Weill Cornell College of Medicine and Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA.
Clin Orthop Relat Res. 2012 Mar;470(3):861-8. doi: 10.1007/s11999-011-2034-4.
Posterior cruciate ligament injuries can occur as isolated ligament ruptures or in association with the multiligament-injured knee. Delayed reconstruction, at 2-3 weeks post-injury, is predominantly recommended for posterior cruciate ligament tears in the multiligament-injured knee. While acute bone and soft tissue avulsion patterns of injury can be amenable to repair, the described techniques have been associated with some difficulties attaching the avulsed ligament.
As part of a reconstruction/repair of a multiligament-injured knee, we performed arthroscopic primary repair of the posterior cruciate ligament by passing Bunnell-type stitches into the substance of the ligament using a reloadable suture passer. We then passed the sutures through drill holes into the femoral footprint of the ligament and tied them over a bony bridge.
We retrospectively reviewed three patients with posterior cruciate ligament tears associated with a multiligament-injured knee. All patients had posterior cruciate ligament soft tissue avulsions or "peel off" injuries diagnosed by MRI. The described repair technique was used to repair the posterior cruciate ligament avulsion. Minimum followup was 64 months (mean, 68 months; range, 64-75 months). ROM, stability testing, and functional outcome scores (Lysholm and modified Cincinnati) were recorded.
Mean ROM was 0° to 127°. Posterior drawer testing was negative in all three patients. The mean Lysholm score was 92 and the mean modified Cincinnati score was 94. Followup MRI confirmed ligament healing in all patients.
We believe arthroscopic posterior cruciate ligament repair for soft tissue peel off injuries is a technique that, when applied to carefully selected patients, may be helpful to the surgeon treating patients with a multiligament-injured knee.
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
后交叉韧带损伤可单独发生韧带撕裂，也可与多韧带损伤的膝关节同时发生。对于多韧带损伤的膝关节后交叉韧带撕裂，主要推荐在损伤后 2-3 周进行延迟重建。虽然急性骨和软组织撕脱伤模式的损伤可以进行修复，但所描述的技术与一些难以附着撕脱韧带有关。
作为多韧带损伤膝关节重建/修复的一部分，我们使用可重新装载的缝线穿线器将 Bunnell 型缝线穿过韧带实质，对后交叉韧带进行关节镜下的初步修复。然后，我们将缝线穿过钻孔进入韧带的股骨足迹，并在骨桥上系紧。
我们回顾性分析了 3 例与多韧带损伤膝关节相关的后交叉韧带撕裂患者。所有患者均通过 MRI 诊断为后交叉韧带软组织撕脱或“剥落”损伤。使用描述的修复技术修复后交叉韧带撕脱。最小随访时间为 64 个月（平均 68 个月；范围 64-75 个月）。记录 ROM、稳定性测试和功能结果评分（Lysholm 和改良 Cincinnati）。
平均 ROM 为 0°至 127°。所有 3 例患者的后抽屉试验均为阴性。平均 Lysholm 评分为 92 分，改良 Cincinnati 评分为 94 分。随访 MRI 证实所有患者的韧带愈合。
我们认为关节镜下后交叉韧带修复对于软组织剥落损伤是一种技术，如果应用于精心选择的患者，可能对治疗多韧带损伤膝关节的外科医生有所帮助。
IV 级，治疗性研究。有关证据水平的完整描述，请参见作者指南。
