here only showed slight dependence on surgical experience, whereby good short-term clinical outcomes were achieved. Therefore, the method is suitable for application at a teaching hospital. A far too anterior femoral tunnel placement will probably lead to a decline in the clinical result.