Traumatology and Orthopedics of RussiaTraumatology and Orthopedics of RussiaТравматология и ортопедия России2311-29052542-0933Vreden National Medical Research Center of Traumatology and Orthopedics144510.21823/2311-2905-2020-26-4-80-92Theoretical and experimental studiesТеоретические и экспериментальные исследованияTheoretical and experimental studiesGender Differences of the ACL Insertion SitesСвязанные с полом особенности строения областей прикрепления передней крестообразной связкиhttps://orcid.org/0000-0001-7507-0570MalaninD. A.МаланинД. А.
Russian Federation

Dmitry A. Malanin — Dr. Sci. (Med.), Professor, Head of Department for Traumatology, Orthopaedics and Field Surgery, Volgograd State Medical University; Head of Laboratory for Clinical and Experimental Orthopaedics, Volgograd Medical Research Center

Volgograd

Маланин Дмитрий Александрович — д-р мед. наук, профессор, заведующий кафедрой травматологии, ортопедии и ВПХ, ФГБОУ ВО «Волгоградский государственный медицинский университет» Минздрава России; заведующий лабораторией клинической и экспериментальной ортопедии, ГБУ «Волгоградский медицинский научный центр»

г. Волгоград

malanin67@mail.ruhttps://orcid.org/0000-0002-8037-1674VolodinI. V.ВолодинИ. В.
Russian Federation

Ilya V. Volodin — PhD Student of Department for Traumatology, Orthopaedics and Field Surgery, Volgograd State Medical University; Researcher, Volgograd Medical Research Center

Volgograd

Володин Илья Владимирович — аспирант кафедры травматологии, ортопедии и ВПХ, ФГБОУ ВО «Волгоградский государственный медицинский университет» Минздрава России; младший научный сотрудник лаборатории клинической и экспериментальной ортопедии, ГБУ «Волгоградский медицинский научный центр»

г. Волгоград

volodin_ili@mail.ruhttps://orcid.org/0000-0001-7375-5365SuchilinI. A.СучилинИ. А.
Russian Federation

Ilya A. Suchilin — Cand. Sci. (Med.), Associated Professor, Department of Traumatology, Orthopaedics and Field Surgery, Volgograd State Medical University; Researcher, Volgograd Medical Research Center

Volgograd

Сучилин Илья Алексеевич — канд. мед. наук, доцент кафедры травматологии, ортопедии и ВПХ, ФГБОУ ВО «Волгоградский государственный медицинский университет» Минздрава России; научный сотрудник ГБУ «Волгоградский медицинский научный центр»

г. Волгоград

omnio@mail.ruhttps://orcid.org/0000-0003-1797-2431DemeshchenkoM. V.ДемещенкоМ. В.
Russian Federation

Maxim V. Demeshchenko — Cand. Sci. (Med.), Assistant Professor, Department of Traumatology, Orthopaedics and Field Surgery, Volgograd State Medical University; Researcher, Volgograd Medical Research Center

Volgograd

Демещенко Максим Васильевич — канд. мед. наук, ассистент кафедры травматологии, ортопедии и ВПХ, ФГБОУ ВО «Волгоградский государственный медицинский университет» Минздрава России; научный сотрудник ГБУ «Волгоградский медицинский научный центр»

г. Волгоград

maximus275@yandex.ruVolgograd State Medical UniversityФГБОУ ВО «Волгоградский государственный медицинский университет» Минздрава РоссииVolgograd Science Medical CenterГБУ «Волгоградский медицинский научный центр»1612202026480922105202028082020https://journal.rniito.org/jour/article/view/1445

Background. The modern principles of reconstruction of the anterior cruciate ligament (ACL) and well-known surgical techniques do not take into account the peculiarities of the anatomical structure of the female knee. This happens due to insufficient substantiation that these peculiarities could influence the results of the treatment. The purpose of this study was to obtain new data on the structure of the areas of the ACL attachment, taking into consideration patient’s gender and the surgical anatomy. Material and Methods. 40 unpaired “fresh” anatomical preparations of the human female and male knees were studied. After preparation of the knee joints, the morphometry of the distal femoral epiphysis and the proximal tibial epiphysis was carried out by a digital sliding caliper according to 16 parameters. The shape, size, area, and the distance of the ACL attachment center from individual bone structures were assessed. The obtained data were correlated with the gender type of the knee structure. Results. The distal femoral epiphysis of the “female” type knee joint compared with the “male” type revealed the significant differences (p<0.05) in the following parameters: the width of the condyles at the level of the transepicondylar line, the width of the intercondylar fossa, the length and height of the lateral condyle, and the ratio of the condyles width at the level of the transepicondylar line to the height of the lateral condyle. The tibial proximal epiphysis showed the gender differences in the articular surface frontal and sagittal dimensions, the width of the intercondylar eminence and the posterior slope of the tibial epiphysis articular surface. These features determined the different proportions of the female knee structure. The area of the anterior cruciate ligament femoral attachment and its center in the “female” type of structure were located 3 mm distal and 1.5 mm posteriorly (anteriorly and downwardly in arthroscopic imaging). The area of the tibial attachment of the same ligament and its center were localized 2 mm anteriorly in comparison with the “male” type structure. Conclusion. The discovered anatomical differences made it possible to distinguish the “female” and “male” types of the knee structure. The topography of the anterior cruciate ligament attachment areas is gender specific. This should be taken into account in the anatomical reconstruction of the ligament.

Актуальность. Современные принципы реконструкции ПКС и известные хирургические техники не учитывают особенностей анатомического строения коленного сустава у женщин ввиду недостаточной обоснованности их влияния на результаты лечения. Цель исследования — получить новые данные о строении областей прикрепления передней крестообразной связки (ПКС) в коленном суставе с учетом половой принадлежности человека и с позиций хирургической анатомии. Материал и методы. Изучено 40 непарных «свежих» анатомических препаратов коленного сустава человека, полученных от лиц женского и мужского пола. После препарирования коленных суставов проведена морфометрия дистального эпифиза бедренной и проксимального эпифиза большеберцовой костей с помощью цифрового скользящего штангенциркуля по 16 параметрам. При исследовании областей прикрепления ПКС оценена их форма, размеры, площадь и удаленность центра от отдельных костных структур. Полученные данные были соотнесены с типом строения коленного сустава. Результаты. В коленных суставах с «женским» типом строения по сравнению с «мужским» при измерении дистального эпифиза бедренной кости достоверные отличия (p<0,05) установлены по следующим параметрам: ширина мыщелков на уровне трансэпикондилярной линии, ширина межмыщелковой ямки, длина и высота наружного мыщелка и отношение ширины мыщелков на уровне трансэпикондилярной линии к высоте наружного мыщелка. В области проксимального эпифиза большеберцовой кости гендерные различия обнаружены при измерении фронтальных и сагиттальных размеров суставной поверхности, ширины межмыщелкового возвышения и заднего наклона суставной поверхности эпифиза большеберцовой кости. Данные особенности формировали иные пропорции в строении коленного сустава для лиц женского пола. Обнаружено, что область бедренного прикрепления ПКС и еe центр в коленных суставах с «женским» типом строения располагались несколько дистальнее (на 3 мм) и кзади (на 1,5 мм) (кпереди и книзу при артроскопической визуализации). В свою очередь, область большеберцового прикрепления и ее центр локализовались на 2 мм кпереди по сравнению с коленными суставами «мужского» типа строения. Заключение. Обнаруженные анатомические особенности позволяют выделять «женский» и «мужской» типы строения коленного сустава, что обусловливает гендерные различия в топографии областей прикрепления ПКС и определяет необходимость их учета при анатомической реконструкции связки.

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