| The injuries of Anterior Curciate Ligament are very common in sport injuries.The injuries mainly effect the stabilization of knee joint,it also is the reason of the degeneration of cartilage in knee joint after ACL injury.However,the ACL injury did effect the patella or not is unknown, there is few literature report it too.This research intend to use biomechanic method observe the biomechanic change of patella after ACL complete rupture or incomplete rupture,further more,use histological methods to observe the pathological change of patella after ACL complete rupture,detect the expression of IL-1β,MMP-13. Through the reaserch to investigate the effect mechanism of pathological changes in patella after ACL rupture,provide the theory evidence of pathological changes in patella after ACL rupture.Chapter1 The biomechanical study of ACL bundles' functional classificationObjective:To investigate the biomechanical function of the ACL bundles for subsequent research.Methods:6 fresh cadaveric knees from adult human beings were used. Selected the bilateral anterior part of the ACL tibial insertion and the bilateral posterior part of the ACL femoral insertion as the measure parts correspond to:anteromedial area fiber bundle(anteromedial bundle),anterolateral area fiber bundle(anterolateral bundle),posteromedial area bundle(posteromedial bundle) and posterolateral area bundle (posterolateral bundle).The strain on the ACL bundles was measured when the knees were applied with 800N axial loading force in 0°,30°,60°,90°positions.The bundles were functional classified by cluster analysis.Results:1.In 0°position,the strain on the posterolateral and anterolateral bundles was significantly larger than the posteromedial and anteromedial bundles(P＜0.05),There were no significant diference between the posterolateral and anterolateral bundles(P＞0.05) and so did the posteromedial and anteromedial bundles(P＞0.05);In 30°and 90°position,the strain on the posteromedial and anteromedial bundles was significantly larger than the posterolateral and anterolateral bundles (P＜0.05),There were no significant difference between the posteromedial and anteromedial bundles(P＞0.05) and so did the posterolateral and anterolateral bundles(P＞0.05);In 60°position,the strain on the posteromedial bundle was the largest,and then the anteromedial,posterolateral,anterolateral bundle,the differences among bundles were all significant(P＜0.05).2.The strain on the posteromedial and anteromedial bundles was increased by degrees when the knee flexed 0°,30°,60°,90°,and all the difference were significant (P＜0.01);There were no significant changes of the strain on the anterolateral bundle among different angles(P＞0.05).The strain on the posterolateral bundle in 60°position was larger than 0°,30°,90°positions,the differences were significant(P＜0.05);The strain in 30°position was significantly smaller than 0°and 90°positions (P＜0.05),but the difference of strain between 0°and 90°positions was not significant(P＞0.05).3.Cluster analysis classfied the anteromedial bundle and the posteromedial bundle as one class and the anterolateral and posterolateral bundles as the other class.Conclusion:Compared with the posteromedial area and anteromedial area fiber bundles,the strain on the posterolateral area and anterolateral area fiber bundles was significantly larger in 0°position and smaller in 30°,60°,90°positions,means the posterolateral area and anterolateral area fiber bundles mainly maintain stability of the knee in extended positions,the posteromedial area and anteromedial area fiber bundles mainly maintain stability of the knee in flexed positions.Combined with the cluster analysis results,ACL may be classified into the anteromedial functional fiber bundle and the posterolateral functional fiber bundle. Chapter 2 The biomechanical influence of ACL rupture on the patellaObjective:To investigate the biomechanical influences of partial and total ACL rupture on the patella.Methods:10 fresh cadaveric knees from adult human beings were divided into ACL intact group(10 samples),AMB broken group(5 samples),PLB broken group(5 samples)and ACL total broken group(10 samples).The knees were applied with 200N～800N axial loading force when they flexed 0°,30°,60°,90°.The strain on the patella was measured and analysed.Results:1.In ACL intact group:①In 0°position,the strain of all 4 test place of patellar were the smallest,and the differences among the parts were not significant(P＞0.05).②In 30°positions,the inferior of patellar was compressive strain,the superior of patellar was tensile strain,the absolute value of strain was increased with the load increased.In 60°positions,the strain of inferior and superior of patellar were tensile strain, the absolute value of strain was increased with the load increased.In 90°positions,the superior of patellar was compressive strain,the inferior of patellar was tensile strain,the absolute value of strain was increased with the load increased.The differences among the parts were all significant(P＜0.05).③In 30°,60°,90°positions,the medial and lateral of patellar were compressive strain,the absolute value of strain was increased with the load increased.The differences among the parts were all significant(P＜0.05).There were no significant differences among the medial and lateral of patellar(P＞0.05).2.In AMB broken group:①In 0°position,the strain of all 4 test place of patellar were the smallest,and the differences among the parts were not significant(P＞0.05).②In 30°positions,the strain of inferior and superior of patellar were compressive strain,the absolute value of strain on the superior of patellar was increased with the load increased.The absolute value of strain on the inferior of patellar was decreased with the load increased.In 60°positions,the superior of patellar was compressive strain,the inferior of patellar was tensile strain,and the absolute value of strain was increased with the load increased.In 90°positions,the superior of patellar was compressive strain,the inferior of patellar was tensile strain,and the absolute value of strain was increased with the load increased.The differences among the parts were all significant(P＜0.05).③In 30°,60°,90°positions,the medial and lateral of patellar were compressive strain,the absolute value of strain was decreased with the load increased. The differences among the parts were all significant(P＜0.05).There were significant differences among the medial and lateral of patellar (P＜0.05).3.In PLB broken group:①In 0°position,the strain of all 4 test place of patellar were the smallest,and the differences among the parts were not significant(P＞0.05).②In 30°positions,the strain of superior of patellar were tensile strain,the inferior of patellar was compressive strain,the absolute value of strain on the superior of patellar was increased with the load increased.The absolute value of strain on the inferior of patellar was increased in first,and then decreased with the load increased.In 60°positions,the superior of patellar was compressive strain,the inferior of patellar was tensile strain, the absolute value of strain was increased with the load increased.In 90°positions,the superior of patellar was compressive strain,the inferior of patellar was tensile strain,and the absolute value of strain was increased with the load increased.The differences among the parts were all significant(P＜0.05).③In 30°,60°,90°positions,the medial and lateral of patellar were compressive strain,In 30°positions,the absolute value of strain was increased in first,then decreased with the load increased. In 60°,90°positions,the absolute value of strain was decreased with the load increased.The differences among the parts were all significant (P＜0.05).There were significant differences among the medial and lateral of patellar(P＜0.05).4.In ACL total broken group:①In 0°position,the strain of all 4 test place of patellar were the smallest,and the differences among the parts were not significant(P＞0.05).②In 30°,60°,90°positions,the inferior of patellar was tensile strain,the superior of patellar was compressive strain,the absolute value of strain was increased with the load increased.The differences among the parts were all significant(P＜0.05).③In 30°,60°,90°positions,the medial and lateral of patellar were compressive strain,the absolute value of strain was decreased with the load increased.The differences among the parts were all significant(P＜0.05).There were significant differences among the medial and lateral of patellar(P＜0.05).Conclusion:1.ACL total rupture may cause abnormal load on the patellar in all the positions.2.AMB rupture may cause abnormal load on the patellar in 30°,60°,90°positions.3.PLB rupture not cause abnormal biomechanical change on patella in 0°position and 200N,400N loaded in 30°position.4.ACL total rupture can cause the strain of lateral of patellar was larger than medial of patellar,which need to be further explored. Chapter 3 The histological influence of ACL rupture on the patellar cartilageObjective:To investigate the tissue construction changes and IL-1,MMP-13 express in the patellar cartilage,to further explore the influence of ACL rupture on the patellar cartilage.Methods:48 male rabbits were randomly divided into four groups,and all were under one side posterior leg ACL cut and the opposite side as the control.HE staining and immunohistochemical methods were used. Tissue construction and IL-1β,MMP-13 expression changes of the lateral tibial plateau cartilage were observed 1,3,6,8 weeks later.Results:1.Gross observation:As the time lasted,the patellar cartilage had the color changed,the gloss decreased,the surface abrased and even had ulcer on the cartilage.2.Routine HE staining:There are abnormal cartilage surface and cell disposition after 3 weeks.The Mankin scores in experimental groups increased as the time lasted,the differences among the groups were all significant(P＜0.01);there was no significant difference between 1-week group and control group(P＞0.05),the Mankin scores in the other experimental groups were significantly higher than that in control group(P＜0.01).3.IL-1βexpression:All the experimental groups had higher IL-1βexpression than that in control groups(P＜0.01).In experimental groups,IL-1βexpressed significantly lower in 1-week group than that in 3,6,8-week groups(p＜0.05);In 6-week group,IL-1βexpressed higher than that in 3-week group and 8-week group(P＜0.01).IL-1βexpressed higher in 8-week group than that in 3-week group(P＜0.01).There were no signifigant differences among the control groups(P＞0.05).4.MMP-13 expression:All the experimental groups had higher IL-1βexpression than that in control groups(P＜0.01).In experimental groups,MMP-13 expressed significantly lower in 1-week group than that in 3,6,8-week groups (p＜0.01);In 6-week group,MMP-13 expressed higher than that in 3-week group and 8-week group(P＜0.01).There was no significant difference between 3-week group and 8-week group(P＞0.05).There were no signifigant differences among the control groups(P＞0.05).Conclusion:1.The reaserch confirmed ACL rupture may cause cartilage degeneration on the patellar cartilage.2.The increased IL-1βand MMP-13 expression suggest that IL-1β,MMP-13 may participate in cartilage degeneration on the patellar after ACL rupture.
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