Zehms Chad T, Whiddon David R, Miller Mark D, Quinby J Scott, Montgomery Scott L, Campbell R Brick, Sekiya Jon K
Bone and Joint/Sports Medicine Institute, Naval Medical Center Portsmouth, Portsmouth, Virginia, USA.
Arthroscopy. 2008 Apr;24(4):472-80. doi: 10.1016/j.arthro.2007.09.012. Epub 2008 Jan 7.
The ideal surgical management of isolated and combined posterior cruciate ligament (PCL) injuries is controversial. One active debate concerns the advantages of an open tibial inlay technique versus an arthroscopic transtibial tunnel technique. Therefore, the goal of this study is to biomechanically compare arthroscopic and open double-bundle PCL tibial inlay procedure with and without posterolateral corner (PLC) deficiency.
Ten matched pairs of cadaveric knees were randomly assigned to undergo PCL sectioning and reconstruction using either the open inlay or arthroscopic inlay approach. Clinical testing consisted of posterior drawer, TELOS stress testing, and dial testing at both 30 degrees and 90 degrees . The knee conditions tested were intact, after PCL sectioning, after PLC release, and following PCL reconstruction, with and without the PLC repair. Both 1-way repeated measures and 2-way mixed design analyses of variance were used to determine differences between the knee conditions, with significance set at P < .05.
After PCL and PLC reconstruction, 10 of 10 open specimens and 9 of 10 arthroscopic specimens were a grade 0 posterior drawer. The remaining arthroscopic specimen was grade I. The average radiographic posterior displacement for arthroscopic and open reconstructions (PCL+/PLC+) was 3.9 and 2.7 mm, respectively, with no significant difference. However, if the PLC was deficient (PCL+/PLC-), the translation for arthroscopic and open specimens increased to 8.5 and 6.5 mm, respectively, and was statistically different from the intact state but not from each other. At 30 degrees of knee flexion, both the open and arthroscopic specimen averaged 8.4 degrees of external rotation. At 90 degrees of knee flexion, the external rotation measurements increased to 9.6 degrees and 9.3 degrees in the arthroscopic and open groups, respectively. Additionally, there was no significant difference in external rotation between intact and reconstructed knees with either group.
The arthroscopic method of double-bundle inlay PCL reconstruction provides comparable stability to the open inlay using clinically relevant measurement tools both in the PLC intact or deficient state.
This novel arthroscopic double-bundle PCL inlay reconstruction provides comparable stability to the open approach with a potential for lower operative morbidity.
孤立性和合并性后交叉韧带（PCL）损伤的理想手术治疗方法存在争议。一个活跃的争论焦点在于开放胫骨嵌体技术与关节镜下经胫骨隧道技术的优势。因此，本研究的目的是对关节镜下和开放双束PCL胫骨嵌体手术在有和没有后外侧角（PLC）缺损情况下进行生物力学比较。
十对匹配的尸体膝关节被随机分配接受PCL切断和重建，采用开放嵌体或关节镜下嵌体方法。临床测试包括后抽屉试验、TELOS应力试验以及在30度和90度时的旋转试验。测试的膝关节状况包括完整状态、PCL切断后、PLC松解后以及PCL重建后，有无PLC修复。采用单向重复测量和双向混合设计方差分析来确定膝关节状况之间的差异，显著性设定为P <.05。
PCL和PLC重建后，10个开放标本中的10个以及10个关节镜标本中的9个后抽屉试验为0级。其余关节镜标本为I级。关节镜下和开放重建（PCL+/PLC+）的平均影像学后移分别为3.9和2.7毫米，无显著差异。然而，如果PLC缺损（PCL+/PLC-），关节镜和开放标本的移位分别增加到8.5和6.5毫米，与完整状态有统计学差异，但两者之间无差异。在膝关节屈曲30度时，开放和关节镜标本的平均外旋均为8.4度。在膝关节屈曲90度时，关节镜组和开放组的外旋测量值分别增加到9.6度和9.3度。此外，两组中完整和重建膝关节之间的外旋无显著差异。
在PLC完整或缺损状态下，关节镜下双束嵌体PCL重建方法使用临床相关测量工具提供了与开放嵌体相当的稳定性。
这种新型关节镜下双束PCL嵌体重建提供了与开放手术相当的稳定性，且手术发病率可能更低。
