Applied Anatomy And Biomechanical Study Of The Quadriceps Tendon

BackgroundWith the improvement of transport, knee ligament injury in clinical practice is more common in people’s outdoor sports activities. Cruciate ligament is an important structure to maintain the stability of the knee, prevented the translocation of the tibia. Cruciate ligament of the knee has the two parts, which wrapped by synovial package. They firmly connect the femur and tibia. Anterior cruciate ligament to reach the front of the uplift from the tibial intercondylar, oblique on the outside, attached to the medial femoral condyle outside. The posterior cruciate ligament to reach the behind the uplift from the tibial intercondylar, inclined forward, attached to the outer side of the lateral femoral condyle. Anterior cruciate ligament in the extensor becomes the tension, to prevent excessive forward tibial. Posterior cruciate ligament in the flexion, to prevent the tibia over-backward Cruciate ligament tear is one of the most common sports injuries among young people. Damage about the cruciate ligament will affect the stability of the knee, leading to the dysfunction of knee motion, increasing the risk of meniscal injury, and accelerating the degeneration of the knee, leading to the occurrence of OA. At present, conservative treatment can not repair a torn meniscus and cruciate ligament. Therefore cruciate ligament reconstruction surgery has been accepted by the majority surgeon. In the seventies of the last century, most of the anterior cruciate ligament reconstruction also need a arthrotomy, open the joint capsule to use ligament reconstruction. Postoperative patients with significant scarring and analgesic treatment and takes a longer hospital stay and postoperative limb fixed time. Arthroscopic surgery reduces the trauma and needs shorten hospital stay,to maximize the recovery of joint stability, to avoid the impact syndrome and other related complications. However, the choice of a substitute for reconstruction of the cruciate ligament in order to achieve good clinical effect is controversial. Cruciate ligament reconstruction graft material should have the following characteristics in our view:strong tension, easy access, minimize to the injury and quick recovery. It is not an ideal graft to meet the above requirements. Clinical method using autogenous patellar tendon or hamstring reconstruction of the cruciate ligament, or the use of allogeneic graft substitute, has also been reported. Artificial ligaments and tissue engineering research is the directions. However, these alternatives has theirs deficiency. In recent years, some scholars try to use the quadriceps tendon with patellar reconstruction of the anterior cruciate ligament and receive a relatively good initial clinical effect. Associated with quadriceps tendon applied anatomy and biomechanics, has not been reported.Objective1. Provide anatomical data for the clinical application of the quadriceps tendon reconstruction of the knee cruciate ligament, and facilitate surgeon to excise the quadriceps tendon, prevent to excessively damage the quadriceps tendon.2. Obtain from fresh cadavers of the quadriceps tendon based on the first step of experimental study, measure the biomechanical property, access to relevant information. Provide biomechanics data for the clinical application of the quadriceps tendon reconstruction of the knee cruciate ligament.Methods1. In10adults anticorrosive cadavers (20knees) anatomy, observe the morphology of the quadriceps tendon and the adjacency relations and anatomical characteristics of the patellar attachment point, measure the starting and ending width of the quadriceps tendon. In the measurement, the rectus femoris muscle mixed department and tendon tissue at the junction known as the starting point of the rectus femoris tendon, end to the part of the patella on the upper pole called ending point. Length of the tendon as the length between two points.2. Utilize the relevant data in the first experiment, excise the quadriceps tendon and anterior cruciate ligament in5fresh adult cadavers(10knees). Saline-soaked gauze wrapped, to prevent ligament degeneration, packed in plastic bags, sealed and placed in the stored at-20℃freezer. Remove the specimen before the experiment and thaw at room temperature with a scalpel along the specimen longitudinal to cut sample, the rectus femoris tendon and anterior cruciate ligament in each group is a total of10samples. The specimens were clamped in the test machine, exert tensile load in10mm/min the experimental speed on the sample, until the destruction of the specimen. The computer automatically output experimental data.Results1.The width of the rectus femoris muscle ended point is (3.20±0.33) cm. The width of the starting point is (1.28±0.25) cm. The length of the tendon tissue is (6.96±0.80) cm. Rectus femoris tendon proximal end about5/4is completely free, distal end about5/1is in the vastus lateralis and vastus intermedius muscle fusion, form the quadriceps tendon, attach to4/3in sagittal front of the patella2. The unit modulus of rectus femoris tendon is equivalent of the anterior cruciate ligament, the maximum unit load is two-thirds of the anterior cruciate ligament. It is the biomechanical basis of replacing the anterior cruciate ligamentConclusions1. To quadriceps tendon of the anatomical features, it can be used as one of the donor site in the knee cruciate ligament reconstruction2. In biomechanics, rectus femoris tendon is suitable for reconstructing anterior cruciate ligament.