Stannard James P, Brown Stephen L, Robinson James T, McGwin Gerald, Volgas David A
Division of Orthopaedic Surgery, The University of Alabama, Birmingham, Alabama 5294-3409, USA.
Arthroscopy. 2005 Sep;21(9):1051-9. doi: 10.1016/j.arthro.2005.05.020.
To describe a technique for reconstruction of the posterolateral corner (PLC) of the knee and report the results of a prospective series of patients.
Case series.
Twenty-two patients with PLC injuries underwent reconstruction; 15 patients had multiligamentous knee injuries and 7 had isolated PLC injuries. We used the modified 2-tailed technique that reconstructs the popliteofibular ligament and fibulocollateral ligament. The technique includes use of an allograft tendon placed through transtibial and transfibular bone tunnels and around a screw on the lateral femoral condyle. All patients have been followed-up prospectively with clinical examinations, Lysholm knee scores, KT-2000 ligament arthrometer examinations, and evaluation of work and recreational functional status.
There were 15 male and 7 female patients (mean age, 32 years; range, 17 to 55 years). Follow-up was a minimum of 24 months (mean, 29.5 months; range, 24 to 38 months). Mean range of motion is extension of 0.2 degrees (range, 0 degrees to 5 degrees) and flexion of 133.4 degrees (80 degrees to 144 degrees). The range of motion for the multiligamentous knees was 0.3 degrees to 129 degrees compared with 0 degrees to 143 degrees for knees with isolated corner injuries. Mean Lysholm knee scores were 90 for the entire group with a score of 92 for the multiligamentous knees and 88 for the isolated corners. Stability was clinically graded on a scale of 0 to 3 for both varus stress and external rotation, with a score of 2 or 3 indicating a failed PLC reconstruction. The mean score for varus stress was 0.2 for the whole group, with 0.3 in the multiligamentous knee and 0.1 for the isolated injuries. Similarly, the mean score for external rotation was 0.4, with a 0.5 for multiligamentous knee and 0.3 for isolated PLC injuries. There were 2 failures in the multiligamentous knee injury group (13%), compared with no failures in the isolated PLC group. The failure rate for the whole study was 9%.
Reconstruction of the PLC using an allograft reconstruction of the popliteus, popliteofibular, and fibulocollateral ligaments yielded a stable reconstruction with excellent functional results. Predictably, range of motion and incidence of failure were both better for patients with isolated PLC injuries than for those with multiligamentous knees. Both groups, however, showed excellent overall functional results.
Level IV, case series.
描述一种膝关节后外侧角（PLC）重建技术，并报告一系列前瞻性患者的结果。
病例系列。
22例PLC损伤患者接受了重建手术；15例患者为膝关节多韧带损伤，7例为单纯PLC损伤。我们采用改良的双尾技术重建腘腓韧带和腓侧副韧带。该技术包括使用同种异体肌腱，通过胫骨和腓骨骨隧道，并绕过股骨外侧髁上的螺钉放置。所有患者均接受前瞻性临床检查、Lysholm膝关节评分、KT-2000韧带关节测量仪检查，以及工作和娱乐功能状态评估。
男性15例，女性7例（平均年龄32岁；范围17至55岁）。随访时间至少24个月（平均29.5个月；范围24至38个月）。平均活动范围为伸直0.2度（范围0度至5度），屈曲133.4度（80度至144度）。多韧带损伤膝关节的活动范围为0.3度至129度，而单纯角部损伤膝关节的活动范围为0度至143度。整个组的平均Lysholm膝关节评分为90分，多韧带损伤膝关节评分为92分，单纯角部损伤评分为88分。内翻应力和外旋的临床稳定性分级为0至3级，2级或3级表示PLC重建失败。整个组内翻应力的平均评分为0.2，多韧带损伤膝关节为0.3，单纯损伤为0.1。同样，外旋的平均评分为0.4，多韧带损伤膝关节为0.5，单纯PLC损伤为0.3。多韧带损伤膝关节组有2例失败（13%），而单纯PLC组无失败病例。整个研究的失败率为9%。
使用同种异体肌腱重建腘肌、腘腓韧带和腓侧副韧带进行PLC重建，可获得稳定的重建效果和出色的功能结果。可以预见，单纯PLC损伤患者的活动范围和失败发生率均优于多韧带损伤膝关节患者。然而，两组的总体功能结果均出色。
IV级，病例系列。
Zotero 插件