Wiley William B, Askew Michael J, Melby Arne, Noe Donald A
Walter A. Hoyt, Jr, Musculoskeletal Research Laboratory, Department of Orthopaedic Surgery, Summa Health System, PO Box 2090, 444 North Main Street, Akron, OH 44309-2090, USA.
Am J Sports Med. 2006 May;34(5):741-8. doi: 10.1177/0363546505282615. Epub 2005 Dec 28.
Single- and double-bundle reconstructions have been proposed for the knee after combined posterior cruciate ligament/posterolateral corner injuries.
The double-bundle posterior cruciate ligament reconstruction is superior to the single-bundle posterior cruciate ligament reconstruction with regard to restoration of normal knee kinematics to the posterior cruciate ligament/posterolateral corner-sectioned knee.
Controlled laboratory study.
Kinematics of 8 fresh-frozen, cadaveric human knees were determined in the following conditions: intact, sectioned posterior cruciate ligament/posterolateral corner, single anterolateral bundle posterior cruciate reconstruction, and double-bundle posterior cruciate reconstruction.
The sectioned knee demonstrated a posterior shift of the tibial neutral position and the abnormal posterior, varus, and external rotation laxities used clinically to define a combined posterior cruciate ligament/posterolateral corner injury. Both reconstructions restored the posterior laxity to levels that were not statistically different from those seen in the intact knee, but the double-bundle reconstruction more closely mimicked the posterior laxity profile of the intact knee, having statistically lower posterior laxities than did the single-bundle reconstruction at 30 degrees, 60 degrees, and 90 degrees of flexion (P < .05, analysis of variance, HSD test). The resting position of the tibia after double-bundle reconstruction trended to be anteriorly subluxated relative to its position for the intact knee at flexion angles of 30 degrees and greater (P <.05, paired t test). Neither technique corrected the abnormal varus or external rotation laxities.
With either single- or double-bundle reconstructions, additional posterolateral reconstruction is recommended to correct the external rotation laxity.
Knowledge of the kinematics of the combined posterior cruciate ligament/posterolateral corner-injured knee is important in the proper diagnosis of the injury and in the selection of the appropriate surgical reconstruction.
对于后交叉韧带/后外侧角联合损伤后的膝关节，已提出单束和双束重建方法。
在恢复后交叉韧带/后外侧角切断的膝关节的正常膝关节运动学方面，双束后交叉韧带重建优于单束后交叉韧带重建。
对照实验室研究。
在以下条件下测定8个新鲜冷冻的人体尸体膝关节的运动学：完整、切断后交叉韧带/后外侧角、单前外侧束后交叉韧带重建和双束后交叉韧带重建。
切断的膝关节表现出胫骨中立位后移以及临床上用于定义后交叉韧带/后外侧角联合损伤的异常后向、内翻和外旋松弛。两种重建均将后向松弛恢复到与完整膝关节无统计学差异的水平，但双束重建更接近完整膝关节的后向松弛曲线，在30度、60度和90度屈曲时，其统计学上的后向松弛低于单束重建（P <.05，方差分析，HSD检验）。双束重建后胫骨的静止位置在30度及以上屈曲角度时相对于完整膝关节的位置有向前半脱位的趋势（P <.05，配对t检验）。两种技术均未纠正异常的内翻或外旋松弛。
无论是单束还是双束重建，建议额外进行后外侧重建以纠正外旋松弛。
了解后交叉韧带/后外侧角联合损伤膝关节的运动学对于损伤的正确诊断和合适手术重建的选择很重要。
