Whiddon David R, Zehms Chad T, Miller Mark D, Quinby J Scott, Montgomery Scott L, Sekiya Jon K
Bone and Joint/Sports Medicine Institute, Naval Medical Center Portsmouth, 620 John Paul Jones Circle, Portsmouth, VA 23708, USA.
J Bone Joint Surg Am. 2008 Sep;90(9):1820-9. doi: 10.2106/JBJS.G.01366.
There is considerable controversy regarding whether a double-bundle reconstruction of the posterior cruciate ligament is superior to single-bundle techniques. The purpose of this study was to compare posterior tibial translation and external rotation following double and single-bundle tibial inlay reconstruction of the posterior cruciate ligament in both a posterolateral corner-deficient and a repaired cadaver model.
Posterior drawer testing, dial testing, and stress radiography were performed on nine cadaver knees. The intact knees served as controls. The posterior cruciate ligament and the posterolateral corner structures were resected, and each knee then underwent a double-bundle reconstruction of the posterior cruciate ligament. Following testing, both with and without the posterolateral corner repaired, the posteromedial bundle was released and the knee was retested with a single-bundle reconstruction.
With dial testing, external rotation measured a mean (and standard error) of 7.6 degrees +/- 0.4 degrees at 30 degrees of knee flexion and 9.0 degrees +/- 0.8 degrees at 90 degrees after the double-bundle reconstruction with posterolateral corner repair, and it measured 11.2 degrees +/- 1.4 degrees at both 30 degrees and 90 degrees after the single-bundle reconstruction with posterolateral corner repair. When dial testing was performed after the double-bundle reconstruction without posterolateral corner repair, external rotation measured a mean of 15.8 degrees +/- 1.9 degrees at 30 degrees and 16.9 degrees +/- 2.0 degrees at 90 degrees; after the single-bundle reconstruction without posterolateral corner repair, it measured 20.1 degrees +/- 1.8 degrees at 30 degrees and 20.3 degrees +/- 1.7 degrees at 90 degrees. Without posterolateral corner repair, the double-bundle reconstruction permitted significantly less external rotation than did the single-bundle reconstruction at 30 degrees (p = 0.03). Stress radiography showed the mean posterior displacement after the double-bundle reconstruction with posterolateral corner repair to be 3.3 +/- 1.4 mm. This value was not significantly different from the mean posterior displacement of 4.8 +/- 1.0 mm after the single-bundle reconstruction with posterolateral corner repair, and both values were similar to that for the intact control (2.9 +/- 0.5 mm) (p = 0.254). However, the single-bundle reconstruction without posterolateral corner repair was associated with significantly increased posterior displacement when compared with the intact controls (p = 0.039) and with the double-bundle reconstruction without posterolateral corner repair (p = 0.026).
Double-bundle reconstruction of the posterior cruciate ligament offers measurable benefits in terms of rotational stability and posterior translation in the setting of an untreated posterolateral corner injury. With the posterolateral corner intact, at time zero, the double-bundle reconstruction used in this study provided more rotational constraint to the knee at 30 degrees and it did not further reduce posterior translation.
关于后交叉韧带双束重建是否优于单束技术存在相当大的争议。本研究的目的是在外侧后角缺损和修复的尸体模型中，比较后交叉韧带双束和单束胫骨嵌体重建后的胫骨后移和外旋情况。
对9个尸体膝关节进行后抽屉试验、旋转试验和应力X线摄影。完整的膝关节作为对照。切除后交叉韧带和外侧后角结构，然后每个膝关节进行后交叉韧带双束重建。在试验后，无论外侧后角是否修复，均松解后内侧束，然后对膝关节进行单束重建并再次测试。
在外侧后角修复的双束重建后，旋转试验中，膝关节屈曲30度时外旋平均（及标准误）为7.6度±0.4度，90度时为9.0度±0.8度；在外侧后角修复的单束重建后，30度和90度时外旋均为11.2度±1.4度。在外侧后角未修复的双束重建后进行旋转试验时，30度时外旋平均为15.8度±1.9度，90度时为16.9度±2.0度；在外侧后角未修复的单束重建后，30度时为20.1度±1.8度，90度时为20.3度±1.7度。外侧后角未修复时，双束重建在30度时允许的外旋明显少于单束重建（p = 0.03）。应力X线摄影显示外侧后角修复的双束重建后平均后移为3.3±1.4 mm。该值与外侧后角修复的单束重建后平均后移4.8±1.0 mm无显著差异，且两个值均与完整对照（2.9±0.5 mm）相似（p = 0.254）。然而，外侧后角未修复的单束重建与完整对照相比（p = 0.039）以及与外侧后角未修复的双束重建相比（p = 0.026），后移明显增加。
在未治疗的外侧后角损伤情况下，后交叉韧带双束重建在旋转稳定性和后移方面有可测量的益处。外侧后角完整时，在初始阶段，本研究中使用的双束重建在30度时为膝关节提供了更多的旋转约束，且并未进一步减少后移。
