Department of Orthopaedic Surgery, Chung-Ang University School of Medicine, Seoul, Korea.
Knee Surg Sports Traumatol Arthrosc. 2010 Sep;18(9):1219-25. doi: 10.1007/s00167-010-1078-4. Epub 2010 Feb 25.
If posterolateral rotatory instability (PLRI) injury in patients with a torn anterior cruciate ligament (ACL) is not diagnosed and treated, ACL reconstruction can fail. We retrospectively evaluated the clinical outcome after reconstructions between 2002 and 2007 of both the ACL and the posterolateral corner (PLC) in 44 knees with combined ACL and PLC injuries. The median follow-up duration was 49 months (range, 24-68 months). ACL reconstruction employed autogenous hamstring grafts from the ipsilateral knee. For grade II PLRI, a posterolateral corner sling through the fibular head was placed obliquely from the anteroinferior aspect to the posterosuperior aspect using autogenous hamstring grafts of the contralateral knee. Clinical outcomes were evaluated using the OAK (Orthopadishe Arbeitsgruppe Knie) and IKDC (International Knee Documentation Committee) knee scoring systems. Anterior stability was measured on pull stress radiographs using a Telos stress device and the manual maximum displacement test using a KT-1000 arthrometer with the knee flexed 30 degrees. PLRI was classified according to varus and rotational instability preoperatively and at final follow-up. Median OAK scores improved from 71 points (range, 48-86) to 93 points (range, 75-100). Satisfactory IKDC results were achieved in 39 knees (89%). As for anterior stability, as measured by anterior stress radiography, mean side-to-side displacement difference dropped significantly from 6.9 +/- 1.9 preoperatively to 1.4 +/- 1.1 mm at final follow-up. Forty patients (91%) had the same or better rotational stability compared to the normal side. Varus stress radiographs showed mean side-to-side displacement differences dropped from 1.8 +/- 1.7 preoperatively to 0.4 +/- 0.8 mm at final follow-up. Thus, chronic ACL deficiency is often accompanied by grade II PLRI and can be treated successfully by arthroscopic ACL reconstruction paired with posterolateral reconstruction employing a single sling through the fibular tunnel and a hamstring tendon autograft.
如果未诊断和治疗前交叉韧带（ACL）撕裂患者的后外侧旋转不稳定（PLRI）损伤，ACL 重建可能会失败。我们回顾性评估了 2002 年至 2007 年间 44 例 ACL 和后外侧角（PLC）合并损伤患者接受 ACL 和 PLC 重建后的临床结果。中位随访时间为 49 个月（范围，24-68 个月）。ACL 重建采用同侧膝关节自体腘绳肌腱移植物。对于 II 级 PLRI，采用对侧膝关节自体腘绳肌腱移植物从前下到后上斜向穿过腓骨头放置后外侧角吊带。使用 OAK（Orthopadishe Arbeitsgruppe Knie）和 IKDC（国际膝关节文献委员会）膝关节评分系统评估临床结果。使用 Telos 应力装置在牵引应力射线照相上测量前向稳定性，并使用 KT-1000 关节测量仪在膝关节屈曲 30 度时使用手动最大位移试验测量前向稳定性。根据术前和最终随访时的内翻和旋转不稳定情况对 PLRI 进行分类。OAK 中位数评分从 71 分（范围，48-86）改善至 93 分（范围，75-100）。39 例（89%）膝关节获得满意的 IKDC 结果。在前向应力射线照相测量的前向稳定性方面，平均侧间差值从术前的 6.9 +/- 1.9 显著下降至最终随访时的 1.4 +/- 1.1 毫米。40 例患者（91%）与健侧相比具有相同或更好的旋转稳定性。内翻应力射线照相显示平均侧间差值从术前的 1.8 +/- 1.7 下降至最终随访时的 0.4 +/- 0.8 毫米。因此，慢性 ACL 缺失常伴有 II 级 PLRI，可通过关节镜 ACL 重建联合后外侧重建成功治疗，采用单一吊带通过腓骨隧道和自体腘绳肌腱移植物。
