人膝关节后交叉韧带的解剖和重建手术的应用研究
|
摘要
1.后交叉韧带股骨止点及胫骨止点的临床解剖研究
目的:研究后交叉韧带股骨止点及胫骨止点的解剖特点及位置,确定可应用于手术中的定位标记,以利于指导临床,有助于达到后交叉解剖重建。
材料与方法:20例膝关节标本,排除膝关节明显退变、损伤。将PCL分为前外束及后内束,观察两束在其股骨止点及胫骨止点的形状、位置并进行测量。确定PCL两束的股骨止点及胫骨止点的位置、面积,并确定其止点中心位置。
结果:在股骨侧:ALB主要附着在股骨髁间窝的顶部,而PMB主要附着在髁间窝的内侧壁。ALB止点位于9:00和12:30之间(左膝)。当与股骨长轴方向平行时,AL束中心位于10:20 ,据前方关节软骨7.8mm处。PMB止点在7:30和10:30间,其中心位于8:30,据前方股骨内髁边缘10.1mm处。而与Blumensaat线平行时,ALB中心位于11:20 ,据前方股骨内髁边缘7.1mm处。PMB止点在7:30和12:30间,其中心位于9:30,据前方关节软骨12.0mm处。ALB、PMB的中心之间距离为11.1mm。AL、PM的中心点至髁间窝顶的距离(与Blumensaat线垂直)分别为4.7mm和11.3mm。AL及PM股骨止点面积87.3±18.9mm2和80.2±17.8 mm2(P<0.05),两者之间有显著性差异。
在胫骨侧:PCL胫骨止点位于后髁间窝,并向关节面远侧延伸。ALB及PMB基本为前后排列。ALB胫骨止点占据前部分大部,其形状为向后的梯形。PMB占据水平部分后侧的一小部分及冠状位部分,后内束的最后及最远附着点位于胫骨平台远端。其纤维与胫骨骨膜和附着在胫骨的关节囊交叉编织融合在一起。其上方附着点与前外束相邻。ALB胫骨止点近远径及分别为:8.3mm和9.1mm。PMB胫骨止点近远径及分别为:7.4mm和10.2mm。AL、PM中心与内侧胫骨平台距离为5.9mm和10.8 mm,与内侧半月板上缘距离为8.9mm和12.3 mm。AL、PM胫骨止点面积分别为70.6 mm2和75.3 mm2。
结论:本文对PCL的前外束及后内束进行了精确的数学解剖研究,确定了PCL前外束及后内束股骨止点和胫骨止点确切位置及特点。有助于PCL重建时隧道的准确定位,达到PCL解剖重建,提高术后疗效。而且本文中的解剖资料有助于术后应用X片、CT或MRI对隧道位置进行评估。
2.股骨足印迹胫骨双隧道重建后交叉韧带的实验研究
目的:本文的研究目的是对胫骨单隧道股骨单隧道、胫骨单隧道股骨双隧道重建、股骨足印迹胫骨双隧道重建PCL进行比较,以确定股骨足印迹胫骨双隧道重建PCL成为PCL重建更好的方法,能达到解剖重建。
材料与方法:选择15例新鲜冷冻膝关节标本,分为3组进行研究。每组5例,在PCL完整、PCL切断后及应用不同方法进行PCL重建后分别应用CSS-44020力学试验仪进行测量,并进行比较。第一组:胫骨单隧道股骨单隧道重建。第二组:胫骨单隧道股骨双隧道重建。第三组:股骨足印迹胫骨双隧道重建。胫骨近端施予100N后向力量时,测试膝关节位于0°、30°、60°、90°、120°时胫骨相对股骨后移的距离。对结果进行比较。
结果:应用股骨足印迹胫骨双隧道重建PCL后,股骨及胫骨侧止点与正常PCL相似。
当PCL完整时,膝关节位于0°、30°、60°、90°、120°时,于胫骨上端向后施加负荷,力量为100N时胫骨后移距离分别为5.5、6.3、4.3、3.2、3.3mm。切断PCL后,关节松驰度发生显著性变化,胫骨后移明显增加。膝关节位于0°、30°、60°、90°、120°力量为100N时胫骨后方移位为9.0、13.3、15.4、16.6、16.0mm;行胫骨单隧道股骨单隧道重建PCL后,后移距离分别为7.0、9.6、6.9、7.0、7.5mm;行胫骨单隧道股骨双隧道重建PCL后,胫骨后移距离分别为6.5、6.2、3.8、4.6、4.1mm。股骨足印迹胫骨双隧道重建PCL后,后移距离分别为5.7、6.2、3.6、3.4、3.3mm。
结论:1胫骨单隧道股骨单隧道、胫骨单隧道股骨双隧道重建、股骨足印迹胫骨双隧道重建PCL均能很好地防止胫骨后移。
2胫骨单隧道股骨双隧道重建、股骨足印迹胫骨双隧道重建PCL较单束重建能更好的恢复PCL的稳定性。
3股骨足印迹胫骨双隧道重建PCL在形态更接近解剖重建,但尚需进一步研究。
3.自体腘绳肌腱及同种异体跟腱经股骨双束双隧道重建后交叉韧带的临床前瞻性研究
目的:观察自体腘绳肌腱及同种异体跟腱经股骨双束双隧道重建后交叉韧带的疗效与差异。
材料与方法:自2005年9月~2006年9月,35例III度PCL损伤患者随机分为2组:A组:自体腘绳肌腱组18例,平均32.6岁,合并II度以下的后外侧结构(PLS)损伤4例。B组:同种异体跟腱组17例,平均31.7岁,合并II度以下的后外侧结构(PLS)损伤3例。两组均采用股骨双束双隧道胫骨单隧道技术进行PCL重建,前外束于屈曲70°时固定,后内束在近伸直位时固定。随访18~30个月,平均25个月,对患者情况,关节功能、韧带稳定性等进行评估。
结果:两组患者术前各项指标(包括年龄、活动范围、随访时间、术前时间等)进行比较无显著性差异(P>0.05)。理学检查、Lysholm及Tenger评分,KT-1000检测,手术前后两组各项指标有显著差异(P<0.05);但两组间比较,B组手术耗时(67.8±9.4分钟)短于A组(84.5±9.8分钟),术后发热时间B组(5.4±1.2天)稍长于A组(3.5±1.3天)(P<0.05),其它各项指标均无明显统计学差异(P>0.05)。后抽屉试验术前两组均为III度,术后则分别为A组1.2士0.4度;B组1.3士0.3度。术前Lysholm评分评分A组50.7士7.1,B组50.8士6.1,术后分别为93.1士2.9和91.6士3.2。术前及术后Tegner评分A组分别为1.2士0.7和6.1士0.7;B组分别为1.3士0.7和6.0士0.7。术前A、B两组胫骨后移分别为11.8士1.6mm和11.9士1.8mm,术后则分别为2.6士1.2mm和2.8士1.5mm。术后健患侧对比,A组平均2.3士1.3mm,其中<3mm者14/18例(77.8%),>5mm2例(11.1%) , B组平均2.7士1.7mm , <3mm者12/17例(70.6%);>5mm2例(11.8%)。
结论:同种异体跟腱与自体腘绳肌腱经股骨双束双隧道重建后交叉韧带的近期疗效相同,可较好的恢复关节功能,同种异体跟腱是重建PCL良好的替代物。同种异体跟腱经股骨双束双隧道移植重建膝关节后交叉韧带是一种既避免移植物供区损伤又符合后交叉韧带生物力学解剖重建的临床治疗方法,近期效果好,远期效果还需进一步观察研究。
4.关节镜下应用异体跟腱股骨双束双隧道同时重建后交叉与前交叉韧带
目的:评价关节镜下应用异体跟腱股骨双束双隧道同时重建后交叉韧带与前交叉韧带的治疗效果。
材料与方法:14例前、后交叉韧带损伤患者,在关节镜下应用异体跟腱同时重建前、后交叉韧带,且后交叉韧带股骨侧应用双束双隧道重建。受伤至手术时间平均19.5 d。术后平均随访34.5个月。采用Lysholm评分和Tegner评分对患膝功能进行评估,通过KT-1000检查了解膝关节的前后松弛度。
结果:术前屈膝活动度(123.6±2.5)°与术后(117.9±2.8)°无显著性差异(t=1.54, P=0.14)。术后Lachman试验阴性者13例(92.9%),后抽屉试验阴性者12例(85.7%)。KT-1000屈膝25°双侧胫骨前后松弛度差值在2mm以内9例, 3~5mm 4例, 6mm 1例。屈膝70°差值2 mm以内10例,3～5 mm 3例,6 mm 1例。Lysholm评分从(52.8±2.2)分提高至(92.9±3.3)分,差异具有统计学意义(t=17.009,P<0.001)。伤前Tegnar评分平均为(5.9±0. 5)分,术前为(1.2±0.9)分,术后终末随访时为(5.4±0. 8)分。手术前后的差异有统计学意义(F=4.2,P<0.01)。11例恢复到受伤前运动水平(78.6%),另外3例运动水平较受伤前有所降低
结论:关节镜下应用异体跟腱股骨双束双隧道同时重建后交叉韧带与前交叉韧带,后交叉韧带股骨侧应用双束双隧道重建,更接近后交叉韧带解剖重建,能够恢复膝关节的稳定性,较满意地恢复膝关节功能。
1、Anatomical study of the femoral and tibial insertions of the human posterior cruciate ligament
Objective:The aim of this study was to determine the precise anatomical measurements of the femoral and tibial insertions for anterolateral (ALB) and posteromedial bundles (PMB) of posterior cruciate ligament (PCL). The results of this study may be applied to the design of guidance system for anatomic PCL reconstruction.
Methods:A total of 20 knees were selected after exclusion of knees that displayed macroscopically degenerative changes or evidence of trauma. PCL were divided into anterolateral bundles and posteromedial bundles to the insertion footprint, and those locations were measured and described. Data were obtained to describe the size, position and center of the PCL related to clock positions and referenced to anterior margin of the medial femoral condyle on the femur, as well as to the mediaolateral and anterioposterior dimensions of the tibia.
Result:On the femur: It can be seen that the ALB attaches mostly to the roof of the intercondylar notch, while the PMB attaches mostly to the medial side wall of the notch on to the medial femoral condyle. The AL bundle was found to lie between the 9:00 and 12:30 o’clock(for a left knee). When viewed from parallel to the femoral long axis ,the AL bundle was centered at 7.8mm from the anterior margin of the medial femoral condyle at 10:20 o’clock. The PM bundle was between 7:30 and 10:30 o’clock, and was centered at 10.1mm from anterior margin of the medial femoral condyle at 8:30 o’clock. But When viewed from parallel to the Blumensaat’s line, the AL bundle was centered at 7.1mm from the anterior magin of the medial femoral condyle at 11:20 o’clock. The PM bundle was between 7:30 and 12:30 o’clock, and was centered at 12.0mm from the anterior margin of the medial femoral condyle at 9:30 o’clock. The distance between the center of ALB and PMB was 11.1mm. The distance from the center of the femoral insertions of the anterolateral, posteromedial bundles to the intercondylar roof averaged 4.8mm and 11.4 mm. The mean areas of the insertions of AL and PM on the femur were 87.3±18.9mm2 and 80.2±17.8 mm2(P<0.05)respectively. On the tibia: The tibial attachment site of PCL was situated in the intercondylar fossa, and extended over the posterior rim of the shelf. The tibial attachment site of ALB and PMB were arranged in the anterior and posterior on the whole. The ALB occupies a central area covering almost the PCL entire flat intercondylar surface of the posterior tibial plateau. Its shape is trapezoidal, wider posteriorly. The attachment of the PM fibre bundle includes the most posterior area above the shelf, and also the area immediately below the shelf. The bundle’s most posterior and distal attachment occurs distal to the tibial plateau. Its fibres blend with those of the tibial periosteum and the attachment of the knee joint capsule to the tibia. Superiorly, its attachment meets that of the AL bundle. The anteroposterior length and width of the ALB was 8.3mm and 9.1mm respectively. The anteroposterior length and width of the PMB was 7.4mm and 10.2mm respectively. The vertical distance from the center of the tibial insertions of the anterolateral, posteromedial bundles to the medial tibial plateau averaged 5.9mm and 10.8 mm, as to the medial meniscus averaged 8.9mm and 12.3 mm. The mean areas of the insertions of AL, PM on the tibia was 70.6 mm2 and 75.3 mm2 respectively.
Conclusion: The present study described the numerical anatomical measurements of the insertions to the femur and tibia of the anterolateral and posteromedial bundles of PCL. The contribution of this study to a better understanding and definition of the anatomy of the anterolateral and posteromedial bundles of PCL will lead to more accurate tunnel placement, anatomic PCL reconstruction, better outcomes in PCL reconstructions. Furthermore, the anatomical information given here may be useful when evaluating tunnel placement using radiographs, CT, or MRI after reconstructive surgery in order to optimize reconstruction for more positive outcomes.
2.Femoral footprint double-bundle transtibial tunnel posterior cruciate ligament reconstruction : an experimental study.
Objective: The purpose of this study was to compare the femoral footprint double-bundle transtibial tunnel PCL reconstruction with the single-bundle PCL reconstruction and double-bundle PCL reconstruction,and make sure that femoral footprint double-bundle transtibial tunnel PCL reconstruction be a new method for anatomic PCL reconstruction.
Methods: 15 fresh-frozen human knee speciments were divided into three groups. For each group, 5 specimens were tested with CSS-44020 load cell in the PCL intact, the PCL dissected, and the PCL reconstructed knee. In the first group, the single bundle PCL reconstruction was performed. In the second group, the single tibial tunnel double-bundle femoral tunnel PCL reconstruction was performed. In the third group , femoral footprint double-bundle transtibial tunnel PCL reconstruction was performed. While 100N posterior load was applied to the proximal part of the tibia, tibial posteror translation were measured as the knee was flexed at 0°、30°、60°、90°、120°. Analysis and comparation were done to the three reconstruction methods.
Results:After femoral footprint double-bundle transtibial tunnel PCL reconstruction, the femoral and tibial attachment was similar to the PCL intact knee. While a 100N posterior force was applied to the proximal part of the tibia, posterior tibial translation of the intact PCL knee was 5.5, 6.3,4.3,3.2,3.3mm at 0°、30°、60°、90°、120°knee flextion respectively. In the PCL dissected knee, the tibial translation increased significantly, was 9.0 ,13.3,15.4,16.6,16.0mm respectively. After the single bundle PCL reconstruction, posterior tibial translation was 7.0,9.6,6.9,7.0,7.5mm respectively. After the single tibial tunnel double-bundle femoral tunnel PCL reconstruction, the posterior tibial translation was 6.5,6.2,3.8,4.6,4.1mm respectively. After femoral footprint double-bundle transtibial tunnel PCL reconstruction, the posterior tibial translation was 5.7,6.2,3.6,3.4,3.3mm respectively. The difference between single tibial tunnel double-bundle femoral tunnel PCL reconstruction,double-bundle transtibial tunnel femoral footprint PCL reconstruction and the intact PCL knee was not significant. The biomechanical properities of single tibial tunnel double-bundle femoral tunnel PCL reconstruction and double-bundle transtibial tunnel femoral footprint PCL reconstruction were more similar to that of the intact PCL knee, than the single bundle PCL reconstruction. The anatomic properities of femoral footprint double-bundle transtibial tunnel PCL reconstruction were similar to that of the intact PCL knee.
Conclusion:1 Single bundle PCL reconstruction, single tibial tunnel double-bundle femoral tunnel PCL reconstruction and femoral footprint double-bundle transtibial tunnel PCL reconstruction can restore the posterior tibial translation
2 Single tibial tunnel double-bundle femoral tunnel PCL reconstruction and femoral footprint double-bundle transtibial tunnel PCL reconstruction could restore normal knee laxity effectively across the full range of flexion.
3 Femoral footprint double-bundle transtibial tunnel PCL reconstruction was anatomically similar to intact PCL, but further studies should be continued.
3. Comparison of clinical results of arthroscopic transtibial double-bundle posterior cruciate ligament reconstruction using hamstring tendon autograft and Achillis tendon allograft
Objective:This prospective clinical study was performed to compare clinical results of arthroscopic transtibial double-bundle posterior cruciate ligament reconstruction using hamstring tendon autograft and Achillis tendon allograft.
Methods: From September 2005 to September 2006, 35 patients with PCL injuries of grade III were divided into 2 groups. Group A: 18 patients, averaged age 32.6 years old, recevied autogeneous hamstring tendon PCL reconstruction. Among the 18 patients, 4 patients accompanied with PLC injury less than grade II. Group B:17 patients, averaged age 31.7 years old, recevied Achillis tendon allograft PCL reconstruction. 3 patients in group B accompanied with PLS injury less than grade II. Arthroscopic transtibial double-bundle posterior cruciate ligament reconstruction was performed with a similar technique in both groups with the exception of graft selection. The anterolateral bundle was tightend and fixed at knee flexion 70°. The posteromedial bundle was tightened and fixed at knee flextion 0°. With an average follow-up of 25 months, the evaluation parameters included functional assessment, ligament laxity, functional score, kinematics evaluation.
Result:Between the 2 groups, preoperative demographic factors( age, gender, activity level and mean duration to surgery) showed no statistically significant difference (P>0.05). The difference between preoperative and postoperative measures in physical examination, Lysholm and Tenger score,KT-1000 examination for both groups was statistically significant (P<0.05). The operative duration in Group B was 67.8±9.4 minutes, shorter than that in Group A ,84.5±9.8 minutes (P<0.05). The fever duration after operation in Group B was 5.4±1.2 days, longer than that in Group A, 3.5±1.3 days (P<0.05). As to other aspects, there were no statistically significant difference between group A and group B (P>0.05). The posterior drawer test showed grade III translation for all the preoperative patients. At final follow-up, it showed grade 1.2士0.4 for group A, and 1.3士0.3 for group B. The Lymsholm knee scores were 50.7士7.1 preoperative and 93.1士2.9 postoperative for Group A, and as to Group B , it was 50.8士6.1 preoperative and 91.6士3.2 postoperative. Tegner scores were 1.2士0.7 preoperative and 6.1士0.7 postoperative for Group A, and as to Group B, it was 1.3士0.7 preoperative and 6.0士0.7 postoperative. KT-1000 arthrometer testing showed that the tibia posterior translation was 11.8士1.6 mm and 11.9士1.8mm preoperative for group A and group B respectively. The tibia posterior translation was 2.6士1.2mm and 2.8士1.5mm postoperative for group A and group B respectively. In Group A, the side-to-side difference was 2.3士1.3mm,less than 3mm in 14/18(77.8%),>5mm in 2/18 (11.1%). In Group B, the side-to-side difference was 2.7士1.7mm, less than 3mm in 12/17(70.6%),>5mm in 2 /17(11.1%)。Conclusion:The clinical results of arthroscopic transtibial double-bundle posterior cruciate ligament reconstruction using hamstring tendon autograft and Achillis tendon allograft are equally effective in PCL reconstruction. Achillis tendon allograft was fit for PCL reconstruction. Double-bundle PCL recostruction using Achillis tendon allograft is a good surgical approach, which not only avoids injuring the donor area, but also accords with the anatomical structure of PCL. The shorter term outcome has been proved, but long-term outcome needs more observations。
4. Arthroscopic simultaneous reconstruction of posterior cruciate ligament using double femoral tunnel technique and anterior cruciate ligament with Achilles allograft
Objective:To introduce the technique of arthroscopic simultaneous reconstruction of posterior cruciate ligament (PCL) using double femoral tunnel, single-bundle transtibial tunnel PCL technique and anterior cruciate ligament (ACL) with Achilles allograft, and to evaluate the clinical outcome.
Methods:We reviewed 14 patients with PCL and ACL injuries after a minimum follow-up 18 months. Arthroscopically assisted simultaneous ACL/PCL reconstruction with Achilles allograft were performed using the single-incision endoscopic ACL technique and the double femoral tunnel, single-bundle transtibial tunnel PCL technique. The Lysholm and Tegner knee score scale were used for functional evaluation . All patients were evaluated with physical examination and KT-1000 arthrometer testing.
Result:The mean time from injury to the reconstructive procedure was 19.5 days. The mean knee flextion was (123.6±2.5)°preoperatively, (117.9±2.8)°postoperatively. There was no signifant difference(t=1.54, P=0.14). As to the Lachmen test for 14 patients , the results of 13 patients (92.9%) was negative. As to posterior drawer test, the results of 12 patients (85.7%) was negative. The Lysholm score was(52.8±2.2)preoperatively compared with (92.9±3.3) postoperatively at finial evaluation (t=17.009,P<0.001)。KT-1000 arthrometer testing at 25°knee flexion showed that the side-to-side difference was below 2mm in 9 cases,3~5mm in 4 cases, 6mm in 1 case。At 75°knee flexion the difference was below 2mm in 10 cases,3~5mm in 3 cases, 6mm in 1 case. The Tegner score was(5.9±0. 5) before injury,(1.2±0. 9)preoperatively, and(5.4±0. 8)postoperatively at finial evaluation. The difference between the preoperative score and the postoperative was statistically significant (F=4.2,P<0.01).
Conclusion:Combined ACL and PCL injuries can be successfully treated with arthroscopic simultaneous reconstruction of PCL using double femoral tunnel technique and ACL with Achilles allograft. The double femoral tunnel technique more closely approximates the anatomic insertion the native PCL. Most patients recover a functionally stable knee.
目的:研究后交叉韧带股骨止点及胫骨止点的解剖特点及位置,确定可应用于手术中的定位标记,以利于指导临床,有助于达到后交叉解剖重建。
材料与方法:20例膝关节标本,排除膝关节明显退变、损伤。将PCL分为前外束及后内束,观察两束在其股骨止点及胫骨止点的形状、位置并进行测量。确定PCL两束的股骨止点及胫骨止点的位置、面积,并确定其止点中心位置。
结果:在股骨侧:ALB主要附着在股骨髁间窝的顶部,而PMB主要附着在髁间窝的内侧壁。ALB止点位于9:00和12:30之间(左膝)。当与股骨长轴方向平行时,AL束中心位于10:20 ,据前方关节软骨7.8mm处。PMB止点在7:30和10:30间,其中心位于8:30,据前方股骨内髁边缘10.1mm处。而与Blumensaat线平行时,ALB中心位于11:20 ,据前方股骨内髁边缘7.1mm处。PMB止点在7:30和12:30间,其中心位于9:30,据前方关节软骨12.0mm处。ALB、PMB的中心之间距离为11.1mm。AL、PM的中心点至髁间窝顶的距离(与Blumensaat线垂直)分别为4.7mm和11.3mm。AL及PM股骨止点面积87.3±18.9mm2和80.2±17.8 mm2(P<0.05),两者之间有显著性差异。
在胫骨侧:PCL胫骨止点位于后髁间窝,并向关节面远侧延伸。ALB及PMB基本为前后排列。ALB胫骨止点占据前部分大部,其形状为向后的梯形。PMB占据水平部分后侧的一小部分及冠状位部分,后内束的最后及最远附着点位于胫骨平台远端。其纤维与胫骨骨膜和附着在胫骨的关节囊交叉编织融合在一起。其上方附着点与前外束相邻。ALB胫骨止点近远径及分别为:8.3mm和9.1mm。PMB胫骨止点近远径及分别为:7.4mm和10.2mm。AL、PM中心与内侧胫骨平台距离为5.9mm和10.8 mm,与内侧半月板上缘距离为8.9mm和12.3 mm。AL、PM胫骨止点面积分别为70.6 mm2和75.3 mm2。
结论:本文对PCL的前外束及后内束进行了精确的数学解剖研究,确定了PCL前外束及后内束股骨止点和胫骨止点确切位置及特点。有助于PCL重建时隧道的准确定位,达到PCL解剖重建,提高术后疗效。而且本文中的解剖资料有助于术后应用X片、CT或MRI对隧道位置进行评估。
2.股骨足印迹胫骨双隧道重建后交叉韧带的实验研究
目的:本文的研究目的是对胫骨单隧道股骨单隧道、胫骨单隧道股骨双隧道重建、股骨足印迹胫骨双隧道重建PCL进行比较,以确定股骨足印迹胫骨双隧道重建PCL成为PCL重建更好的方法,能达到解剖重建。
材料与方法:选择15例新鲜冷冻膝关节标本,分为3组进行研究。每组5例,在PCL完整、PCL切断后及应用不同方法进行PCL重建后分别应用CSS-44020力学试验仪进行测量,并进行比较。第一组:胫骨单隧道股骨单隧道重建。第二组:胫骨单隧道股骨双隧道重建。第三组:股骨足印迹胫骨双隧道重建。胫骨近端施予100N后向力量时,测试膝关节位于0°、30°、60°、90°、120°时胫骨相对股骨后移的距离。对结果进行比较。
结果:应用股骨足印迹胫骨双隧道重建PCL后,股骨及胫骨侧止点与正常PCL相似。
当PCL完整时,膝关节位于0°、30°、60°、90°、120°时,于胫骨上端向后施加负荷,力量为100N时胫骨后移距离分别为5.5、6.3、4.3、3.2、3.3mm。切断PCL后,关节松驰度发生显著性变化,胫骨后移明显增加。膝关节位于0°、30°、60°、90°、120°力量为100N时胫骨后方移位为9.0、13.3、15.4、16.6、16.0mm;行胫骨单隧道股骨单隧道重建PCL后,后移距离分别为7.0、9.6、6.9、7.0、7.5mm;行胫骨单隧道股骨双隧道重建PCL后,胫骨后移距离分别为6.5、6.2、3.8、4.6、4.1mm。股骨足印迹胫骨双隧道重建PCL后,后移距离分别为5.7、6.2、3.6、3.4、3.3mm。
结论:1胫骨单隧道股骨单隧道、胫骨单隧道股骨双隧道重建、股骨足印迹胫骨双隧道重建PCL均能很好地防止胫骨后移。
2胫骨单隧道股骨双隧道重建、股骨足印迹胫骨双隧道重建PCL较单束重建能更好的恢复PCL的稳定性。
3股骨足印迹胫骨双隧道重建PCL在形态更接近解剖重建,但尚需进一步研究。
3.自体腘绳肌腱及同种异体跟腱经股骨双束双隧道重建后交叉韧带的临床前瞻性研究
目的:观察自体腘绳肌腱及同种异体跟腱经股骨双束双隧道重建后交叉韧带的疗效与差异。
材料与方法:自2005年9月~2006年9月,35例III度PCL损伤患者随机分为2组:A组:自体腘绳肌腱组18例,平均32.6岁,合并II度以下的后外侧结构(PLS)损伤4例。B组:同种异体跟腱组17例,平均31.7岁,合并II度以下的后外侧结构(PLS)损伤3例。两组均采用股骨双束双隧道胫骨单隧道技术进行PCL重建,前外束于屈曲70°时固定,后内束在近伸直位时固定。随访18~30个月,平均25个月,对患者情况,关节功能、韧带稳定性等进行评估。
结果:两组患者术前各项指标(包括年龄、活动范围、随访时间、术前时间等)进行比较无显著性差异(P>0.05)。理学检查、Lysholm及Tenger评分,KT-1000检测,手术前后两组各项指标有显著差异(P<0.05);但两组间比较,B组手术耗时(67.8±9.4分钟)短于A组(84.5±9.8分钟),术后发热时间B组(5.4±1.2天)稍长于A组(3.5±1.3天)(P<0.05),其它各项指标均无明显统计学差异(P>0.05)。后抽屉试验术前两组均为III度,术后则分别为A组1.2士0.4度;B组1.3士0.3度。术前Lysholm评分评分A组50.7士7.1,B组50.8士6.1,术后分别为93.1士2.9和91.6士3.2。术前及术后Tegner评分A组分别为1.2士0.7和6.1士0.7;B组分别为1.3士0.7和6.0士0.7。术前A、B两组胫骨后移分别为11.8士1.6mm和11.9士1.8mm,术后则分别为2.6士1.2mm和2.8士1.5mm。术后健患侧对比,A组平均2.3士1.3mm,其中<3mm者14/18例(77.8%),>5mm2例(11.1%) , B组平均2.7士1.7mm , <3mm者12/17例(70.6%);>5mm2例(11.8%)。
结论:同种异体跟腱与自体腘绳肌腱经股骨双束双隧道重建后交叉韧带的近期疗效相同,可较好的恢复关节功能,同种异体跟腱是重建PCL良好的替代物。同种异体跟腱经股骨双束双隧道移植重建膝关节后交叉韧带是一种既避免移植物供区损伤又符合后交叉韧带生物力学解剖重建的临床治疗方法,近期效果好,远期效果还需进一步观察研究。
4.关节镜下应用异体跟腱股骨双束双隧道同时重建后交叉与前交叉韧带
目的:评价关节镜下应用异体跟腱股骨双束双隧道同时重建后交叉韧带与前交叉韧带的治疗效果。
材料与方法:14例前、后交叉韧带损伤患者,在关节镜下应用异体跟腱同时重建前、后交叉韧带,且后交叉韧带股骨侧应用双束双隧道重建。受伤至手术时间平均19.5 d。术后平均随访34.5个月。采用Lysholm评分和Tegner评分对患膝功能进行评估,通过KT-1000检查了解膝关节的前后松弛度。
结果:术前屈膝活动度(123.6±2.5)°与术后(117.9±2.8)°无显著性差异(t=1.54, P=0.14)。术后Lachman试验阴性者13例(92.9%),后抽屉试验阴性者12例(85.7%)。KT-1000屈膝25°双侧胫骨前后松弛度差值在2mm以内9例, 3~5mm 4例, 6mm 1例。屈膝70°差值2 mm以内10例,3～5 mm 3例,6 mm 1例。Lysholm评分从(52.8±2.2)分提高至(92.9±3.3)分,差异具有统计学意义(t=17.009,P<0.001)。伤前Tegnar评分平均为(5.9±0. 5)分,术前为(1.2±0.9)分,术后终末随访时为(5.4±0. 8)分。手术前后的差异有统计学意义(F=4.2,P<0.01)。11例恢复到受伤前运动水平(78.6%),另外3例运动水平较受伤前有所降低
结论:关节镜下应用异体跟腱股骨双束双隧道同时重建后交叉韧带与前交叉韧带,后交叉韧带股骨侧应用双束双隧道重建,更接近后交叉韧带解剖重建,能够恢复膝关节的稳定性,较满意地恢复膝关节功能。
1、Anatomical study of the femoral and tibial insertions of the human posterior cruciate ligament
Objective:The aim of this study was to determine the precise anatomical measurements of the femoral and tibial insertions for anterolateral (ALB) and posteromedial bundles (PMB) of posterior cruciate ligament (PCL). The results of this study may be applied to the design of guidance system for anatomic PCL reconstruction.
Methods:A total of 20 knees were selected after exclusion of knees that displayed macroscopically degenerative changes or evidence of trauma. PCL were divided into anterolateral bundles and posteromedial bundles to the insertion footprint, and those locations were measured and described. Data were obtained to describe the size, position and center of the PCL related to clock positions and referenced to anterior margin of the medial femoral condyle on the femur, as well as to the mediaolateral and anterioposterior dimensions of the tibia.
Result:On the femur: It can be seen that the ALB attaches mostly to the roof of the intercondylar notch, while the PMB attaches mostly to the medial side wall of the notch on to the medial femoral condyle. The AL bundle was found to lie between the 9:00 and 12:30 o’clock(for a left knee). When viewed from parallel to the femoral long axis ,the AL bundle was centered at 7.8mm from the anterior margin of the medial femoral condyle at 10:20 o’clock. The PM bundle was between 7:30 and 10:30 o’clock, and was centered at 10.1mm from anterior margin of the medial femoral condyle at 8:30 o’clock. But When viewed from parallel to the Blumensaat’s line, the AL bundle was centered at 7.1mm from the anterior magin of the medial femoral condyle at 11:20 o’clock. The PM bundle was between 7:30 and 12:30 o’clock, and was centered at 12.0mm from the anterior margin of the medial femoral condyle at 9:30 o’clock. The distance between the center of ALB and PMB was 11.1mm. The distance from the center of the femoral insertions of the anterolateral, posteromedial bundles to the intercondylar roof averaged 4.8mm and 11.4 mm. The mean areas of the insertions of AL and PM on the femur were 87.3±18.9mm2 and 80.2±17.8 mm2(P<0.05)respectively. On the tibia: The tibial attachment site of PCL was situated in the intercondylar fossa, and extended over the posterior rim of the shelf. The tibial attachment site of ALB and PMB were arranged in the anterior and posterior on the whole. The ALB occupies a central area covering almost the PCL entire flat intercondylar surface of the posterior tibial plateau. Its shape is trapezoidal, wider posteriorly. The attachment of the PM fibre bundle includes the most posterior area above the shelf, and also the area immediately below the shelf. The bundle’s most posterior and distal attachment occurs distal to the tibial plateau. Its fibres blend with those of the tibial periosteum and the attachment of the knee joint capsule to the tibia. Superiorly, its attachment meets that of the AL bundle. The anteroposterior length and width of the ALB was 8.3mm and 9.1mm respectively. The anteroposterior length and width of the PMB was 7.4mm and 10.2mm respectively. The vertical distance from the center of the tibial insertions of the anterolateral, posteromedial bundles to the medial tibial plateau averaged 5.9mm and 10.8 mm, as to the medial meniscus averaged 8.9mm and 12.3 mm. The mean areas of the insertions of AL, PM on the tibia was 70.6 mm2 and 75.3 mm2 respectively.
Conclusion: The present study described the numerical anatomical measurements of the insertions to the femur and tibia of the anterolateral and posteromedial bundles of PCL. The contribution of this study to a better understanding and definition of the anatomy of the anterolateral and posteromedial bundles of PCL will lead to more accurate tunnel placement, anatomic PCL reconstruction, better outcomes in PCL reconstructions. Furthermore, the anatomical information given here may be useful when evaluating tunnel placement using radiographs, CT, or MRI after reconstructive surgery in order to optimize reconstruction for more positive outcomes.
2.Femoral footprint double-bundle transtibial tunnel posterior cruciate ligament reconstruction : an experimental study.
Objective: The purpose of this study was to compare the femoral footprint double-bundle transtibial tunnel PCL reconstruction with the single-bundle PCL reconstruction and double-bundle PCL reconstruction,and make sure that femoral footprint double-bundle transtibial tunnel PCL reconstruction be a new method for anatomic PCL reconstruction.
Methods: 15 fresh-frozen human knee speciments were divided into three groups. For each group, 5 specimens were tested with CSS-44020 load cell in the PCL intact, the PCL dissected, and the PCL reconstructed knee. In the first group, the single bundle PCL reconstruction was performed. In the second group, the single tibial tunnel double-bundle femoral tunnel PCL reconstruction was performed. In the third group , femoral footprint double-bundle transtibial tunnel PCL reconstruction was performed. While 100N posterior load was applied to the proximal part of the tibia, tibial posteror translation were measured as the knee was flexed at 0°、30°、60°、90°、120°. Analysis and comparation were done to the three reconstruction methods.
Results:After femoral footprint double-bundle transtibial tunnel PCL reconstruction, the femoral and tibial attachment was similar to the PCL intact knee. While a 100N posterior force was applied to the proximal part of the tibia, posterior tibial translation of the intact PCL knee was 5.5, 6.3,4.3,3.2,3.3mm at 0°、30°、60°、90°、120°knee flextion respectively. In the PCL dissected knee, the tibial translation increased significantly, was 9.0 ,13.3,15.4,16.6,16.0mm respectively. After the single bundle PCL reconstruction, posterior tibial translation was 7.0,9.6,6.9,7.0,7.5mm respectively. After the single tibial tunnel double-bundle femoral tunnel PCL reconstruction, the posterior tibial translation was 6.5,6.2,3.8,4.6,4.1mm respectively. After femoral footprint double-bundle transtibial tunnel PCL reconstruction, the posterior tibial translation was 5.7,6.2,3.6,3.4,3.3mm respectively. The difference between single tibial tunnel double-bundle femoral tunnel PCL reconstruction,double-bundle transtibial tunnel femoral footprint PCL reconstruction and the intact PCL knee was not significant. The biomechanical properities of single tibial tunnel double-bundle femoral tunnel PCL reconstruction and double-bundle transtibial tunnel femoral footprint PCL reconstruction were more similar to that of the intact PCL knee, than the single bundle PCL reconstruction. The anatomic properities of femoral footprint double-bundle transtibial tunnel PCL reconstruction were similar to that of the intact PCL knee.
Conclusion:1 Single bundle PCL reconstruction, single tibial tunnel double-bundle femoral tunnel PCL reconstruction and femoral footprint double-bundle transtibial tunnel PCL reconstruction can restore the posterior tibial translation
2 Single tibial tunnel double-bundle femoral tunnel PCL reconstruction and femoral footprint double-bundle transtibial tunnel PCL reconstruction could restore normal knee laxity effectively across the full range of flexion.
3 Femoral footprint double-bundle transtibial tunnel PCL reconstruction was anatomically similar to intact PCL, but further studies should be continued.
3. Comparison of clinical results of arthroscopic transtibial double-bundle posterior cruciate ligament reconstruction using hamstring tendon autograft and Achillis tendon allograft
Objective:This prospective clinical study was performed to compare clinical results of arthroscopic transtibial double-bundle posterior cruciate ligament reconstruction using hamstring tendon autograft and Achillis tendon allograft.
Methods: From September 2005 to September 2006, 35 patients with PCL injuries of grade III were divided into 2 groups. Group A: 18 patients, averaged age 32.6 years old, recevied autogeneous hamstring tendon PCL reconstruction. Among the 18 patients, 4 patients accompanied with PLC injury less than grade II. Group B:17 patients, averaged age 31.7 years old, recevied Achillis tendon allograft PCL reconstruction. 3 patients in group B accompanied with PLS injury less than grade II. Arthroscopic transtibial double-bundle posterior cruciate ligament reconstruction was performed with a similar technique in both groups with the exception of graft selection. The anterolateral bundle was tightend and fixed at knee flexion 70°. The posteromedial bundle was tightened and fixed at knee flextion 0°. With an average follow-up of 25 months, the evaluation parameters included functional assessment, ligament laxity, functional score, kinematics evaluation.
Result:Between the 2 groups, preoperative demographic factors( age, gender, activity level and mean duration to surgery) showed no statistically significant difference (P>0.05). The difference between preoperative and postoperative measures in physical examination, Lysholm and Tenger score,KT-1000 examination for both groups was statistically significant (P<0.05). The operative duration in Group B was 67.8±9.4 minutes, shorter than that in Group A ,84.5±9.8 minutes (P<0.05). The fever duration after operation in Group B was 5.4±1.2 days, longer than that in Group A, 3.5±1.3 days (P<0.05). As to other aspects, there were no statistically significant difference between group A and group B (P>0.05). The posterior drawer test showed grade III translation for all the preoperative patients. At final follow-up, it showed grade 1.2士0.4 for group A, and 1.3士0.3 for group B. The Lymsholm knee scores were 50.7士7.1 preoperative and 93.1士2.9 postoperative for Group A, and as to Group B , it was 50.8士6.1 preoperative and 91.6士3.2 postoperative. Tegner scores were 1.2士0.7 preoperative and 6.1士0.7 postoperative for Group A, and as to Group B, it was 1.3士0.7 preoperative and 6.0士0.7 postoperative. KT-1000 arthrometer testing showed that the tibia posterior translation was 11.8士1.6 mm and 11.9士1.8mm preoperative for group A and group B respectively. The tibia posterior translation was 2.6士1.2mm and 2.8士1.5mm postoperative for group A and group B respectively. In Group A, the side-to-side difference was 2.3士1.3mm,less than 3mm in 14/18(77.8%),>5mm in 2/18 (11.1%). In Group B, the side-to-side difference was 2.7士1.7mm, less than 3mm in 12/17(70.6%),>5mm in 2 /17(11.1%)。Conclusion:The clinical results of arthroscopic transtibial double-bundle posterior cruciate ligament reconstruction using hamstring tendon autograft and Achillis tendon allograft are equally effective in PCL reconstruction. Achillis tendon allograft was fit for PCL reconstruction. Double-bundle PCL recostruction using Achillis tendon allograft is a good surgical approach, which not only avoids injuring the donor area, but also accords with the anatomical structure of PCL. The shorter term outcome has been proved, but long-term outcome needs more observations。
4. Arthroscopic simultaneous reconstruction of posterior cruciate ligament using double femoral tunnel technique and anterior cruciate ligament with Achilles allograft
Objective:To introduce the technique of arthroscopic simultaneous reconstruction of posterior cruciate ligament (PCL) using double femoral tunnel, single-bundle transtibial tunnel PCL technique and anterior cruciate ligament (ACL) with Achilles allograft, and to evaluate the clinical outcome.
Methods:We reviewed 14 patients with PCL and ACL injuries after a minimum follow-up 18 months. Arthroscopically assisted simultaneous ACL/PCL reconstruction with Achilles allograft were performed using the single-incision endoscopic ACL technique and the double femoral tunnel, single-bundle transtibial tunnel PCL technique. The Lysholm and Tegner knee score scale were used for functional evaluation . All patients were evaluated with physical examination and KT-1000 arthrometer testing.
Result:The mean time from injury to the reconstructive procedure was 19.5 days. The mean knee flextion was (123.6±2.5)°preoperatively, (117.9±2.8)°postoperatively. There was no signifant difference(t=1.54, P=0.14). As to the Lachmen test for 14 patients , the results of 13 patients (92.9%) was negative. As to posterior drawer test, the results of 12 patients (85.7%) was negative. The Lysholm score was(52.8±2.2)preoperatively compared with (92.9±3.3) postoperatively at finial evaluation (t=17.009,P<0.001)。KT-1000 arthrometer testing at 25°knee flexion showed that the side-to-side difference was below 2mm in 9 cases,3~5mm in 4 cases, 6mm in 1 case。At 75°knee flexion the difference was below 2mm in 10 cases,3~5mm in 3 cases, 6mm in 1 case. The Tegner score was(5.9±0. 5) before injury,(1.2±0. 9)preoperatively, and(5.4±0. 8)postoperatively at finial evaluation. The difference between the preoperative score and the postoperative was statistically significant (F=4.2,P<0.01).
Conclusion:Combined ACL and PCL injuries can be successfully treated with arthroscopic simultaneous reconstruction of PCL using double femoral tunnel technique and ACL with Achilles allograft. The double femoral tunnel technique more closely approximates the anatomic insertion the native PCL. Most patients recover a functionally stable knee.
引文
1 Amis AA, Gupte CM, Bull AM,et al. Anatomy of the posterior cruciate ligament and the meniscofemoral ligaments. Knee Surg Sports Traumatol Arthrosc, 2006,14:257–263
2 Cosgarea AJ, Jay PR. Posterior cruciate ligament injuries: evaluation and management. J Am Acad Orthop Surg ,2001, 9:297–307
3 Edwards A, Bull AMJ, Amiss AA. The attachments of the fiber bundles of the posterior cruciate ligament: an anatomy study. Arthroscopy, 2007,23(3):284-290
4 Fox RJ, Harner CD, Sakane M. Determination of the in situ forces in the human posterior cruciate ligament using robotic technology. A cadaver study. Am J Sports Med,1998,26,395-401
5 Garofalo R, Jolles BM, Moretti, et al. Double-bundle transtibial posterior cruciate ligament reconstruction with a tendon-patellar bone-semitendinosus tendon autograft: clinical results with a minimum of
2 years’follow-up. Arthroscopy,2006,22(12): 1331-1338.el.
6 Gill TG, DeFrate LE, Wang C, et al. The biomechanical effect of posterior cruciate ligament reconstruction on knee joint function. Kinematic response to simulated muscle loads. Am J Sports Med,2003,31,530-536
7 Girgis FG, Marshall JL, Monajem A. The cruciate ligaments of the knee joint. Anatomical, functional and experimental analysis. Clin Orthop Relat Res ,1975,106:216–231
8 Gupte CM, Bull AMJ, Thomas RW, et al. The meniscofemoral ligaments: secondary restraints to posterior drawer. Analysis of anteroposterior and rotatory laxity in the intact andposterior-cruciate-deficient knee. J Bone Joint Surg, 2003,85B:765–773
9 Gupte CM, Smith A, McDermott ID, et al. Meniscofemoral ligaments revisited. Anatomical study, age correlation and clinical implications. J Bone Joint Surg, 2002 84B:846–851
10 Harner CD, Baek GH, Vogrin TM, et al. Quantitative analysis of humancruciate ligament insertions. Arthroscopy , 1999,15:741–9
11 Harner CD, Baek GH, Vogrin TM, et al. Quantitative analysis of human cruciate ligament insertions. Arthroscopy,1999,15(7): 741-749
12 Harner CD, Janaushek MA, Yagi M,et al. Biomechanical analysis of a double-bundled posterior cruciate ligament reconstruction. Am J Sports Med,2000,28,144-151
13 Makino A, Aponte Tinao L, Ayerza MA, et al. Anatomic double-bundle posterior cruciate ligament reconstruction using double-bundle tunnel with tibial anterior and posterior fresh-frozen allograft. Arthroscopy, 2006,22(6): 684.el-5
14 Makris CA, Georgoulis AD, Papageorgiou CD, et al. Posterior cruciate ligament architecture: evaluation under microsurgical dissection. Arthroscopy, 2000,16:627–632
15 Mannor DA, Shearn JT, Grood ES, et al. Two-bundle posterior cruciate ligament reconstruction.An in vitro analysis of graft placement and tension. Am J Sports Med,2000,28,833-845
16 Morgan CD, Kalman VR, Grawl DM .The anatomic origin of the posterior cruciate ligament: where is it? Reference landmarks for PCL reconstruction. Arthroscopy, 1997 13:325–331
17 Racanelli JA,Drez D Jr.Posterior cruciate ligament tibial attachment anatomy and radiographic landmarks for tibial tunnel placement in PCL reconstruction. Arthroscopy,1994,10(5): 546-549
18 Race A,Amiss AA. PCL reconstruction.In vitro biomechanical comparistion of ‘isometric’ versus single and double-bundled ‘anatomic’ grafts. J Bone J Surg Br,1998,80:173-179
19 Sekiya JK, Kurtz CA, Carr DR.Transtibial and inlay double-bundle posterior cruciate ligament reconstruction:Surgical technique using a bifid bone-patellar tendon-bone allograft. Arthroscopy,2004,20(10): 1095-1100.
20 Sheps DM,Otto D, Fernhout M. The anatomic characteristics of tibial insertion of the posterior cruciate ligament. Arthroscopy,2005,21(7): 820-825
21 Takahashi M, Matsubara Takamas,Doi M,et al. Anatomical study of the femoral and tibial insertions of the anterolateral and posteromedial bundles of human posterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc, 2006 (14):1055–1059
22 Van Dommelen BA, Fowler PJ. Anatomy of the posterior cruciate ligament. A review. Am J Sports Med, 1989,17:24–29
23 Wind WM Jr, Bergfeld JA, Parker RD . Evaluation and treatment of posterior cruciate ligament injuries: revisited.Am J Sports Med , 2004,32:1765–1775
1 Clancy WG, Shelbourne KD, Zoellner GB. Treament of knee joint instability secondary to rupture of posterior cruciate ligament. J Bone Joint Surg Am,1983,65:310-322
2 Race A, Amis AA. PCL reconstuction: in vitro biomechanical comparison of ‘isometric’ versus single and double-bundled ‘anatomic’ grafts. J Bone Joint Surg Br, 1998;80:173-9
3 Shearn JT. Grood ES, Noyes FR, et al. Two-bundle posterior cruciate ligament reconstruction: how bundle tension depends on femoral placement. J Bone Joint Surg Am.2004 Jun 86-A(6):1267-70
4 Harner CD, Janaushek MA, Kanamori A, et al. Biomechanical analysis of a double-bundle posterior cruciate ligament reconstruction. Am J Sports Med. 2000 Mar-Apr;28(2):144-51
5 Valdevit A, Kambic H , Lilly D,et al. Non-linear fitting of mechanical data for efficacy determination of single versus double bundle Achilles tendon grafts for PCL reconstructions. Biomed Mater Eng.2002;12(3):309-17
6 Janousek AT, Jones DG, Clatworthy M. Posterior cruciate Ligament injuries of the knee joint. Sports Med.1999Dec;28(6):429-41
7 Davis DK,Goltz DH, Fithian DC, et al. Anatomical posterior cruciate ligament transplation. A biomechanical analysis. Am J Sports Med,2006, 34,1126-1133
8 Racanelli JA,Drez D Jr. Posterior cruciate ligament tibial attachment anatomy and radiographic landmarks for tibial tunnel placement in PCL reconstruction. Arthroscopy,1994,10(5): 546-9
9 Garofalo R, Jolles BM, Moretti, et al. Double-bundle transtibial posterior cruciate ligament reconstruction with a tendon-patellar bone-semitendinosus tendon autograft:clinical results with a minimum of 2 years’ follow-up. Arthroscopy,2006,22(12): 1331-1338.el
10 Sekiya JK, Kurtz CA, Carr DR. Transtibial and inlay double-bundleposterior cruciate ligament reconstruction:Surgical technique using a bifid bone-patellar tendon-bone allograft. Arthroscopy,2004,20(10): 1095-1100
11 Sheps DM, Otto D, Fernhout M. The anatomic characteristics of tibial insertion of the posterior cruciate ligament. Arthroscopy,2005,21(7): 820-5
12 Makino A, Aponte Tinao L, Ayerza MA, et al. Anatomic double bundle posterior cruciate ligament reconstruction using double-bundle tunnel with tibial anterior and posterior fresh-frozen allograft. Arthroscopy, 2006,22(6): 684.el-5
1 Galloway M T, Grood ES, Mehalik JN , et al. Posterior cruciate ligament reconstruction: an in vitro study of femoral and tibial graft placement. AM J Sports Med, 1996; 24 (4) 437-445
2 Shino K, Nakagawa S, Nakamura N , et al. Arthroscopic posterior cruciate ligament reconstruction using hamstring tendons: 1 incision technique with Endobutton. Arthroscopy, 1996; 12 (6) : 638
3 Race A , Amis AA. PCL resonstruction: In vitro biomechanical comparison of isometric versus single and double bundled anatomic grafts. J Bone Joint Surg Br, 1998; 80 (2) : 173-9
4 Gregory C, Fanelli K, Danville JD, et al. Current concepts of posterior cruciate ligament and posterolateral complex. In: AAOS Annual Meeting Proceeding. Unpubeished data, Meeting of the American Academy of Orthopaedic Surgeons, Dalas, DX 2002:312
5 Chen CH, ChenWJ , Shih CH. Double-Bundle posterior cruciate ligament reconstruction with quadriceps and semitendinosus tendon grafts. Arthroscopy, 2003; 19 (10) : 1023-6
6 Stahelin AC, Sudkamp NP, Weiler A. Anatomic double bundle posterior cruciate ligament reconstruction using hamstring tendons. Arthroscopy 2001;17(1):88—97
7 Sekiya JK, Kurtz CA , Carr DR. Transtibial and tibial inlay double bundle posterior cruciate ligament reconstruction : surgical technique using a bifid bone patellar tendon bone allograft. Arthroscopy, 2004; 20 (10) : 1101
8 KirkPatriek JS,Seaver AV,Glison RR,et al .Cryopreserved ACL allograft in anaine model. J South Orthop Assoe.1996,5:20一29
9 Aha JH, Yoo JC, Wang JH. Posterior cruciate ligament reconstruction: double-loop hamstring tendon autograft versus Achilles tendon allograft- clinical results of minium 2-year follow-up. Arthroscopy,2005,21:965-969
10 Volpi P, Sch?nhuber H, Denti M. The double femoral tunnel technique for arthroscopic reconstruction of the posterior cruciate ligamnet with thesemitendinosus and gracilis autograft.Techniques in Knee Surgery, 2007, 6(1):37-41
11 Wang CJ , Chan YS, Weng LH, et al. Comparison of autogenous and allogenous posterior cruciate ligament reconstructions of the knee. Injury, 2004 ,35:1279-85
1 陈百成,毛远青,高石军, 等.双束股骨双隧道法重建后十字韧带的实验研究 .中华骨科杂志,2003,23:308-312
2 陈百成, 高石军,王晓峰, 等.关节镜下股骨单隧道与双隧道重建后十字韧带的疗效分析.中华骨科杂志,2004,24:129-132
3 Meyers MH, Moore TM, Harvey JP Jr. Traumatic dislocation of the knee joint. J Bone Joint Surg Am,1975,57:430-433
4 Frassica FJ,Sim FH,Staeheli JW. Pairolero PC. Dislocation of the knee.Clin Orthop Relat Res, 1991(263):200-205
5 Shapiro MS, Freedman EL. Allograft reconstruction of the anterior and posterior cruciate ligaments after traumatic knee dislocation. Am J Sports Med,1995,23:580-587
6 Fanelli GC, Giannotti BF, Edson CJ. Arthroscopically assisted combined anterior and posterior cruciate ligament reconstruction. Arthroscopy, 1996,12:5-14
7 Fanelli GC, Edson CJ. Arthroscopically assisted combined anterior and posterior cruciate ligament reconstruction in the multiple ligament injured knee: 2-to 10-year follow-up. Arthroscopy, 2002,18:703-714
8 Harner CD, Waltrip RL, Bennett CH, et al. Surgical management of knee dislocations. J Bone Joint Surg Am,2004,86:262-273
9 Wascher DC, Becker JR, Dexter JG, et al. Reconstruction of the anterior and posterior cruciate ligaments after knee dislocation: results using fresh-frozen nonirradiated allografts.Am J Sports Med,1999,27:189-196
10 Fanelli GC, Edson CJ, Orcuff DR, et al. Treament of combined anterior cruciate-posterior cruciate ligament-medial-lareral side knee injuries . J Knee Surg, 2005, 18:240-248
11 Mae T, Shino K, Maeda A, et al. Effect of gamma irradiation on remodeling process of tendon allograft. Clin Orthop Relat Res,2003,414:305-314
12 Harner CD, Janaushek MA, Kanamori,A, et al. Biomechanical analysis ofa double-bundle posterior cruciate ligament reconstruction. Am J Sports Med,2000,28:144-151
13 Mannor DA, Shearn JT,Grood ES,et al. Two-bundle posterior cruciate ligament reconstruction.An in vitro analysis of graft placement and tension. Am J Sports Med,2000,28:833-845
14 Race A, Amis AA.PCL reconstruction.Invitro biomechanical comparison of 'isometric' versus single and double 'anatomic' grafts. J Bone Joint Surg Br, 1998, 80:173-179
1 Aha JH, Yoo JC, Wang JH. Posterior cruciate ligament reconstruction: double-loop hamstring tendon autograft versus Achilles tendon allograft- clinical results of minium 2-year follow-up. Arthroscopy, 2005, 21:965 -969
2 Arendt E, Dick R. Knee injury patterns among men and women in collegiate basketball and soccer. NCAA data and review of literature. Am J Sports Med, 1995;23(6):694-701
3 Bendjaballah MZ, Shirazi-Adl A, Zukor DJ. Biomechanical response of the passive human knee joint under anterior-posterior forces. Clin Biomech (Bristol,Avon). 1998 Dec;l3(8):625-633
4 Berg EE. Posterior cruciate ligament tibial inlay reconstruction. Arthroscopy 1995;11:69-76
5 Berg EE.Posterior cruciate ligament recession. Arthroscopy, 1999; 15(6):644-7
6 Bergfeld JA, McAllister DR, Parker RD, et al. The effects of tibial rotation on posterior translation in knees in which the posterior cruciate ligament has been cut. J Bone Joint Surg Am.2001Sep;83-A(9):1339-43
7 Bergfeld JA, McAllister DR, Parkr RD,et al. A biomechanical comparison of posterior cruciate ligament reconstruction techniques. Am J Sports Med,2001;29(2):129-36
8 Boks SS, Vroegindeweij D, Koes BW, et al.: Follow-up of posttraumatic ligamentous and meniscal knee lesions detected at MR imaging: systematic review. Radiology. 2006 Mar;238(3):863-71
9 Brown JP, Trojian TH. Anterior and posterior cruciate ligament injuries. Prim Care, 2004 Dec;31(4):925-56
10 Brunet P,Charrois O,Degeorges R,et al. Reconstruction of acute posterior cruciate ligament tears using a synthetic ligament.Rev Chir Orthop Reparatrice Appar Mot 2005;91(1):34-431
11 Carlin GJ, Livesay GA ,Harner CD, et al. In-situ forces in the humanposterior cruciate ligament in response to posterior tibial loading. Ann Biomed Eng,1996;24(2):193-7
12 Cerullo G, Puddu G, Gianni E,et al. Anterior cruciate ligament patellar tendon reconstruction: it is probably better to leave the tendon defect open! Knee Surg Sports Traumatol Arthrosc. 1995;3(1):14-17
13 Chen CH ; Chen WJ ; Shih CH; Double-bundle posterior cruciate ligamentreconstruction with quadriceps and semitendinosus tendon grafts. Arthroscopy. 2003,19N9:1023-1026
14 Covey DC. Injuries of the posterolateral corner of the knee. J Bone Joint Surg Am.2001 Jan;83-A(1):106-18
15 Covey DC, Sapega AA. Anatomy and function of the Posterior cruciate ligament. Clin Sports Med 1994; 13(3): 509-18
16 Covey DC,Sapega AA,Sherman GM. Testing for isometry during reconstruction of the posterior cruciate ligament. Anatomic and biomechanical considerations.Am J Sports Med,1996,24(6):740-6
17 Cross MJ, Powell JF. Long-term followup of posterior cruciate ligament rupture: a study of 116 cases. Am J Sports Med,1984;12(4):292-7
18 Dandy DJ, Pusey RJ. T The long-term results of unrepaired tears of the posterior cruciate ligament. J Bone Joint Surg.Br,1982;64(1):92-4
19 Dejour H, Walch G, Peyrot J, et al. The natural history of rupture of the posterior cruciate ligament. Rev Chir Orthop Reparatrice Appar Mot. 1988;74(1):35-43
20 Dennis MG, Fox JA, Alford JW, et al. Posterior cruciate ligament reconstruction: current trends. J Knee Surg,2004;17(3):133-9
21 Dunlop DG, Woodnut DJ, Nuton RW. A new method to determine graft angles after knee ligament reconstruction. Knee,2004,11 (1):19-24
22 Dürselen L, Claes L, Kiefer H. The influence of muscle forces and external loads on cruciate ligament strain. Am J Sports Med,1995;23(1):129-36
23 Fanelli GC, Edson CJ. Posterior cruciate ligament injuries in trauma patients: Part II. Arthroscopy 1995,11(5):526-9
24 Fanelli GC, Edson CJ. Arthroscopically assisted combined anterior and posterior cruciate ligament reconstruction in the multiple ligament injured knee: 2- to 10-year follow-up. Arthroscopy, 2002,18(7):703-714
25 Fanelli GC, Giannotti BF, Edson CJ. Arthroscopically assisted combined anterior and posterior cruciate ligament reconstruction. Arthroscopy, 1996,12(1):5-14
26 Fox RJ, Harner CD, Sakane M,et al . Determination of the in situ forces in the human posterior cruciate ligament using robotic technology. A cadaveric study .Am J Sports Med 1998;26(3):395-401
27 Girgis FG, Marshall JL , Monajem A.The cruciate ligaments of the knee joint: anatomical functional and experimental analysis, 1975,106:216-31
28 Grood ES, Hefzy MS, Lindenfield TN. Factors affecting the region of most isometric femoral attachments. Part I: The posterior cruciate ligament.Am J Sports Med. 1989,17(2):197-207
29 Grood ES, Stowers SF, Noyes FR. Limits of movement in the Human knee:effect of sectioning the posterior cruciate ligament and posterolateral structures. J Bone Joint Surg Am 1988; 70(1): 88-97
30 Gupte CM, Bull AM, Thomas RD, et al. A review of the function and biomechanics of the meniscofemoral ligaments. Arthroscopy, 2003,19(2):161-71
31 Gupte CM, Smith A, Jamieson N, et al. Meniscofemoral ligaments –structural and material properites.J Biomech,2002 Dec;35(12):1623-9
32 Gupte CM, Smith A, McDermott ID, et al .Meniscofemoral ligaments revisited. Anatomical study, age correlation and clinical implications. J Bone Joint Surg Br. 2002 84(6):846-51
33 Harner CD, Baek GH, Vogrin TM, et al. Quantitative analysis of Human cruciate ligament insertions.Arthroscopy,1999,15(7) :741-9
34 Harner CD, Janaushek MA, Kanamori A, et al. Biomechanical analysis of a double-bundle posterior cruciate ligament reconstruction. Am J Sports Med. 2000 Mar-Apr;28(2):144-51
35 Harner CD, Janaushek MA, Ma CB,et al. The effect of knee Flexion angle and application of an anterior tibial load at the time of graft fixation on the biomechanics of a posterior curciate ligament-reconstructed knee. Am J Sports Med.2000; 28 (4):460-5
36 Harner CD, Livesay GA, Kashiwaguchi S, et al .Comparative study of the size and shape of human anterior and posterior cruciate ligaments. J Orthop Res, 1995,13(3): 429-34
37 Harner CD, Vogrin TM, H?her J,et al. Biomechanical analysis of a posterior cruciate ligament reconstruction. Deficiency of the posterolateral structures as a cause of graft failure. Am J Sports Med. 2000 Jan-Feb;28(1):32-9
38 Harner CD, Xerogeanes JW,Livesay GA,et al. The human posterior cruciate ligament complex: an interdisciplinary study. Ligament morphology and biomechanical evaluation. Am J Sports Med. 1995 Nov-Dec;23(6):736-45
39 Harner CD, H?her J, Vogrin TM. et al. The effects of a popliteus muscle load on in situ forces in the posterior cruciate ligament and on knee kinematics. A human cadaveric study. Am J Sports Med. 1998,Sep-Oct;26(5):669-73
40 Harner CD, Vogrin TM, H?her J, et al. Biomechanical analysis of a posterior cruciate ligament reconstruction. Deficiency of the posterolateral structures as a cause of graft failure. Am J Sports Med. 2000 Jan-Feb;28(1):32-9
41 H?her J, Harner CD, Vogrin TM, et al. In situ forces in the posterolateral structures of the knee under posterior tibial loading in the intact and posterior cruciate ligament-deficient knee. J Orthop Res. 1998 Nov;16(6):675-81
42 Hoher J, Scheffler S, Weiler A. Graft choice and graft fixation in PCL reconstruction. Knee Surg Sports Traumatol Arthrosc, 2003;11 (5):297 -306
43 Janousek AT, Jones DG, Clatworthy M. Posterior cruciate Ligament injuries of the knee joint. Sports Med.1999Dec;28(6):429-41
44 Kennedy JC, Hawkins RJ, Willis RB, et al. Tension studies of human knee ligaments. Yield point, ultimate failure, and disruption of the cruciate and tibial collateral ligaments.J Bone Joint Surg Am. 1976 Apr;58(3):350-5
45 Kurosawa H, Yamakoshi K, Yasuda K,et al. Simultaneous measurement of changes in length of the cruciate ligaments during knee motion. Clin Orthop Relat Res. 1991 Apr;(265):233-40
46 Levy AS, Wetzler MJ, Lewars M,et al. Knee injuries in women collegiate rugby players. Am J Sports Med. 1997 May-Jun;25(3):360-2
47 Logan M, Williams A, Lavelle J,et al. The effect of posterior cruciate ligament deficiency on knee kinematics. Am J Sports Med. 2004 Dec;32(8):1915-22
48 Mannor DA, Shearn JT,Grood ES,Noyes FR, et al. Two-bundle posterior cruciate ligament reconstruction. An in vitro analysis of graft placement and tension. Am J Sport Med. 2000. Nov-Dec;28(6):833-45
49 Margheritini F, Rihn J, Musahl V,et al. Posterior cruciate Ligament injuries in the athlete:an anatomical, biomechanical and clinical review. Sports Med,2002;32(6):393-408
50 Makino A, Aponte Tinao L, Ayerza MA, et al. Anatomic double -bundle posterior cruciate ligament reconstruction using double -bundle tunnel with tibial anterior and posterior fresh-frozen allograft. Arthroscopy, 2006, 22(6): 684.el-5
51 Markolf KL,Slauterbeck JR,Armstrong KL,et al. A biomechanical study of replacement of the posterior cruciate ligament with a graft. Part 1: Isometry, pre-tension of the graft, and anterior-posterior laxity. J Bone Joint Surg Am. 1997 Mar;79(3):375-80
52 Markolf KL,Wascher DC, Finerman GA. Direct in vitro measurement of forces in the cruciate ligaments. Part II: The effect of section of the posterolateral structures. J Bone Joint Surg Am. 1993 Mar;75(3):387-94
53 Maynard MJ, Deng X, Wickiewicz TL, et al. The popliteofibular ligament. Rediscovery of a key element in posterolateral stability. Am J Sports Med.1996 May-Jun;24(3):311-6
54 McAllister DR , Markolf KL , Oakes DA,et al. A biomechanical comparison of tibial inlay and tibial tunnel posterior cruciate ligament reconstruction techniques: graft pretension and knee laxity. Am J Sports Med,2002 May-Jun;30(3):312-7
55 McGuire DA, Wolchok JC. Posterolateral corner reconstruction. Arthroscopy. 2003 Sep;19(7):790-3
56 Morgan-Jones RL, Cross MJ. The intercruciate band of the human knee: An anatomical and histological study. J Bone Joint Surg Br,1999 Nov;81(6):991-994
57 Neilsen S, Helmig P. Posterior instability of the knee joint.An experimental study. Arch Orthop Trauma Surg,1986;105(2):121-5
58 Neurath MF, Stofft E. Structure and function of matrix components in the cruciate ligaments. An immunohistochemical, electron-microscopic, and immunoelectron-microscopic study. Acta Anat (Basel).1992 145(4): 387-94
59 Oakes DA, Markolf KL, McWilliams J,et al. Biomechanical comparison of tibial inlay and tibial tunnel techniques for reconstruction of the posterior cruciate ligament. Analysis of graft forces. J Bone Joint Surg Am,2002; 84-A(6):938-944
60 Parolie JM, Bergfeld JA: Long-term results of nonoperative treatment of isolated posterior cruciate ligament injuries in the athlete. Am J Sports Med 1986, 14(1):35–38
61 Race A , Amis AA. The mechanical properties of the two bundles of the human posterior cruciate ligament. J Biomech. 1994 Jan;27(1):13-24
62 Race A, Amis AA. PCL reconstruction. In vitro biomechanical comparison of ‘isometric' versus single and double-bundled ‘anatomic’ grafts. J Bone Joint Surg Br. 1998 Jan;80(1):173-9
63 Schulz MS, Russe K, Weiler A, et al. Epidemiology of posterior cruciate ligament injuries. Arch Orthop Trauma Surg. 2003 May;123(4):186-91
64 Schulz MS, Steenlage ES, Russe K, Strobel MJ: Distribution of posteriortibial displacement in knees with posterior cruciate ligament tears. J Bone Joint Surg Am 2007, 89(2):332-8
65 Servant CT, Ramos JP, Thomas NP.The accuracy of magnetic resonance imaging in diagnosing chronic posterior cruciate ligament injury. Knee. 2004 Aug;11(4):265-70
66 Shearn JT. Grood ES, Noyes FR, et al. Two-bundle posterior Cruciate ligament reconstruction: how bundle tension depends on femoral placement. J Bone Joint Surg Am.2004 Jun 86-A(6):1267-70
67 Shelbourne KD, Muthukaruppan Y. Subjective results of nonoperatively treated, acute, isolated posterior cruciate ligament injuries. Arthroscopy. 2005 Apr;21(4):457-61
68 Sheps DM, Otto D, Fernhout M. The anatomic characteristics of tibial insertion of the posterior cruciate ligament. Arthroscopy. 2005 Jul;21(7): 820-5
69 Shino K, Horibe S, Nakata K,et al. Conservative treatment of isolated injuries to the posterior cruciate ligament in athletes.. J Bone Joint Surg Br. 1995 Nov;77(6):895-900
70 Skynar MJ,W arren RF, Oruz GJ,et al.The effects or sectioning of the posterior cruciate ligament and the posterolateral complex on the articular contact pressures within the knee. J Bone Joint Surg Am 1993;75:694-9
71 Strobel MJ, Weiler A, Schulz MS, et al. Arthroscopic evaluation of articular cartilage lesions in posterior cruciate ligament-deficient knees. Arthroscopy,2003Mar;19 (3):262-8
72 Terry GC, LaPrade RF. The posterolateral aspect of the knee. Anatomy and surgical approach. Am J Sports Med. 1996 Nov-Dec; 24(6) :732-9
73 Torg JS, Barton TM, Pavlov H,et al. Natural history of the posterior cruciate ligament-deficient knee.Clin Orthop Relat Res. 1989 Sep; (246) :208-16
74 Toritsuka Y, Horibe S, Hiro-Oka A,et al. Conservative treatment For rugby football players with an acute isolated posterior cruciate Ligament injury. Knee Surg Sports Traumatol Arthrosc.2004Mar;12 (2):110-4
75 Trieb K, Blahovec H, Brand G,et al. In vivo and in vitro cellular ingrowth into a new generation of artificial ligaments. Eur Surg Res. 2004 May-Jun;36(3):148-51
76 Vahey JW, Draganich LF. Tensions in the anterior and posterior cruciate ligaments of the knee during passive loading: predicting ligament loads from in situ measurements. J Orthop Res. 1991 Jul;9(4):529-38
77 Valdevit A, Kambic H , Lilly D,et al. Non-linear fitting of mechanical data for efficacy determination of single versus double bundle Achilles tendon grafts for PCL reconstructions.Biomed Mater Eng.2002;12(3):309-17
78 Veltri DM, Deng XH, Torzilli PA, et al. The role of the cruciate and posterolateral ligaments in stability of the knee: a biomechanical study.Am J Sports Med. 1995 Jul-Aug;23(4):436-43
79 Veltri DM, Warren RF. Anatomy, biomechanics, and physical findings in posterolateral knee instability. Clin Sports Med. 1994 Jul;13(3):599-614
80 Veltri DM, Warren RF. Isolated and combined posterior cruciate ligament injuries. J Am Acad Orthop Surg. 1993 Nov;1(2):67-75
81 Vogrin TM, H?her J, Ar?en A,et al. Effects of sectioning the posterolateral structures on knee kinematics and in situ forces in the posterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc. 2000;8(2):93-8
82 Wang CJ, Chen HH, Chen HS,,et al. Effects of knee position, graft tension, and mode of fixation in posterior cruciate ligament reconstruction: a cadaveric knee study. Arthroscopy. 2002 May-Jun;18(5):496-501
83 Watanabe Y, Moriya H, Takahashi K,,et al. Functional anatomy of the posterolateral structures of the knee. Arthroscopy. 1993;9(1):57-62
84 陈百成,高石军,王晓峰等,关节镜下股骨单遂道与双遂道重建后十字韧带的疗效分析,中华骨科杂志.2004,24(3).12 9-32
85 陈百成,毛远青,高石军等,双束股骨双遂道法重建后十字韧带的实验研究.中华骨科杂志.2003.23 :308-312
86 吴宇黎,吴海山,李晓华,钱齐荣.LARS 人工韧带关节镜下移植治疗膝关 节后交叉韧带损伤的随访效果分析[J].中国组织工程研究与临床康复,2007,11(12):2209-2212
87 吕厚山,主译.膝关节外科学.北京,人民卫生出版社,2006
2 Cosgarea AJ, Jay PR. Posterior cruciate ligament injuries: evaluation and management. J Am Acad Orthop Surg ,2001, 9:297–307
3 Edwards A, Bull AMJ, Amiss AA. The attachments of the fiber bundles of the posterior cruciate ligament: an anatomy study. Arthroscopy, 2007,23(3):284-290
4 Fox RJ, Harner CD, Sakane M. Determination of the in situ forces in the human posterior cruciate ligament using robotic technology. A cadaver study. Am J Sports Med,1998,26,395-401
5 Garofalo R, Jolles BM, Moretti, et al. Double-bundle transtibial posterior cruciate ligament reconstruction with a tendon-patellar bone-semitendinosus tendon autograft: clinical results with a minimum of
2 years’follow-up. Arthroscopy,2006,22(12): 1331-1338.el.
6 Gill TG, DeFrate LE, Wang C, et al. The biomechanical effect of posterior cruciate ligament reconstruction on knee joint function. Kinematic response to simulated muscle loads. Am J Sports Med,2003,31,530-536
7 Girgis FG, Marshall JL, Monajem A. The cruciate ligaments of the knee joint. Anatomical, functional and experimental analysis. Clin Orthop Relat Res ,1975,106:216–231
8 Gupte CM, Bull AMJ, Thomas RW, et al. The meniscofemoral ligaments: secondary restraints to posterior drawer. Analysis of anteroposterior and rotatory laxity in the intact andposterior-cruciate-deficient knee. J Bone Joint Surg, 2003,85B:765–773
9 Gupte CM, Smith A, McDermott ID, et al. Meniscofemoral ligaments revisited. Anatomical study, age correlation and clinical implications. J Bone Joint Surg, 2002 84B:846–851
10 Harner CD, Baek GH, Vogrin TM, et al. Quantitative analysis of humancruciate ligament insertions. Arthroscopy , 1999,15:741–9
11 Harner CD, Baek GH, Vogrin TM, et al. Quantitative analysis of human cruciate ligament insertions. Arthroscopy,1999,15(7): 741-749
12 Harner CD, Janaushek MA, Yagi M,et al. Biomechanical analysis of a double-bundled posterior cruciate ligament reconstruction. Am J Sports Med,2000,28,144-151
13 Makino A, Aponte Tinao L, Ayerza MA, et al. Anatomic double-bundle posterior cruciate ligament reconstruction using double-bundle tunnel with tibial anterior and posterior fresh-frozen allograft. Arthroscopy, 2006,22(6): 684.el-5
14 Makris CA, Georgoulis AD, Papageorgiou CD, et al. Posterior cruciate ligament architecture: evaluation under microsurgical dissection. Arthroscopy, 2000,16:627–632
15 Mannor DA, Shearn JT, Grood ES, et al. Two-bundle posterior cruciate ligament reconstruction.An in vitro analysis of graft placement and tension. Am J Sports Med,2000,28,833-845
16 Morgan CD, Kalman VR, Grawl DM .The anatomic origin of the posterior cruciate ligament: where is it? Reference landmarks for PCL reconstruction. Arthroscopy, 1997 13:325–331
17 Racanelli JA,Drez D Jr.Posterior cruciate ligament tibial attachment anatomy and radiographic landmarks for tibial tunnel placement in PCL reconstruction. Arthroscopy,1994,10(5): 546-549
18 Race A,Amiss AA. PCL reconstruction.In vitro biomechanical comparistion of ‘isometric’ versus single and double-bundled ‘anatomic’ grafts. J Bone J Surg Br,1998,80:173-179
19 Sekiya JK, Kurtz CA, Carr DR.Transtibial and inlay double-bundle posterior cruciate ligament reconstruction:Surgical technique using a bifid bone-patellar tendon-bone allograft. Arthroscopy,2004,20(10): 1095-1100.
20 Sheps DM,Otto D, Fernhout M. The anatomic characteristics of tibial insertion of the posterior cruciate ligament. Arthroscopy,2005,21(7): 820-825
21 Takahashi M, Matsubara Takamas,Doi M,et al. Anatomical study of the femoral and tibial insertions of the anterolateral and posteromedial bundles of human posterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc, 2006 (14):1055–1059
22 Van Dommelen BA, Fowler PJ. Anatomy of the posterior cruciate ligament. A review. Am J Sports Med, 1989,17:24–29
23 Wind WM Jr, Bergfeld JA, Parker RD . Evaluation and treatment of posterior cruciate ligament injuries: revisited.Am J Sports Med , 2004,32:1765–1775
1 Clancy WG, Shelbourne KD, Zoellner GB. Treament of knee joint instability secondary to rupture of posterior cruciate ligament. J Bone Joint Surg Am,1983,65:310-322
2 Race A, Amis AA. PCL reconstuction: in vitro biomechanical comparison of ‘isometric’ versus single and double-bundled ‘anatomic’ grafts. J Bone Joint Surg Br, 1998;80:173-9
3 Shearn JT. Grood ES, Noyes FR, et al. Two-bundle posterior cruciate ligament reconstruction: how bundle tension depends on femoral placement. J Bone Joint Surg Am.2004 Jun 86-A(6):1267-70
4 Harner CD, Janaushek MA, Kanamori A, et al. Biomechanical analysis of a double-bundle posterior cruciate ligament reconstruction. Am J Sports Med. 2000 Mar-Apr;28(2):144-51
5 Valdevit A, Kambic H , Lilly D,et al. Non-linear fitting of mechanical data for efficacy determination of single versus double bundle Achilles tendon grafts for PCL reconstructions. Biomed Mater Eng.2002;12(3):309-17
6 Janousek AT, Jones DG, Clatworthy M. Posterior cruciate Ligament injuries of the knee joint. Sports Med.1999Dec;28(6):429-41
7 Davis DK,Goltz DH, Fithian DC, et al. Anatomical posterior cruciate ligament transplation. A biomechanical analysis. Am J Sports Med,2006, 34,1126-1133
8 Racanelli JA,Drez D Jr. Posterior cruciate ligament tibial attachment anatomy and radiographic landmarks for tibial tunnel placement in PCL reconstruction. Arthroscopy,1994,10(5): 546-9
9 Garofalo R, Jolles BM, Moretti, et al. Double-bundle transtibial posterior cruciate ligament reconstruction with a tendon-patellar bone-semitendinosus tendon autograft:clinical results with a minimum of 2 years’ follow-up. Arthroscopy,2006,22(12): 1331-1338.el
10 Sekiya JK, Kurtz CA, Carr DR. Transtibial and inlay double-bundleposterior cruciate ligament reconstruction:Surgical technique using a bifid bone-patellar tendon-bone allograft. Arthroscopy,2004,20(10): 1095-1100
11 Sheps DM, Otto D, Fernhout M. The anatomic characteristics of tibial insertion of the posterior cruciate ligament. Arthroscopy,2005,21(7): 820-5
12 Makino A, Aponte Tinao L, Ayerza MA, et al. Anatomic double bundle posterior cruciate ligament reconstruction using double-bundle tunnel with tibial anterior and posterior fresh-frozen allograft. Arthroscopy, 2006,22(6): 684.el-5
1 Galloway M T, Grood ES, Mehalik JN , et al. Posterior cruciate ligament reconstruction: an in vitro study of femoral and tibial graft placement. AM J Sports Med, 1996; 24 (4) 437-445
2 Shino K, Nakagawa S, Nakamura N , et al. Arthroscopic posterior cruciate ligament reconstruction using hamstring tendons: 1 incision technique with Endobutton. Arthroscopy, 1996; 12 (6) : 638
3 Race A , Amis AA. PCL resonstruction: In vitro biomechanical comparison of isometric versus single and double bundled anatomic grafts. J Bone Joint Surg Br, 1998; 80 (2) : 173-9
4 Gregory C, Fanelli K, Danville JD, et al. Current concepts of posterior cruciate ligament and posterolateral complex. In: AAOS Annual Meeting Proceeding. Unpubeished data, Meeting of the American Academy of Orthopaedic Surgeons, Dalas, DX 2002:312
5 Chen CH, ChenWJ , Shih CH. Double-Bundle posterior cruciate ligament reconstruction with quadriceps and semitendinosus tendon grafts. Arthroscopy, 2003; 19 (10) : 1023-6
6 Stahelin AC, Sudkamp NP, Weiler A. Anatomic double bundle posterior cruciate ligament reconstruction using hamstring tendons. Arthroscopy 2001;17(1):88—97
7 Sekiya JK, Kurtz CA , Carr DR. Transtibial and tibial inlay double bundle posterior cruciate ligament reconstruction : surgical technique using a bifid bone patellar tendon bone allograft. Arthroscopy, 2004; 20 (10) : 1101
8 KirkPatriek JS,Seaver AV,Glison RR,et al .Cryopreserved ACL allograft in anaine model. J South Orthop Assoe.1996,5:20一29
9 Aha JH, Yoo JC, Wang JH. Posterior cruciate ligament reconstruction: double-loop hamstring tendon autograft versus Achilles tendon allograft- clinical results of minium 2-year follow-up. Arthroscopy,2005,21:965-969
10 Volpi P, Sch?nhuber H, Denti M. The double femoral tunnel technique for arthroscopic reconstruction of the posterior cruciate ligamnet with thesemitendinosus and gracilis autograft.Techniques in Knee Surgery, 2007, 6(1):37-41
11 Wang CJ , Chan YS, Weng LH, et al. Comparison of autogenous and allogenous posterior cruciate ligament reconstructions of the knee. Injury, 2004 ,35:1279-85
1 陈百成,毛远青,高石军, 等.双束股骨双隧道法重建后十字韧带的实验研究 .中华骨科杂志,2003,23:308-312
2 陈百成, 高石军,王晓峰, 等.关节镜下股骨单隧道与双隧道重建后十字韧带的疗效分析.中华骨科杂志,2004,24:129-132
3 Meyers MH, Moore TM, Harvey JP Jr. Traumatic dislocation of the knee joint. J Bone Joint Surg Am,1975,57:430-433
4 Frassica FJ,Sim FH,Staeheli JW. Pairolero PC. Dislocation of the knee.Clin Orthop Relat Res, 1991(263):200-205
5 Shapiro MS, Freedman EL. Allograft reconstruction of the anterior and posterior cruciate ligaments after traumatic knee dislocation. Am J Sports Med,1995,23:580-587
6 Fanelli GC, Giannotti BF, Edson CJ. Arthroscopically assisted combined anterior and posterior cruciate ligament reconstruction. Arthroscopy, 1996,12:5-14
7 Fanelli GC, Edson CJ. Arthroscopically assisted combined anterior and posterior cruciate ligament reconstruction in the multiple ligament injured knee: 2-to 10-year follow-up. Arthroscopy, 2002,18:703-714
8 Harner CD, Waltrip RL, Bennett CH, et al. Surgical management of knee dislocations. J Bone Joint Surg Am,2004,86:262-273
9 Wascher DC, Becker JR, Dexter JG, et al. Reconstruction of the anterior and posterior cruciate ligaments after knee dislocation: results using fresh-frozen nonirradiated allografts.Am J Sports Med,1999,27:189-196
10 Fanelli GC, Edson CJ, Orcuff DR, et al. Treament of combined anterior cruciate-posterior cruciate ligament-medial-lareral side knee injuries . J Knee Surg, 2005, 18:240-248
11 Mae T, Shino K, Maeda A, et al. Effect of gamma irradiation on remodeling process of tendon allograft. Clin Orthop Relat Res,2003,414:305-314
12 Harner CD, Janaushek MA, Kanamori,A, et al. Biomechanical analysis ofa double-bundle posterior cruciate ligament reconstruction. Am J Sports Med,2000,28:144-151
13 Mannor DA, Shearn JT,Grood ES,et al. Two-bundle posterior cruciate ligament reconstruction.An in vitro analysis of graft placement and tension. Am J Sports Med,2000,28:833-845
14 Race A, Amis AA.PCL reconstruction.Invitro biomechanical comparison of 'isometric' versus single and double 'anatomic' grafts. J Bone Joint Surg Br, 1998, 80:173-179
1 Aha JH, Yoo JC, Wang JH. Posterior cruciate ligament reconstruction: double-loop hamstring tendon autograft versus Achilles tendon allograft- clinical results of minium 2-year follow-up. Arthroscopy, 2005, 21:965 -969
2 Arendt E, Dick R. Knee injury patterns among men and women in collegiate basketball and soccer. NCAA data and review of literature. Am J Sports Med, 1995;23(6):694-701
3 Bendjaballah MZ, Shirazi-Adl A, Zukor DJ. Biomechanical response of the passive human knee joint under anterior-posterior forces. Clin Biomech (Bristol,Avon). 1998 Dec;l3(8):625-633
4 Berg EE. Posterior cruciate ligament tibial inlay reconstruction. Arthroscopy 1995;11:69-76
5 Berg EE.Posterior cruciate ligament recession. Arthroscopy, 1999; 15(6):644-7
6 Bergfeld JA, McAllister DR, Parker RD, et al. The effects of tibial rotation on posterior translation in knees in which the posterior cruciate ligament has been cut. J Bone Joint Surg Am.2001Sep;83-A(9):1339-43
7 Bergfeld JA, McAllister DR, Parkr RD,et al. A biomechanical comparison of posterior cruciate ligament reconstruction techniques. Am J Sports Med,2001;29(2):129-36
8 Boks SS, Vroegindeweij D, Koes BW, et al.: Follow-up of posttraumatic ligamentous and meniscal knee lesions detected at MR imaging: systematic review. Radiology. 2006 Mar;238(3):863-71
9 Brown JP, Trojian TH. Anterior and posterior cruciate ligament injuries. Prim Care, 2004 Dec;31(4):925-56
10 Brunet P,Charrois O,Degeorges R,et al. Reconstruction of acute posterior cruciate ligament tears using a synthetic ligament.Rev Chir Orthop Reparatrice Appar Mot 2005;91(1):34-431
11 Carlin GJ, Livesay GA ,Harner CD, et al. In-situ forces in the humanposterior cruciate ligament in response to posterior tibial loading. Ann Biomed Eng,1996;24(2):193-7
12 Cerullo G, Puddu G, Gianni E,et al. Anterior cruciate ligament patellar tendon reconstruction: it is probably better to leave the tendon defect open! Knee Surg Sports Traumatol Arthrosc. 1995;3(1):14-17
13 Chen CH ; Chen WJ ; Shih CH; Double-bundle posterior cruciate ligamentreconstruction with quadriceps and semitendinosus tendon grafts. Arthroscopy. 2003,19N9:1023-1026
14 Covey DC. Injuries of the posterolateral corner of the knee. J Bone Joint Surg Am.2001 Jan;83-A(1):106-18
15 Covey DC, Sapega AA. Anatomy and function of the Posterior cruciate ligament. Clin Sports Med 1994; 13(3): 509-18
16 Covey DC,Sapega AA,Sherman GM. Testing for isometry during reconstruction of the posterior cruciate ligament. Anatomic and biomechanical considerations.Am J Sports Med,1996,24(6):740-6
17 Cross MJ, Powell JF. Long-term followup of posterior cruciate ligament rupture: a study of 116 cases. Am J Sports Med,1984;12(4):292-7
18 Dandy DJ, Pusey RJ. T The long-term results of unrepaired tears of the posterior cruciate ligament. J Bone Joint Surg.Br,1982;64(1):92-4
19 Dejour H, Walch G, Peyrot J, et al. The natural history of rupture of the posterior cruciate ligament. Rev Chir Orthop Reparatrice Appar Mot. 1988;74(1):35-43
20 Dennis MG, Fox JA, Alford JW, et al. Posterior cruciate ligament reconstruction: current trends. J Knee Surg,2004;17(3):133-9
21 Dunlop DG, Woodnut DJ, Nuton RW. A new method to determine graft angles after knee ligament reconstruction. Knee,2004,11 (1):19-24
22 Dürselen L, Claes L, Kiefer H. The influence of muscle forces and external loads on cruciate ligament strain. Am J Sports Med,1995;23(1):129-36
23 Fanelli GC, Edson CJ. Posterior cruciate ligament injuries in trauma patients: Part II. Arthroscopy 1995,11(5):526-9
24 Fanelli GC, Edson CJ. Arthroscopically assisted combined anterior and posterior cruciate ligament reconstruction in the multiple ligament injured knee: 2- to 10-year follow-up. Arthroscopy, 2002,18(7):703-714
25 Fanelli GC, Giannotti BF, Edson CJ. Arthroscopically assisted combined anterior and posterior cruciate ligament reconstruction. Arthroscopy, 1996,12(1):5-14
26 Fox RJ, Harner CD, Sakane M,et al . Determination of the in situ forces in the human posterior cruciate ligament using robotic technology. A cadaveric study .Am J Sports Med 1998;26(3):395-401
27 Girgis FG, Marshall JL , Monajem A.The cruciate ligaments of the knee joint: anatomical functional and experimental analysis, 1975,106:216-31
28 Grood ES, Hefzy MS, Lindenfield TN. Factors affecting the region of most isometric femoral attachments. Part I: The posterior cruciate ligament.Am J Sports Med. 1989,17(2):197-207
29 Grood ES, Stowers SF, Noyes FR. Limits of movement in the Human knee:effect of sectioning the posterior cruciate ligament and posterolateral structures. J Bone Joint Surg Am 1988; 70(1): 88-97
30 Gupte CM, Bull AM, Thomas RD, et al. A review of the function and biomechanics of the meniscofemoral ligaments. Arthroscopy, 2003,19(2):161-71
31 Gupte CM, Smith A, Jamieson N, et al. Meniscofemoral ligaments –structural and material properites.J Biomech,2002 Dec;35(12):1623-9
32 Gupte CM, Smith A, McDermott ID, et al .Meniscofemoral ligaments revisited. Anatomical study, age correlation and clinical implications. J Bone Joint Surg Br. 2002 84(6):846-51
33 Harner CD, Baek GH, Vogrin TM, et al. Quantitative analysis of Human cruciate ligament insertions.Arthroscopy,1999,15(7) :741-9
34 Harner CD, Janaushek MA, Kanamori A, et al. Biomechanical analysis of a double-bundle posterior cruciate ligament reconstruction. Am J Sports Med. 2000 Mar-Apr;28(2):144-51
35 Harner CD, Janaushek MA, Ma CB,et al. The effect of knee Flexion angle and application of an anterior tibial load at the time of graft fixation on the biomechanics of a posterior curciate ligament-reconstructed knee. Am J Sports Med.2000; 28 (4):460-5
36 Harner CD, Livesay GA, Kashiwaguchi S, et al .Comparative study of the size and shape of human anterior and posterior cruciate ligaments. J Orthop Res, 1995,13(3): 429-34
37 Harner CD, Vogrin TM, H?her J,et al. Biomechanical analysis of a posterior cruciate ligament reconstruction. Deficiency of the posterolateral structures as a cause of graft failure. Am J Sports Med. 2000 Jan-Feb;28(1):32-9
38 Harner CD, Xerogeanes JW,Livesay GA,et al. The human posterior cruciate ligament complex: an interdisciplinary study. Ligament morphology and biomechanical evaluation. Am J Sports Med. 1995 Nov-Dec;23(6):736-45
39 Harner CD, H?her J, Vogrin TM. et al. The effects of a popliteus muscle load on in situ forces in the posterior cruciate ligament and on knee kinematics. A human cadaveric study. Am J Sports Med. 1998,Sep-Oct;26(5):669-73
40 Harner CD, Vogrin TM, H?her J, et al. Biomechanical analysis of a posterior cruciate ligament reconstruction. Deficiency of the posterolateral structures as a cause of graft failure. Am J Sports Med. 2000 Jan-Feb;28(1):32-9
41 H?her J, Harner CD, Vogrin TM, et al. In situ forces in the posterolateral structures of the knee under posterior tibial loading in the intact and posterior cruciate ligament-deficient knee. J Orthop Res. 1998 Nov;16(6):675-81
42 Hoher J, Scheffler S, Weiler A. Graft choice and graft fixation in PCL reconstruction. Knee Surg Sports Traumatol Arthrosc, 2003;11 (5):297 -306
43 Janousek AT, Jones DG, Clatworthy M. Posterior cruciate Ligament injuries of the knee joint. Sports Med.1999Dec;28(6):429-41
44 Kennedy JC, Hawkins RJ, Willis RB, et al. Tension studies of human knee ligaments. Yield point, ultimate failure, and disruption of the cruciate and tibial collateral ligaments.J Bone Joint Surg Am. 1976 Apr;58(3):350-5
45 Kurosawa H, Yamakoshi K, Yasuda K,et al. Simultaneous measurement of changes in length of the cruciate ligaments during knee motion. Clin Orthop Relat Res. 1991 Apr;(265):233-40
46 Levy AS, Wetzler MJ, Lewars M,et al. Knee injuries in women collegiate rugby players. Am J Sports Med. 1997 May-Jun;25(3):360-2
47 Logan M, Williams A, Lavelle J,et al. The effect of posterior cruciate ligament deficiency on knee kinematics. Am J Sports Med. 2004 Dec;32(8):1915-22
48 Mannor DA, Shearn JT,Grood ES,Noyes FR, et al. Two-bundle posterior cruciate ligament reconstruction. An in vitro analysis of graft placement and tension. Am J Sport Med. 2000. Nov-Dec;28(6):833-45
49 Margheritini F, Rihn J, Musahl V,et al. Posterior cruciate Ligament injuries in the athlete:an anatomical, biomechanical and clinical review. Sports Med,2002;32(6):393-408
50 Makino A, Aponte Tinao L, Ayerza MA, et al. Anatomic double -bundle posterior cruciate ligament reconstruction using double -bundle tunnel with tibial anterior and posterior fresh-frozen allograft. Arthroscopy, 2006, 22(6): 684.el-5
51 Markolf KL,Slauterbeck JR,Armstrong KL,et al. A biomechanical study of replacement of the posterior cruciate ligament with a graft. Part 1: Isometry, pre-tension of the graft, and anterior-posterior laxity. J Bone Joint Surg Am. 1997 Mar;79(3):375-80
52 Markolf KL,Wascher DC, Finerman GA. Direct in vitro measurement of forces in the cruciate ligaments. Part II: The effect of section of the posterolateral structures. J Bone Joint Surg Am. 1993 Mar;75(3):387-94
53 Maynard MJ, Deng X, Wickiewicz TL, et al. The popliteofibular ligament. Rediscovery of a key element in posterolateral stability. Am J Sports Med.1996 May-Jun;24(3):311-6
54 McAllister DR , Markolf KL , Oakes DA,et al. A biomechanical comparison of tibial inlay and tibial tunnel posterior cruciate ligament reconstruction techniques: graft pretension and knee laxity. Am J Sports Med,2002 May-Jun;30(3):312-7
55 McGuire DA, Wolchok JC. Posterolateral corner reconstruction. Arthroscopy. 2003 Sep;19(7):790-3
56 Morgan-Jones RL, Cross MJ. The intercruciate band of the human knee: An anatomical and histological study. J Bone Joint Surg Br,1999 Nov;81(6):991-994
57 Neilsen S, Helmig P. Posterior instability of the knee joint.An experimental study. Arch Orthop Trauma Surg,1986;105(2):121-5
58 Neurath MF, Stofft E. Structure and function of matrix components in the cruciate ligaments. An immunohistochemical, electron-microscopic, and immunoelectron-microscopic study. Acta Anat (Basel).1992 145(4): 387-94
59 Oakes DA, Markolf KL, McWilliams J,et al. Biomechanical comparison of tibial inlay and tibial tunnel techniques for reconstruction of the posterior cruciate ligament. Analysis of graft forces. J Bone Joint Surg Am,2002; 84-A(6):938-944
60 Parolie JM, Bergfeld JA: Long-term results of nonoperative treatment of isolated posterior cruciate ligament injuries in the athlete. Am J Sports Med 1986, 14(1):35–38
61 Race A , Amis AA. The mechanical properties of the two bundles of the human posterior cruciate ligament. J Biomech. 1994 Jan;27(1):13-24
62 Race A, Amis AA. PCL reconstruction. In vitro biomechanical comparison of ‘isometric' versus single and double-bundled ‘anatomic’ grafts. J Bone Joint Surg Br. 1998 Jan;80(1):173-9
63 Schulz MS, Russe K, Weiler A, et al. Epidemiology of posterior cruciate ligament injuries. Arch Orthop Trauma Surg. 2003 May;123(4):186-91
64 Schulz MS, Steenlage ES, Russe K, Strobel MJ: Distribution of posteriortibial displacement in knees with posterior cruciate ligament tears. J Bone Joint Surg Am 2007, 89(2):332-8
65 Servant CT, Ramos JP, Thomas NP.The accuracy of magnetic resonance imaging in diagnosing chronic posterior cruciate ligament injury. Knee. 2004 Aug;11(4):265-70
66 Shearn JT. Grood ES, Noyes FR, et al. Two-bundle posterior Cruciate ligament reconstruction: how bundle tension depends on femoral placement. J Bone Joint Surg Am.2004 Jun 86-A(6):1267-70
67 Shelbourne KD, Muthukaruppan Y. Subjective results of nonoperatively treated, acute, isolated posterior cruciate ligament injuries. Arthroscopy. 2005 Apr;21(4):457-61
68 Sheps DM, Otto D, Fernhout M. The anatomic characteristics of tibial insertion of the posterior cruciate ligament. Arthroscopy. 2005 Jul;21(7): 820-5
69 Shino K, Horibe S, Nakata K,et al. Conservative treatment of isolated injuries to the posterior cruciate ligament in athletes.. J Bone Joint Surg Br. 1995 Nov;77(6):895-900
70 Skynar MJ,W arren RF, Oruz GJ,et al.The effects or sectioning of the posterior cruciate ligament and the posterolateral complex on the articular contact pressures within the knee. J Bone Joint Surg Am 1993;75:694-9
71 Strobel MJ, Weiler A, Schulz MS, et al. Arthroscopic evaluation of articular cartilage lesions in posterior cruciate ligament-deficient knees. Arthroscopy,2003Mar;19 (3):262-8
72 Terry GC, LaPrade RF. The posterolateral aspect of the knee. Anatomy and surgical approach. Am J Sports Med. 1996 Nov-Dec; 24(6) :732-9
73 Torg JS, Barton TM, Pavlov H,et al. Natural history of the posterior cruciate ligament-deficient knee.Clin Orthop Relat Res. 1989 Sep; (246) :208-16
74 Toritsuka Y, Horibe S, Hiro-Oka A,et al. Conservative treatment For rugby football players with an acute isolated posterior cruciate Ligament injury. Knee Surg Sports Traumatol Arthrosc.2004Mar;12 (2):110-4
75 Trieb K, Blahovec H, Brand G,et al. In vivo and in vitro cellular ingrowth into a new generation of artificial ligaments. Eur Surg Res. 2004 May-Jun;36(3):148-51
76 Vahey JW, Draganich LF. Tensions in the anterior and posterior cruciate ligaments of the knee during passive loading: predicting ligament loads from in situ measurements. J Orthop Res. 1991 Jul;9(4):529-38
77 Valdevit A, Kambic H , Lilly D,et al. Non-linear fitting of mechanical data for efficacy determination of single versus double bundle Achilles tendon grafts for PCL reconstructions.Biomed Mater Eng.2002;12(3):309-17
78 Veltri DM, Deng XH, Torzilli PA, et al. The role of the cruciate and posterolateral ligaments in stability of the knee: a biomechanical study.Am J Sports Med. 1995 Jul-Aug;23(4):436-43
79 Veltri DM, Warren RF. Anatomy, biomechanics, and physical findings in posterolateral knee instability. Clin Sports Med. 1994 Jul;13(3):599-614
80 Veltri DM, Warren RF. Isolated and combined posterior cruciate ligament injuries. J Am Acad Orthop Surg. 1993 Nov;1(2):67-75
81 Vogrin TM, H?her J, Ar?en A,et al. Effects of sectioning the posterolateral structures on knee kinematics and in situ forces in the posterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc. 2000;8(2):93-8
82 Wang CJ, Chen HH, Chen HS,,et al. Effects of knee position, graft tension, and mode of fixation in posterior cruciate ligament reconstruction: a cadaveric knee study. Arthroscopy. 2002 May-Jun;18(5):496-501
83 Watanabe Y, Moriya H, Takahashi K,,et al. Functional anatomy of the posterolateral structures of the knee. Arthroscopy. 1993;9(1):57-62
84 陈百成,高石军,王晓峰等,关节镜下股骨单遂道与双遂道重建后十字韧带的疗效分析,中华骨科杂志.2004,24(3).12 9-32
85 陈百成,毛远青,高石军等,双束股骨双遂道法重建后十字韧带的实验研究.中华骨科杂志.2003.23 :308-312
86 吴宇黎,吴海山,李晓华,钱齐荣.LARS 人工韧带关节镜下移植治疗膝关 节后交叉韧带损伤的随访效果分析[J].中国组织工程研究与临床康复,2007,11(12):2209-2212
87 吕厚山,主译.膝关节外科学.北京,人民卫生出版社,2006
© 2004-2018 中国地质图书馆版权所有 京ICP备05064691号 京公网安备11010802017129号 地址：北京市海淀区学院路29号 邮编：100083 电话：办公室：(+86 10)66554848；文献借阅、咨询服务、科技查新：66554700 |