Collateral ligament strain is linearly related to coronal lower limb alignment: A biomechanical study

IF 3.3 2区医学 Q1 ORTHOPEDICS

Knee Surgery, Sports Traumatology, Arthroscopy Pub Date : 2024-06-27 DOI:10.1002/ksa.12340

Christian Peez, Luise Maria Hägerich, Felix Ruhl, Matthias Klimek, Thorben Briese, Johannes Glasbrenner, Adrian Deichsel, Michael J. Raschke, Christoph Kittl, Elmar Herbst

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引用次数: 0

Abstract

Purpose

The purpose of this study was to analyse the influence of coronal lower limb alignment on collateral ligament strain.

Methods

Twelve fresh-frozen human cadaveric knees were used. Long-leg standing radiographs were obtained to assess lower limb alignment. Specimens were axially loaded in a custom-made kinematics rig with 200 and 400 N, and dynamic varus/valgus angulation was simulated in 0°, 30°, and 60° of knee flexion. The changes in varus/valgus angulation and strain within different fibre regions of the collateral ligaments were captured using a three-dimensional optical measuring system to examine the axis-dependent strain behaviour of the superficial medial collateral ligament (sMCL) and lateral collateral ligament (LCL) at intervals of 2°.

Results

The LCL and sMCL were exposed to the highest strain values at full extension (p < 0.001). Regardless of flexion angle and extent of axial loading, the ligament strain showed a strong and linear association with varus (all Pearson's r ≥ 0.98; p < 0.001) and valgus angulation (all Pearson's r ≥ −0.97; p < 0.01). At full extension and 400 N of axial loading, the anterior and posterior LCL fibres exceeded 4% ligament strain at 3.9° and 4.0° of varus, while the sMCL showed corresponding strain values of more than 4% at a valgus angle of 6.8°, 5.4° and 4.9° for its anterior, middle and posterior fibres, respectively.

Conclusion

The strain within the native LCL and sMCL was linearly related to coronal lower limb alignment. Strain levels associated with potential ultrastructural damages to the ligaments of more than 4% were observed at 4° of varus and about 5° of valgus malalignment, respectively. When reconstructing the collateral ligaments, an additional realigning osteotomy should be considered in cases of chronic instability with a coronal malalignment exceeding 4°–5° to protect the graft and potentially reduce failures.

Level of Evidence

There is no level of evidence as this study was an experimental laboratory study.

查看原文本刊更多论文

侧韧带应变与下肢冠状排列呈线性关系：一项生物力学研究。

目的：本研究旨在分析下肢冠状排列对副韧带应变的影响：方法：使用 12 个新鲜冷冻的人体尸体膝关节。获取长腿站立X光片以评估下肢对齐情况。在定制的运动学装置中对标本进行 200 和 400 N 的轴向加载，并在膝关节屈曲 0°、30° 和 60°的情况下模拟动态屈曲/外翻角度。使用三维光学测量系统捕捉侧副韧带不同纤维区域内的曲度/外翻角度和应变的变化，以检查浅内侧副韧带（sMCL）和外侧副韧带（LCL）每隔 2°随轴变化的应变行为：结果：LCL 和 sMCL 在完全伸展时的应变值最高（p 结论）：原生 LCL 和 sMCL 的应变与下肢冠状排列呈线性关系。在外翻 4° 和外翻约 5° 时，分别观察到与韧带潜在超微结构损伤超过 4% 相关的应变水平。在重建副韧带时，对于冠状位错位超过4°-5°的慢性不稳定病例，应考虑进行额外的重新排列截骨术，以保护移植物并减少潜在的失败：由于该研究是一项实验室实验研究，因此没有证据等级。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Knee Surgery, Sports Traumatology, Arthroscopy 医学-外科

CiteScore

8.10

自引率

18.40%

发文量

418

审稿时长

2 months

期刊介绍： Few other areas of orthopedic surgery and traumatology have undergone such a dramatic evolution in the last 10 years as knee surgery, arthroscopy and sports traumatology. Ranked among the top 33% of journals in both Orthopedics and Sports Sciences, the goal of this European journal is to publish papers about innovative knee surgery, sports trauma surgery and arthroscopy. Each issue features a series of peer-reviewed articles that deal with diagnosis and management and with basic research. Each issue also contains at least one review article about an important clinical problem. Case presentations or short notes about technical innovations are also accepted for publication. The articles cover all aspects of knee surgery and all types of sports trauma; in addition, epidemiology, diagnosis, treatment and prevention, and all types of arthroscopy (not only the knee but also the shoulder, elbow, wrist, hip, ankle, etc.) are addressed. Articles on new diagnostic techniques such as MRI and ultrasound and high-quality articles about the biomechanics of joints, muscles and tendons are included. Although this is largely a clinical journal, it is also open to basic research with clinical relevance. Because the journal is supported by a distinguished European Editorial Board, assisted by an international Advisory Board, you can be assured that the journal maintains the highest standards. Official Clinical Journal of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA).