Strobel Michael J, Schulz Martin S, Petersen Wolf J, Eichhorn H Jürgen
Orthopaedische Gemeinschaftspraxis, Straubing, Germany.
Arthroscopy. 2006 Feb;22(2):182-92. doi: 10.1016/j.arthro.2005.11.001.
The purpose of this study was to evaluate the clinical outcome after 1-stage reconstructions of the anterior and posterior cruciate ligaments (ACL, PCL) with reconstruction of the posterolateral corner (PLC) structures using autogenous hamstring grafts in chronic knee injuries.
Prospective case series.
We reviewed 17 patients (13 men and 4 women) with chronic multiligamentous injuries after a minimum follow-up of 2 years (range, 24 to 66.3 months). Arthroscopically assisted combined ACL/PCL reconstructions with autogenous semitendinosus-gracilis tendon grafts were performed using the single-incision endoscopic ACL technique and the single femoral tunnel, single-bundle transtibial tunnel PCL technique. The PLC was reconstructed with a free autogenous semitendinous tendon graft. The primary outcome measures were the International Knee Documentation Committee (IKDC) score and stress radiography. As secondary outcome measure, all patients were evaluated with a subjective questionnaire, physical examination, radiologic assessment, and KT-1000 arthrometer testing.
The mean time from injury to the reconstructive procedure was 70.2 +/- 96.7 months (range, 5.1 to 312.6 months). At final IKDC evaluation, 4 patients (29.4%) were graded level B (nearly normal), 10 patients (58.8%) level C (abnormal), and 2 patients (11.8%) level D (grossly abnormal). The mean postoperative subjective IKDC score was 71.8 +/- 19.3 points. Mean posterior tibial displacement as measured through stress radiography at 90 degrees of knee flexion was reduced from -15.06 +/- 4.68 mm preoperatively to -7.12 +/- 3.37 mm postoperatively (P < .001). Mean anterior tibial displacement was 0.94 +/- 2.75 mm preoperatively compared with -1.59 +/- 3.50 mm postoperatively (P < .01). Three patients had a fixed posterior tibial subluxation (posterior tibial displacement < or = -3 mm on anterior stress radiographs) postoperatively. Severe subjective instability was reduced significantly by the operative procedure (P < .001). The mean postoperative total anterior-posterior side-to-side difference with the KT-1000 arthrometer testing was 2.00 +/- 2.23 mm (range, -4 to 7 mm).
Combined chronic ACL/PCL/PLC instabilities can be successfully treated with 1-stage arthroscopic cruciate ligament reconstruction combined with PLC reconstruction using autogenous hamstring grafts. Although current reconstruction techniques are not able to restore normal tibiofemoral kinematics, most patients recover a functionally stable knee and have considerably improved knee function compared with their preoperative status, based on subjective parameters and objective criteria.
Level IV, case series, no historical or control group.
本研究旨在评估在慢性膝关节损伤中，采用自体腘绳肌腱移植对前交叉韧带（ACL）、后交叉韧带（PCL）进行一期重建并同时重建后外侧角（PLC）结构后的临床疗效。
前瞻性病例系列研究。
我们回顾了17例患者（13例男性，4例女性），这些患者均为慢性多韧带损伤，随访时间至少2年（范围为24至66.3个月）。采用单切口内镜下ACL技术及单股骨隧道、单束经胫骨隧道PCL技术，通过关节镜辅助，使用自体半腱肌-股薄肌腱移植进行ACL/PCL联合重建。采用游离自体半腱肌腱移植重建PLC。主要结局指标为国际膝关节文献委员会（IKDC）评分及应力位X线片。作为次要结局指标，所有患者均通过主观问卷、体格检查、影像学评估及KT-1000关节测量仪检查进行评估。
从受伤至重建手术的平均时间为70.2±96.7个月（范围为5.1至312.6个月）。在最终的IKDC评估中，4例患者（29.4%）评定为B级（接近正常），10例患者（58.8%）为C级（异常），2例患者（11.8%）为D级（严重异常）。术后主观IKDC评分平均为71.8±19.3分。通过应力位X线片测量，膝关节屈曲90°时胫骨后移的平均值从术前的-15.06±4.68 mm降至术后的-7.12±3.37 mm（P < 0.001）。术前胫骨前移平均值为0.94±2.75 mm，术后为-1.59±3.50 mm（P < 0.01）。3例患者术后存在固定的胫骨后外侧半脱位（前向应力位X线片显示胫骨后移≤-3 mm）。手术显著降低了严重的主观不稳定感（P < 0.001）。术后使用KT-1000关节测量仪检测的前后侧左右平均差值为2.00±2.23 mm（范围为-4至7 mm）。
对于慢性ACL/PCL/PLC联合不稳定，采用一期关节镜下交叉韧带重建联合PLC重建并使用自体腘绳肌腱移植可成功治疗。尽管目前的重建技术无法恢复正常的胫股关节运动学，但基于主观参数和客观标准，大多数患者的膝关节恢复了功能稳定性，与术前状态相比膝关节功能有显著改善。
IV级，病例系列研究，无历史对照或对照组。
