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首页> 外文期刊>Arthroscopy: the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association >Magnetic resonance imaging evaluation of knee kinematics after anterior cruciate ligament reconstruction with anteromedial and transtibial femoral tunnel drilling techniques
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Magnetic resonance imaging evaluation of knee kinematics after anterior cruciate ligament reconstruction with anteromedial and transtibial femoral tunnel drilling techniques

机译：前交叉韧带股骨隧道钻技术重建前交叉韧带后膝关节运动学的磁共振成像评估

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Purpose: The purpose of this study was to use magnetic resonance (MR) imaging to evaluate the translational and rotational kinematics of anterior cruciate ligament (ACL) reconstructed knees with transtibial (TT) and anteromedial (AM) femoral tunnel drilling. Methods: ACL reconstruction was performed in 21 subjects: 12 with AM drilling (5 men and 7 women; mean age, 33 ± 9 years; imaged 18 ± 5 months after surgery) and 9 with TT drilling (5 men and 4 women; mean age, 32 ± 9 years; imaged 12 ± 8 months after surgery). Three-tesla MR imaging was obtained bilaterally at extension and 30°to 40°of flexion under simulated loading (125 N). MR images were segmented and kinematic calculations done with in-house MATLAB software (The MathWorks, Natick, MA). Translation and rotation of the tibia and the tibiofemoral contact area were measured. Statistical analysis treated reconstructed and contralateral knees as independent groups. Reconstructed groups were compared with analysis of covariance using contralateral knees as baseline. P <.05 indicated significance. Results: All kinematic measures in the AM group were similar to contralateral knees. The TT group showed significantly more total tibial rotation than contralateral knees (TT, 8.4°± 3.9°; contralateral, 2.9°± 6.8°) (P =.03), whereas the AM group did not (AM, 3.1°± 5.6°; contralateral, 2.3°± 5.4°) (P =.36). At knee extension, the tibia was more externally rotated in the TT group than in controls. Medial tibial translation was greater in the TT group than in controls. The AM group showed increased contact area in the lateral compartment compared with controls; no differences were seen in the TT group. Conclusions: Using an MR-based approach, we found that knee kinematics were better restored with the AM femoral tunnel drilling ACL reconstruction than with the TT femoral tunnel drilling approach, which resulted in increased knee laxity. Our in vivo results support previous cadaveric and clinical studies that have found AM ACL reconstruction to restore anatomy and stability better than the TT approach. However, the clinical significance of increased contact area in the AM group remains unclear. Level of Evidence: Level III, retrospective comparative study.
机译：目的：本研究的目的是利用磁共振（MR）成像评估前交叉韧带（ACL）重建的胫骨（TT）和股骨前（AM）股骨隧道的平移和旋转运动学。方法：对21名受试者进行ACL重建：12例行AM钻孔术（5例男性和7名女性;平均年龄33±9岁;成像后18±5个月）; 9例进行TT钻孔术（5例男性和4例女性;平均年龄为32±9岁;在术后12±8个月成像）。在模拟载荷（125 N）下，在伸展和屈曲30°至40°的情况下，双侧获得三特斯拉MR成像。 MR图像被分割，并使用内部MATLAB软件（马萨诸塞州内蒂克市的MathWorks）进行运动学计算。测量胫骨的平移和旋转以及胫股接触面积。统计分析将重建和对侧膝关节作为独立组。以对侧膝盖为基线，将重建组与协方差分析进行比较。 P <.05表示显着性。结果：AM组的所有运动学指标均与对侧膝盖相似。 TT组的胫骨总旋转度明显高于对侧膝关节（TT，8.4°±3.9°;对侧膝关节，2.9°±6.8°）（P = .03），而AM组则没有（对侧膝关节，3.1°±5.6°） ;对侧为2.3°±5.4°）（P = .36）。在膝关节伸展时，与对照组相比，TT组胫骨更向外旋转。 TT组的胫骨内侧翻译比对照组大。与对照组相比，AM组的外侧隔室接触面积增加。 TT组未见差异。结论：使用基于MR的方法，我们发现AM股骨隧道钻孔ACL重建比TT股骨隧道钻孔方法能更好地恢复膝关节运动学，从而导致膝盖松弛。我们的体内结果支持以前的尸体和临床研究，这些研究发现AM ACL重建比TT方法更好地恢复了解剖结构和稳定性。但是，AM组接触面积增加的临床意义尚不清楚。证据级别：III级，回顾性比较研究。

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