Coobs Benjamin R, LaPrade Robert F, Griffith Chad J, Nelson Bradley J
Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN 55454, USA.
Am J Sports Med. 2007 Sep;35(9):1521-7. doi: 10.1177/0363546507302217. Epub 2007 May 10.
The fibular collateral ligament is the primary stabilizer to varus instability of the knee. Untreated fibular collateral ligament injuries can lead to residual knee instability and can increase the risk of concurrent cruciate ligament reconstruction graft failures. Anatomic reconstructions of the fibular collateral ligament have not been biomechanically validated.
To describe an anatomic fibular collateral ligament reconstruction using an autogenous semitendinosus graft and to test the hypothesis that using this reconstruction technique to treat an isolated fibular collateral ligament injury will restore the knee to near normal stability.
Controlled laboratory study.
Ten nonpaired, fresh-frozen cadaveric knees were biomechanically subjected to a 10 N.m varus moment and 5 N.m external and internal rotation torques at 0 degrees, 15 degrees, 30 degrees, 60 degrees, and 90 degrees of knee flexion. Testing was performed with an intact and sectioned fibular collateral ligament, and also after an anatomic reconstruction of the fibular collateral ligament with an autogenous semitendinosus graft. Motion changes were assessed with a 6 degree of freedom electromagnetic motion analysis system.
After sectioning, we found significant increases in varus rotation at 0 degrees, 15 degrees, 30 degrees, 60 degrees, and 90 degrees, external rotation at 60 degrees and 90 degrees, and internal rotation at 0 degrees, 15 degrees, 30 degrees, 60 degrees, and 90 degrees of knee flexion. After reconstruction, there were significant decreases in motion in varus rotation at 0 degrees, 15 degrees, 30 degrees, 60 degrees, and 90 degrees, external rotation at 60 degrees and 90 degrees, and internal rotation at 0 degrees, 15 degrees, and 30 degrees of knee flexion. In addition, we observed a full recovery of knee stability in varus rotation at 0 degrees, 60 degrees, and 90 degrees, external rotation at 60 degrees and 90 degrees, and internal rotation at 0 degrees and 30 degrees of knee flexion.
An anatomic fibular collateral ligament reconstruction restores varus, external, and internal rotation to near normal stability in a knee with an isolated fibular collateral ligament injury.
An anatomic reconstruction of the fibular collateral ligament with an autogenous semitendinosus graft is a viable option to treat nonrepairable acute or chronic fibular collateral ligament tears in patients with varus instability.
腓侧副韧带是膝关节内翻不稳定的主要稳定结构。未经治疗的腓侧副韧带损伤可导致膝关节残留不稳定，并增加同时进行的交叉韧带重建移植物失败的风险。腓侧副韧带的解剖重建尚未经过生物力学验证。
描述一种使用自体半腱肌移植物进行腓侧副韧带解剖重建的方法，并验证使用这种重建技术治疗孤立性腓侧副韧带损伤可使膝关节恢复接近正常稳定性的假设。
对照实验室研究。
对10个非配对的新鲜冷冻尸体膝关节进行生物力学测试，在膝关节屈曲0度、15度、30度、60度和90度时施加10 N·m的内翻力矩以及5 N·m的外旋和内旋扭矩。测试在腓侧副韧带完整、切断以及使用自体半腱肌移植物对腓侧副韧带进行解剖重建后进行。使用六自由度电磁运动分析系统评估运动变化。
切断腓侧副韧带后，在膝关节屈曲0度、15度、30度、60度和90度时内翻旋转显著增加，在60度和90度时外旋显著增加，在0度、15度、30度、60度和90度时内旋显著增加。重建后，在膝关节屈曲0度、15度、30度、60度和90度时内翻旋转运动显著减少，在60度和90度时外旋运动显著减少，在0度、15度和30度时内旋运动显著减少。此外，我们观察到在膝关节屈曲0度、60度和90度时内翻旋转、60度和90度时外旋以及0度和30度时内旋的膝关节稳定性完全恢复。
对于孤立性腓侧副韧带损伤的膝关节，腓侧副韧带解剖重建可使内翻、外旋和内旋恢复至接近正常的稳定性。
使用自体半腱肌移植物对腓侧副韧带进行解剖重建是治疗内翻不稳定患者不可修复的急性或慢性腓侧副韧带撕裂的可行选择。
