Department of Orthopedic Surgery, Saarland University, Kirrberger Street, Homburg, Saarland, Germany.
Knee Surg Sports Traumatol Arthrosc. 2012 May;20(5):844-50. doi: 10.1007/s00167-011-1635-5. Epub 2011 Aug 3.
The goal of the present study was to evaluate static anteroposterior and rotational knee laxity after ACL reconstructions with two noninvasive measurement devices by comparing the measured results of the operated with the contralateral healthy knees of the patients.
Fifty-two consecutive patients were reviewed after isolated single-bundle transtibial ACL reconstruction using a BPTB graft. At a mean follow-up of 27 months, sagittal AP laxity was tested using a noninvasive knee measurement system (Genourob) with an applied pressure of 67 N, 89 N and 134 N. Rotational laxity was measured using a noninvasive rotational knee laxity device (Rotameter) with an applied torque of 5, 8 and 10 Nm. The results were compared with the measurements of the patients' healthy contralateral knees. Tegner, Lysholm and IKDC score were used in order to evaluate the clinical outcome.
Pivot shift was negative (33) or glide (16) in 49 patients with 12 of 16 (75%) patients having also a pivot glide on the healthy contralateral side; Lachman tests were negative in 50 cases. Subjective assessment of the IKDC score was classified according to category A in 44 patients, B in 5 patients and C in 3 patients. Mean Lysholm score was 94.5 ± 9.5, median Tegner score was 7 (3-9) preoperative and 6 (3-9) at follow-up (n.s.). Anteroposterior knee laxity measurements revealed mean side-to-side differences of 0.6-1.3 mm (P < 0.0001). Rotational laxity measurements revealed no statistical significant differences between the operated and the contralateral knee (n.s.). The measured differences in the entire rotational range varied from 0.2° to 1° depending on the applied torque. In those 3 patients with a positive pivot shift, differences in the entire rotational range of 4.5° at 5 N, 4.6° at 8 N and 4.1° at 10 N were found.
Static knee laxity was quantified after ACL surgery using the introduced noninvasive measurement systems by comparing the measured results of the operated with the contralateral healthy knees. Significant differences were found in AP laxity although they were defined as clinically successful according to the IKDC classification. No significant differences were found in rotational knee laxity measurements. Therefore, the used noninvasive masurement devices might offer a high potential for objective quality control in knee ligament injuries and their treatment.
Retrospective case series, Level IV.
本研究的目的是通过比较患者手术侧和对侧健康膝关节的测量结果，评估两种非侵入性测量设备在 ACL 重建后膝关节的前后向和旋转松弛度。
对 52 例接受单束腘绳肌腱胫骨止点重建的 ACL 患者进行回顾性分析。平均随访 27 个月后，使用非侵入性膝关节测量系统（Genourob）在施加 67 N、89 N 和 134 N 压力下测试矢状面 AP 松弛度。使用非侵入性旋转膝关节松弛度测量装置（Rotameter）在施加 5、8 和 10 Nm 扭矩下测量旋转松弛度。将结果与患者健康对侧膝关节的测量结果进行比较。使用 Tegner、Lysholm 和 IKDC 评分评估临床结果。
49 例患者中，有 33 例（67%）出现阴性（33 例）或滑动（16 例）前抽屉征，16 例患者中（75%）有 12 例对侧膝关节也出现滑动前抽屉征；50 例患者的 Lachman 试验均为阴性。根据 IKDC 评分的 A 类，44 例患者的主观评估为 A 类，5 例患者为 B 类，3 例患者为 C 类。平均 Lysholm 评分为 94.5±9.5，术前中位数 Tegner 评分为 7（3-9），随访时为 6（3-9）（无统计学意义）。前后向膝关节松弛度测量显示，侧-侧差值为 0.6-1.3mm（P＜0.0001）。旋转松弛度测量显示手术侧和对侧膝关节之间无统计学差异（无统计学意义）。在整个旋转范围内，所测量的差异取决于施加的扭矩，在 0.2°至 1°之间变化。在 3 例前抽屉征阳性的患者中，在 5 N 时整个旋转范围的差异为 4.5°，在 8 N 时为 4.6°，在 10 N 时为 4.1°。
本研究使用介绍的非侵入性测量系统，通过比较手术侧与对侧健康膝关节的测量结果，对 ACL 术后膝关节的静态松弛度进行了量化。尽管根据 IKDC 分类，这些差异被定义为临床成功，但在 AP 松弛度方面仍存在显著差异。在旋转膝关节松弛度测量方面未发现显著差异。因此，所使用的非侵入性测量设备可能为膝关节韧带损伤及其治疗的客观质量控制提供了很大的潜力。
回顾性病例系列，IV 级。
