Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN 55905, USA.
Am J Sports Med. 2010 Apr;38(4):804-9. doi: 10.1177/0363546509352459. Epub 2010 Jan 31.
Treatment of the multiligament-injured knee remains controversial.
To compare clinical and functional outcomes of a consecutive series of multiligament-injured knees that underwent repair of the fibular collateral ligament (FCL) and posterolateral corner (PLC), followed by delayed cruciate ligament reconstructions, with those that had single-stage multiligament reconstruction.
Cohort study; Level of evidence, 3. Methods Patients with multiligament knee injury treated by a single surgeon were identified in our prospective database. Between February 2004 and May 2005, patients underwent repair of medial- and lateral-sided injuries, followed by delayed cruciate ligament reconstructions. Between May 2005 and February 2007, patients underwent single-stage multiligament knee reconstruction. All patients followed a standard rehabilitation protocol. Inclusion criteria were minimum 2-year follow-up and multiligament knee injury including the FCL/PLC. International Knee Documentation Committee subjective and Lysholm scores and objective clinical data were documented.
We identified 45 knees (42 patients); 17 knees (14 patients) were excluded, leaving 28 knees (28 patients) in the study. The repair/staged group (10 knees in 10 patients) had a mean follow-up of 34 months (range, 24-49 months). The reconstruction group (18 knees in 18 patients) had a mean follow-up of 28 months (range, 24-41 months). Four of the 10 FCL/PLC repairs (40%) and 1 of the 18 FCL/PLC reconstructions (6%) failed (P = .04). After revision reconstructions, there were no statistically significant differences between mean International Knee Documentation Committee subjective scores (79 vs. 77, P = .92) and mean Lysholm scores (85 vs 88, P = .92). Regression analysis showed no effect on failure based on age, sex, injury mechanism, time to surgery, interval between stages, total number of ligaments injured, or location of tear.
Our series demonstrated a statistically significant higher rate of failure for repair compared with reconstruction of the FCL/PLC. Reconstruction of the FCL/PLC structures is a more reliable option than repair alone in the setting of a multiligament knee injury.
多韧带损伤膝关节的治疗仍存在争议。
比较连续系列多韧带损伤膝关节的临床和功能结果,这些膝关节先修复腓侧副韧带(FCL)和后外侧角(PLC),然后延迟进行十字韧带重建,与那些进行单阶段多韧带重建的膝关节进行比较。
队列研究;证据水平,3 级。方法:在我们的前瞻性数据库中确定由一位外科医生治疗的多韧带膝关节损伤患者。2004 年 2 月至 2005 年 5 月,患者接受内侧和外侧损伤修复,然后延迟进行十字韧带重建。2005 年 5 月至 2007 年 2 月,患者接受单阶段多韧带膝关节重建。所有患者均遵循标准康复方案。纳入标准为至少 2 年随访和多韧带膝关节损伤包括 FCL/PLC。记录国际膝关节文献委员会(International Knee Documentation Committee,IKDC)主观和 Lysholm 评分以及客观临床数据。
我们确定了 45 个膝关节(42 例患者);17 个膝关节(14 例患者)被排除,研究中共有 28 个膝关节(28 例患者)。修复/分期组(10 个膝关节,10 例患者)的平均随访时间为 34 个月(范围,24-49 个月)。重建组(18 个膝关节,18 例患者)的平均随访时间为 28 个月(范围,24-41 个月)。10 个 FCL/PLC 修复中的 4 个(40%)和 18 个 FCL/PLC 重建中的 1 个(6%)失败(P =.04)。在进行翻修重建后,IKDC 主观评分(79 分比 77 分,P =.92)和 Lysholm 评分(85 分比 88 分,P =.92)之间无统计学差异。回归分析显示,失败与年龄、性别、损伤机制、手术时间、分期之间的时间间隔、损伤的总韧带数或撕裂部位无关。
我们的系列研究表明,FCL/PLC 修复的失败率明显高于重建。在多韧带膝关节损伤的情况下,FCL/PLC 结构的重建是比单独修复更可靠的选择。