前内侧结构，包括关节囊套和深副韧带，在交叉韧带缺乏的膝关节中起到稳定作用，有助于中屈曲的稳定性：一项尸体研究。

IF 2.7 Q1 ORTHOPEDICS

Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine Pub Date : 2025-06-18 DOI:10.1016/j.jisako.2025.100913

Takashi Tsuda , Kazunori Hino , Tatsuhiko Kutsuna , Kunihiko Watamori , Tomofumi Kinoshita , Yusuke Horita , Masaki Takao

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引用次数: 0

摘要

前言/目的：胫骨缘软组织附着物的具体作用尚不清楚，而膝关节内侧稳定性的重要性已被广泛强调。本研究旨在通过复制全膝关节置换术中典型的软组织释放来评估释放单个前内侧稳定剂的效果。方法：对8例尸体膝关节进行评估。在无图像导航监测下，对膝关节各方向施加6个自由度的被动应力。在软组织结构顺序释放后进行测量：切除正常、前后交叉韧带；解除前内侧半月板韧带1cm，切除内侧半月板；关节前内侧囊释放3cm；胫骨附着物释放深副韧带。整个切片依次在同一尸体膝盖上进行。结果：与前一节相比，在内侧半月板和半月板韧带以中等屈曲角度剥离1厘米后，前平移表现出统计学上显著的增加。内侧半月板剥离及半月板韧带总屈曲角度1 cm后，外部松弛度有统计学意义显著增加。此外，在3厘米的前内侧关节囊释放和随后的深副韧带释放整个大屈曲角度后，观察到进一步的外部旋转松弛。由于各内侧结构的剥离，各切片的外旋松弛度逐渐增加，差异有统计学意义。深副韧带分离后，与前后交叉韧带分离后观察到的值相比，6个自由度中每个自由度的松弛度增加了约20-30%。结论：附着于胫骨前内侧缘的结构在十字交叉缺陷膝关节中屈曲时可作为关键的二级稳定器，尽管存在完整的浅内侧副韧带，但前内侧关节囊套和深内侧副韧带有助于旋转稳定。证据等级:V。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

Anteromedial structures, including the joint capsule sleeve and the deep collateral ligament, serve as a stabilizer and contribute to midflexion stability in cruciate ligament-deficient knees: A cadaveric study

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Introduction/objectives

The specific contributions of the soft tissue attachments along the tibial rim remain poorly understood, while the importance of medial stability in the knee joint has been widely emphasized. This study aimed to evaluate the effect of releasing individual anteromedial stabilizers by replicating the soft tissue release typically performed in total knee arthroplasty.

Methods

Eight cadaveric knees were evaluated. Passive stress in each direction with six degrees of freedom was applied to the knees under image-free navigation monitoring. Measurements were taken following the sequential release of soft tissue structures: normal; anterior and posterior cruciate ligament resection; removal of the medial meniscus with 1 cm of anteromedial meniscotibial ligament release; 3 cm of anteromedial joint capsule release; and tibial attachment release of the deep collateral ligament. The entire section was performed sequentially on the identical cadaver knee.

Results

Anterior translation exhibited a statistically significant increase following dissection of the medial meniscus and 1 cm of the meniscotibial ligament at an intermediate flexion angle compared with the previous section. External laxity statistically significantly increased following dissection of the medial meniscus and 1 cm of the meniscotibial ligament overall flexion angle. Moreover, further external rotational laxity was observed following 3-cm anteromedial joint capsule release and subsequent deep collateral ligament release throughout an extensive flexion angle. Due to the dissection of each medial structure, gradual increases in external rotation laxity were observed in all sections, with statistically significant differences. Following deep collateral ligament dissection, laxity in each of the six degrees of freedom increased by approximately 20-30 % compared with the values observed after anterior and posterior cruciate ligament dissection.

Conclusion

Structures attaching to the anteromedial rim of the tibia serve as critical secondary stabilizers during midflexion in cruciate-deficient knees, with the anteromedial joint capsule sleeve and deep medial collateral ligament contributing to rotational stability despite the presence of an intact superficial medial collateral ligament.