Bergfeld J A, McAllister D R, Parker R D, Valdevit A D, Kambic H
Department of Orthopaedic Surgery, The Cleveland Clinic Foundation, Ohio 44195, USA.
J Bone Joint Surg Am. 2001 Sep;83(9):1339-43. doi: 10.2106/00004623-200109000-00008.
One of the most useful clinical tests for diagnosing an isolated injury of the posterior cruciate ligament is the posterior drawer maneuver performed with the knee in 90 degrees of flexion. Previously, it was thought that internally rotating the tibia during posterior drawer testing would decrease posterior laxity in a knee with an isolated posterior cruciate ligament injury. In this study, we evaluated the effects of internal and external tibial rotation on posterior laxity with the knee held in varying degrees of flexion after the posterior cruciate and meniscofemoral ligaments had been cut.
Twenty cadaveric knees were used. Each knee was mounted in a fixture with six degrees of freedom, and anterior and posterior forces of 150 N were applied. The testing was conducted with the knee in 90 degrees, 60 degrees, 30 degrees, and 0 degrees of flexion with the tibia in neutral, internal, and external rotation. All knees were tested with the posterior cruciate and meniscofemoral ligaments intact and transected. Repeated-measures analysis of variance was used for statistical analysis.
At 30 degrees, 60 degrees, and 90 degrees of flexion, there was a significant increase in posterior laxity following transection of the posterior cruciate and meniscofemoral ligaments. At 60 degrees and 90 degrees of flexion, there was significantly less posterior laxity when the tibia was held in internal compared with external rotation. At 0 degrees and 30 degrees of flexion, there was no significant difference in posterior laxity when the tibia was held in internal compared with external rotation.
After the posterior cruciate and meniscofemoral ligaments had been cut, posterior laxity was significantly decreased by both internal and external rotation of the tibia. Internal tibial rotation resulted in significantly less laxity than external tibial rotation did at 60 degrees and 90 degrees of knee flexion.
诊断单纯后交叉韧带损伤最有用的临床检查之一是在膝关节屈曲90度时进行后抽屉试验。此前，人们认为在后抽屉试验过程中使胫骨内旋会减少单纯后交叉韧带损伤膝关节的后向松弛度。在本研究中，我们在切断后交叉韧带和半月板股骨韧带后，评估了胫骨内旋和外旋对膝关节处于不同屈曲度时后向松弛度的影响。
使用20具尸体膝关节。每个膝关节安装在一个具有六个自由度的固定装置中，并施加150N的前后向力。测试在膝关节屈曲90度、60度、30度和0度时进行，胫骨处于中立、内旋和外旋状态。所有膝关节在完整和切断后交叉韧带及半月板股骨韧带的情况下均进行了测试。采用重复测量方差分析进行统计分析。
在屈曲30度、60度和90度时，切断后交叉韧带和半月板股骨韧带后后向松弛度显著增加。在屈曲60度和90度时，与外旋相比，胫骨内旋时后向松弛度显著减小。在屈曲0度和30度时，胫骨内旋与外旋时后向松弛度无显著差异。
切断后交叉韧带和半月板股骨韧带后，胫骨内旋和外旋均显著降低了后向松弛度。在膝关节屈曲60度和90度时，胫骨内旋导致的松弛度明显小于外旋。
