一种定位内侧髌骨胫骨韧带重建胫骨止点的方法：一项尸体解剖与影像学研究
简介
本研究通过解剖与影像学测量，明确了内侧髌股韧带（MPFL）和内侧髌胫韧带（MPTL）的附着点，并提出MPTL重建时胫骨止点的定位方法。对26例成人膝关节标本（16例福尔马林固定，10例新鲜冰冻）进行解剖与X线测量，记录韧带形态及附着点与骨性标志的距离。MPTL胫骨止点定位采用两个参数：（1）与胫骨关节面的垂直距离；（2）正位X线片上a/b比值（a为MPTL胫…
英文摘要
PURPOSE: To determine the attachment sites of the medial patellofemoral ligament (MPFL) and medial patellotibial ligament (MPTL) through anatomical and imaging measurements, and to suggest a possible method for locating the tibial attachment of MPTL for reconstruction purposes. METHODS: Twenty-six adult knee specimens (16 formalin-fixed, 10 fresh-frozen) underwent anatomical and imaging measurements, including the morphology of MPFL and MPTL and distances from their attachment points to bony landmarks. Two parameters were used to determine the MPTL tibial attachment position: (1) Anatomical vertical distance to the tibial joint line; (2) a/b ratio on anteroposterior (AP) X-ray. For the a/b ratio, line 1 was defined as perpendicular to the tibial joint line and passing through the tibial tuberosity centre, and line 2 was drawn parallel to line 1 and passing through the medial edge of the femoral medial epicondyle; the vertical distance from the MPTL tibial attachment to line 1 was termed 'a', and the distance between line 1 and line 2 was termed 'b'. RESULTS: The MPFL and MPTL were consistently identified in second layer of the medial retinaculum. The tibial attachment of MPTL was 14.0 ± 0.7 mm from the tibial joint line, and the a/b ratio on the AP X-ray was 0.51 ± 0.03. Additional anatomical parameters, including ligament dimensions and distances to surrounding bony landmarks, were also documented. There were no significant differences between the results of the imaging and anatomical measurements of the distances from the ligament attachment points to the bony landmarks (p > 0.05). CONCLUSION: For MPTL reconstruction, the tibial attachment can be located 14 mm distal to the joint line and halfway between the tibial tuberosity centre and medial epicondyle (a/b = 0.51). This method serves as a reference and warrants further validation in biomechanical and reproducibility studies. LEVEL OF EVIDENCE: Level V, cadaveric anatomical study.