Whiteside L A, Saeki K, Mihalko W M
Biomechanical Research Laboratory, Missouri Bone and Joint Center, St Louis, USA.
Clin Orthop Relat Res. 2000 Nov(380):45-57. doi: 10.1097/00003086-200011000-00007.
Function of the anterior and posterior oblique portions of the medial collateral ligament and the posterior capsule in flexion and extension was evaluated in eight knee specimens after posterior cruciate retaining total knee arthroplasty. The posterior oblique portion of the medial collateral ligament was released subperiosteally in four specimens, and the anterior portion was released in four specimens. The medial posterior capsule was released in each group, then the remaining portion of the medial collateral ligament was released. Release of the posterior oblique portion produced moderate laxity at full extension and at 30 degrees flexion, and posterior capsule release produced additional laxity in full extension. Release of the anterior portion produced major laxity at 60 degrees and 90 degrees flexion. Complete medial collateral ligament release increased laxity significantly in both groups in flexion and extension. This rationale was tested in a clinical study of 82 knees (76 patients) in which 62 (76%) required medial collateral ligament release to correct varus deformity during posterior cruciate retaining total knee arthroplasty. Twenty-two knees (35.5%) were tight medially in extension only, and were corrected by releasing the posterior oblique portion. Thirty-one knees (50%) were tight medially in flexion only, and were corrected by releasing the anterior portion. Nine knees (14.5%) were tight medially in flexion and extension and required complete medial collateral ligament release, but three knees (4.8%) remained tight in extension and required medial posterior capsule release to correct flexion contracture and medial ligament contracture. Seventeen (27%) had partial posterior cruciate ligament release to correct excessive rollback of the femoral component on the tibial surface.
在8个后交叉韧带保留型全膝关节置换术后的膝关节标本中，评估了内侧副韧带前后斜部及后关节囊在屈伸过程中的功能。内侧副韧带后斜部在4个标本中进行骨膜下松解，前斜部在4个标本中进行松解。每组均松解内侧后关节囊，然后松解内侧副韧带的其余部分。后斜部松解在完全伸直和30度屈曲时产生中度松弛，后关节囊松解在完全伸直时产生额外松弛。前斜部松解在60度和90度屈曲时产生严重松弛。两组中完全松解内侧副韧带在屈伸时均显著增加松弛度。在一项对82个膝关节（76例患者）的临床研究中验证了这一理论，其中62个膝关节（76%）在进行后交叉韧带保留型全膝关节置换术时需要松解内侧副韧带以纠正内翻畸形。22个膝关节（35.5%）仅在伸直时内侧紧张，通过松解后斜部得以纠正。31个膝关节（50%）仅在屈曲时内侧紧张，通过松解前斜部得以纠正。9个膝关节（14.5%）在屈伸时内侧均紧张，需要完全松解内侧副韧带，但3个膝关节（4.8%）在伸直时仍紧张，需要松解内侧后关节囊以纠正屈曲挛缩和内侧韧带挛缩。17个膝关节（27%）进行了部分后交叉韧带松解以纠正股骨部件在胫骨表面的过度后倾。
