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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >The Role of the Lateral Soft Tissues in Controlling Anterior Translation And Internal Rotation of the Tibia, And An Investigation of Lateral Reconstructions Accompanying ACL Reconstruction
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The Role of the Lateral Soft Tissues in Controlling Anterior Translation And Internal Rotation of the Tibia, And An Investigation of Lateral Reconstructions Accompanying ACL Reconstruction

机译：外侧软组织在控制胫骨前平移和内旋中的作用以及伴随ACL重建的侧向重建研究

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Introduction: There is considerable current interest in the role of the lateral soft tissue structures in the context of ACL deficiency (ACLD). Of course the topic is not new but a re-visitation, although with improved experimental techniques available. It was clear that there was a rush to create surgical techniques based on the ‘Anterolateral Ligament’ (ALL) but without investigative ‘due-diligence’ and without consideration that other structures may be important, or more important. Objectives: To study the anatomy and biomechanics of the lateral soft tissues relevant to the ACL and ACL reconstruction techniques investigating isometricity, structures’ contributions to resistance of anterior tibial translation (ATT), internal rotation (IR), and pivot shift (PS). Also we studied the impact of various reconstructions on restoration of kinematics and potential over-constraint and effects on articular surface compression load. Methods: Several studies were undertaken. In all healthy fresh-frozen cadaveric specimens were used. Descriptive anatomy was described. Length changes of suture fixed at structure and reconstruction attachment points on the tibia and femur were measured with linear variable displacement transducers (LVDTs). To investigate structures’ contribution to resist translation and torque a 6-degrees of freedom robot with a universal force-moment sensor was used in a classic ‘cutting study’. The robot replayed the same movement with sequential sectioning of structures recording the decrease in force / torque needed to reach the same movement limit. In this way the structure’s resistance to motion as a percentage of the total could be calculated. In other studies knees were mounted in a test rig where knee kinematics were recorded from 0° to 100° of flexion by use of an optical tracking system. Joint surface compression was measured with Tekscan pressure-sensitive film. Results: The Anterolateral Ligament exists attaching to the tibia mid-way between the LCL attachment to the fibula and Gerdy’s tubercle, and the femur proximal and posterior to the femoral LCL attachment~(1). However the most isometric structure is the ITB~(2)from Gerdy’s tubercle to its attachments to the distal lateral femur. The ACL is the primary restraint to resist ATT, but is only the primary restraint to IR / PS close to extension. The ITB, with its attachments to the lateral distal femur, is the most important restraint at all other angles, whilst the ALL / capsule contribute very little restraint to ATT / IR / PS at any angle~(3). ITB-based tenodeses taken deep to the LCL, irrespective of femoral attachment points, are more isometric~(1)and restore kinematics more closely to normal compared to an ALL reconstruction. Fixation of the tenodeses with the knee with 0° tibial rotation, and tension of 20 N resulted in no change in tibio-femoral / patello-femoral contact pressures. Fixation with significant external rotation or excess tension (40 N) did increase contact pressures and lead to over-constraint. Conclusion: Despite recent interest the ALL is not as important to the ITB with its femoral attachments in controlling IR / PS. ITB-based tenodeses taken deep to the LCL perform well unless over-tensioned or fixed with tibial ER in the lab. 1 The Anterolateral Ligament: Anatomy, length changes and association with the Segond fracture A. L. Dodds, C. Halewood, C. M. Gupte, A. Williams, and A. A. Amis. Bone Joint J 2014 96-B: 325-331 2 Length change patterns of the lateral extra-articular structures of the knee and related reconstructions. C.Kittl, C Halewood, J Stephen, Gupte C, A Weiler, A. Williams, A.A. Amis. AJSM 2015; 43(2): 354-62 3 The role of the anterolateral structures and the ACL in controlling laxity of the intact and ACL-deficient knee. C Kittl, H El-Daou, KK Athwal, CM Gupte, A Weiler, A Williams, AA Amis. AJSM 2016; 44: 345-354.
机译：简介：在ACL缺乏症（ACLD）的背景下，外侧软组织结构的作用引起了人们的广泛关注。当然，尽管可以使用改进的实验技术，但这个话题不是新话题而是重新访问。很明显，急于根据“前外侧韧带”（ALL）创建手术技术，却没有进行调查性的“尽职调查”，也没有考虑其他结构可能是重要的或更重要的。目的：研究与ACL和ACL重建技术相关的外侧软组织的解剖学和生物力学，以研究其等距性，结构对胫骨前移（ATT），内旋（IR）和枢转（PS）阻力的贡献。我们还研究了各种重建对运动学恢复和潜在过度约束的影响，以及对关节表面压缩负荷的影响。方法：进行了数项研究。所有健康的新鲜冷冻尸体标本都被使用。描述性解剖。使用线性可变位移传感器（LVDT）测量固定在胫骨和股骨上的结构和重建附着点的缝合线的长度变化。为了研究结构在抵抗平移和扭矩方面的作用，经典的“切割研究”中使用了带有通用力矩传感器的6自由度机器人。机器人重播了相同的运动，并按顺序对结构进行了切片，记录了达到相同运动极限所需的力/扭矩的减小。通过这种方式，可以计算出结构的运动阻力占总运动阻力的百分比。在其他研究中，将膝盖安装在测试设备中，在该设备中，使用光学跟踪系统记录了0°至100°屈曲的膝盖运动学。用Tekscan压敏膜测量关节表面压缩。结果：前外侧韧带附着在胫骨LCL附着处和Gerdy结节之间，以及股骨LCL附着处附近和之后的股骨中段〜（1）。然而，最等距的结构是从Gerdy的结节到其与股骨远端外侧的附件的ITB〜（2）。 ACL是抵制ATT的主要限制，但仅是IR / PS接近扩展的主要限制。 ITB及其连接到股骨远端外侧，在所有其他角度上都是最重要的约束，而ALL /胶囊在任何角度下对ATT / IR / PS的约束都很小（3）。与ALL重建相比，深处到LCL的基于ITB的肌腱等距处（1）更大，等距运动更接近正常。用0°胫骨旋转将腱固定在膝盖上，张力为20 N，导致胫股/ bio骨股接触压力无变化。带有大量外部旋转或过大拉力（40 N）的固定确实会增加接触压力并导致过度约束。结论：尽管最近有兴趣，但是ALL对它的股骨附件在控制IR / PS方面并不重要。深入实验室的基于ITB的肌腱表现良好，除非在实验室中用胫骨ER过度拉伸或固定。 1前外侧韧带：解剖学，长度变化以及与Segond骨折的关系A. L. Dodds，C。Halewood，C。M. Gupte，A。Williams和A. A. Amis。 Bone Joint J 2014 96-B：325-331 2膝关节外侧关节外结构的长度变化模式及相关重建。 C.Kittl，C Halewood，J Stephen，Gupte C，A Weiler，A.Williams，A.A。阿米斯2015年AJSM; 43（2）：354-62 3前外侧结构和ACL在控制完整和ACL缺陷膝关节松弛中的作用。 C Kittl，H El-Daou，KK Athwal，CM Gupte，A Weiler，A Williams，AA Amis。 AJSM 2016; 44：345-354。

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