LaPrade Robert F, Muench Carter, Wentorf Fred, Lewis Jack L
Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota 55455, USA.
Am J Sports Med. 2002 Mar-Apr;30(2):233-8. doi: 10.1177/03635465020300021501.
To determine whether untreated grade 3 posterolateral knee injuries contribute to a significant increase in force on a posterior cruciate ligament reconstruction graft, we measured the force on the graft during joint loading of a posterior cruciate ligament-reconstructed knee with otherwise intact structures and then selectively cut the popliteofibular ligament, popliteus tendon, and the fibular collateral ligament. A posterior cruciate ligament reconstruction was performed in eight fresh-frozen cadaveric knees. One end of the graft was fixed to a tensioning jig with a load cell used to measure force in the graft as loads were applied to the knee. The force on the graft was significantly higher with the posterolateral structures cut during varus loading at 30 degrees, 60 degrees, and 90 degrees of flexion than it was in the same joint under the same loading conditions but with the posterolateral structures intact. Additionally, coupled loading of posterior drawer force and external tibial torque at 30 degrees, 60 degrees, and 90 degrees significantly increased force on the graft with the posterolateral structures cut. There was no significant increase in force on the graft under any condition with a posterior force, valgus force, or internal and external tibial torque applied alone. A significant increase in force occurs in a posterior cruciate ligament graft in knees with deficient posterolateral knee structures. We recommend that in knees with grade 3 posterolateral injuries and evidence of varus or coupled posterior-external rotation instability the posterolateral structures be repaired or reconstructed at the time of posterior cruciate ligament reconstruction to decrease the chance of later graft failure.
为了确定未经治疗的膝关节后外侧3级损伤是否会显著增加后交叉韧带重建移植物上的受力，我们在一个后交叉韧带重建的膝关节（其他结构完好）的关节加载过程中测量了移植物上的受力，然后选择性地切断了腘腓韧带、腘肌腱和腓侧副韧带。对8个新鲜冷冻的尸体膝关节进行了后交叉韧带重建。移植物的一端固定在一个带有测力传感器的张紧夹具上，在对膝关节施加负荷时用于测量移植物中的力。在30度、60度和90度屈曲的内翻加载过程中，切断后外侧结构时移植物上的受力明显高于在相同加载条件下但后外侧结构完整的同一关节。此外，在30度、60度和90度时，后抽屉力和胫骨外扭矩的联合加载在切断后外侧结构时显著增加了移植物上的受力。单独施加后向力、外翻力或胫骨内、外扭矩时，在任何情况下移植物上的受力均无显著增加。后外侧膝关节结构缺损的膝关节后交叉韧带移植物受力显著增加。我们建议，对于有3级后外侧损伤且有内翻或联合后外侧旋转不稳定证据的膝关节，在进行后交叉韧带重建时应修复或重建后外侧结构，以降低后期移植物失败的几率。
