Sohn David H, Balasubramanian Sriram, Demetropoulos Constantine, Yang King, Guettler Joseph, Jurist Kenneth A
University of Toledo Medical Center, Toledo, Ohio, USA.
Orthopedics. 2010 May 12;33(5). doi: 10.3928/01477447-20100329-12.
Treatment of isolated posterior cruciate ligament (PCL) injuries is controversial. This is due in part to the discrepancy between clinical and biomechanical studies in the literature. Clinically, isolated PCL injuries are treated nonoperatively, and patients do well as long as they have adequate quadriceps function. Biomechanically, however, PCL injuries have been shown in cadavers to lead to altered kinematics and increased contact pressures. These studies, however, did not simulate weight-bearing muscle forces, which can compensate for the PCL deficiency. We sought to study the biomechanical effects of PCL deficiency and reconstruction in a cadaveric knee, but with reproduction of the muscle-stabilizing effects of the quadriceps and hamstring muscles. We used a novel 6 degrees of freedom testing system to simulate a muscle-stabilized cadaveric knee and recorded both kinematics and contact pressure data. Four conditions were tested: normal, PCL-deficient, and PCL single- and double-bundle reconstructed states. We found that with muscle stabilization, there were no significant changes in kinematics or contact pressures in the knee between any of these conditions. This corroborates clinical findings and verifies that PCL reconstruction is unnecessary in the muscle-stabilized knee.
孤立性后交叉韧带（PCL）损伤的治疗存在争议。部分原因在于文献中临床研究与生物力学研究结果之间的差异。临床上，孤立性PCL损伤采用非手术治疗，只要患者股四头肌功能正常，恢复情况就良好。然而，在生物力学方面，尸体研究表明PCL损伤会导致运动学改变和接触压力增加。不过，这些研究并未模拟负重时的肌肉力量，而这种力量可以代偿PCL的缺损。我们试图在尸体膝关节上研究PCL缺损及重建的生物力学效应，但要重现股四头肌和腘绳肌的肌肉稳定作用。我们使用一种新型的六自由度测试系统来模拟肌肉稳定的尸体膝关节，并记录运动学和接触压力数据。测试了四种情况：正常、PCL缺损、PCL单束重建和双束重建状态。我们发现，在肌肉稳定的情况下，这些情况中的任何一种之间膝关节的运动学或接触压力均无显著变化。这证实了临床研究结果，并验证了在肌肉稳定的膝关节中PCL重建是不必要的。
