Cloutier J M, Sabouret P, Deghrar A
Centre Hospitalier de l'Université de Montréal, Québec, Canada.
J Bone Joint Surg Am. 1999 May;81(5):697-702. doi: 10.2106/00004623-199905000-00011.
Although many early designs of total knee arthroplasty allowed the retention of both cruciate ligaments, in most current designs of knee replacement systems, either both cruciate ligaments are removed or the posterior cruciate ligament alone is retained. This report is a review of a series of total knee arthroplasties in which both cruciate ligaments were retained.
The results of 163 total knee arthroplasties (130 patients) in which both cruciate ligaments were retained were assessed prospectively. One hundred and seven knees (eighty-nine patients) were followed for an average of ten years. There were thirty-four men and ninety-six women, and the average age at the time of the index arthroplasty was sixty-seven years (range, forty-two to eighty-four years). The diagnosis was osteoarthritis in 122 (75 percent) of the knees and rheumatoid arthritis in forty-one (25 percent). Twenty-six knees had a valgus deformity, 109 had a varus deformity, and twenty-eight had a normal alignment of 5 to 10 degrees of valgus. The anterior cruciate ligament was relatively normal in ninety-six knees and was partly degenerated in sixty-seven knees. With use of the rating system of the Knee Society, all 163 knees were prospectively evaluated at yearly intervals; fifty-six of these knees (in forty-one patients) were followed in this manner until the patient died or was lost to follow-up.
One hundred and four (97 percent) of the 107 knees available for study at an average of ten years had an excellent or good result. At the time of the latest follow-up, pain was adequately relieved in ninety-seven knees (91 percent) and the average range of flexion was 107+/-12.6 degrees (range, 65 to 135 degrees). Ninety-five knees (89 percent) had normal anteroposterior stability (less than five millimeters of movement in this plane), and twelve knees (11 percent) had five to ten millimeters of movement as demonstrated by the drawer sign. Ninety-six knees (90 percent) had normal mediolateral stability, and eleven (10 percent) had 5 to 10 degrees of laxity. Ninety-four knees (88 percent) had valgus alignment of 5 to 10 degrees. The average knee score was 91+/-8.4 points (range, 54 to 100 points), and the average functional score was 82+/-21 (range, 10 to 100 points). The survival rate at ten years, with revision as the end point, was 95+/-2.0 percent. Seven (4 percent) of the 163 knees in this series were revised. There were no revisions for patellar problems or aseptic loosening of the tibial component.
The good anteroposterior stability in this series after an average follow-up period of ten years indicates that both the anterior and the posterior cruciate ligaments, even when partly degenerated, remain functional when they are preserved in a total knee arthroplasty.
尽管许多早期全膝关节置换术的设计允许保留两条交叉韧带，但在当前大多数膝关节置换系统的设计中，要么两条交叉韧带都被切除，要么仅保留后交叉韧带。本报告回顾了一系列保留两条交叉韧带的全膝关节置换术。
对163例（130例患者）保留两条交叉韧带的全膝关节置换术的结果进行前瞻性评估。107例膝关节（89例患者）平均随访10年。其中男性34例，女性96例，初次置换时的平均年龄为67岁（范围42至84岁）。122例（75%）膝关节的诊断为骨关节炎，41例（25%）为类风湿关节炎。26例膝关节有外翻畸形，109例有内翻畸形，28例有5至10度的轻度外翻对线。96例膝关节的前交叉韧带相对正常，67例部分退变。采用膝关节协会评分系统，每年对所有163例膝关节进行前瞻性评估；其中56例膝关节（41例患者）以这种方式随访至患者死亡或失访。
平均随访10年时，可供研究的107例膝关节中有104例（97%）结果为优或良。在最近一次随访时，97例膝关节（91%）疼痛得到充分缓解，平均屈曲范围为107±12.6度（范围65至135度）。95例膝关节（89%）前后向稳定性正常（该平面活动度小于5毫米），12例膝关节（11%）抽屉试验显示有5至10毫米的活动度。96例膝关节（90%）内外侧稳定性正常，11例（10%）有5至10度的松弛。94例膝关节（88%）有5至10度的外翻对线。平均膝关节评分为91±8.4分（范围54至100分），平均功能评分为82±21分（范围10至100分）。以翻修为终点的10年生存率为95±2.0%。本系列163例膝关节中有7例（4%）进行了翻修。没有因髌股问题或胫骨假体无菌性松动而进行的翻修。
本系列平均随访10年后良好的前后向稳定性表明，在全膝关节置换术中保留的前、后交叉韧带，即使部分退变，仍具有功能。
