Department of Orthopaedic Surgery, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, South Korea.
Arthroscopy. 2011 Dec;27(12):1679-87. doi: 10.1016/j.arthro.2011.06.030. Epub 2011 Sep 22.
The purpose of this study was to evaluate the clinical and magnetic resonance imaging (MRI) outcomes of nonoperative management of acute, isolated posterior cruciate ligament (PCL) injuries.
From February 2001 to January 2008, 49 consecutive patients with acute (<4 weeks), isolated PCL injuries underwent nonoperative treatment with cast immobilization and PCL braces. Of these patients, 38 who satisfied our inclusion criteria and could be followed up for a minimum of 24 months (median, 51 months) were enrolled in our study. Functional outcomes were evaluated at follow-up with the Lysholm knee scoring system, Hospital for Special Surgery knee scoring system, and International Knee Documentation Committee subjective and objective knee scoring systems. PCL injury status on MRI was assessed using a different scale for initial and follow-up MRI.
The grade of posterior instability was significantly improved from initial grades of I in 13 patients (34%) and II in 25 patients (66%) to follow-up grades of 0 in 3 patients (8%), I in 21 patients (55%), and II in 14 patients (37%) (P = .007). The mean side-to-side difference in posterior translation measured with the KT-1000 arthrometer (MEDmetric, San Diego, CA) was initially 6.7 mm and significantly improved to 5.2 mm at the latest follow-up (P < .001). At latest follow-up, the mean Lysholm knee score, Hospital for Special Surgery knee score, and International Knee Documentation Committee subjective score were 88, 91, and 83, respectively. The continuity of the PCL on follow-up MRI showed statistically less posterior instability on both physical examination (P = .010) and KT-1000 arthrometer testing (P = .003).
Our active, nonoperative method of casting and bracing with attached tibial supporters, which was designed to prevent posterior displacement at the knee, yielded satisfactory functional and MRI results in the majority of patients at intermediate-term follow-up. The continuity of the PCL with low signal intensity on follow-up MRI was a predictable factor for a favorable prognosis in patients with acute PCL injuries.
Level IV, therapeutic case series.
本研究旨在评估急性孤立性后交叉韧带（PCL）损伤的非手术治疗的临床和磁共振成像（MRI）结果。
从 2001 年 2 月至 2008 年 1 月，49 例急性（<4 周）、孤立性 PCL 损伤患者采用石膏固定和 PCL 支具进行非手术治疗。其中，38 例符合纳入标准且可随访至少 24 个月（中位数 51 个月）的患者纳入本研究。通过 Lysholm 膝关节评分系统、特种外科医院膝关节评分系统和国际膝关节文献委员会主观和客观膝关节评分系统对功能结果进行评估。通过初始和随访 MRI 使用不同的评分标准评估 PCL 损伤情况。
最初有 13 例（34%）患者为 I 级和 25 例（66%）患者为 II 级的后向不稳定程度，在随访时分别改善至 3 例（8%）、I 级 21 例（55%）和 II 级 14 例（37%）（P=.007）。KT-1000 关节测量仪（MEDmetric，圣地亚哥，CA）测量的后向平移侧间差值平均为 6.7mm，在随访时显著改善至 5.2mm（P <.001）。在末次随访时，平均 Lysholm 膝关节评分、特种外科医院膝关节评分和国际膝关节文献委员会主观评分分别为 88、91 和 83。在随访 MRI 上，PCL 的连续性显示出在体格检查（P=.010）和 KT-1000 关节测量仪检查（P=.003）中后向不稳定程度均有统计学意义的改善。
我们采用积极的非手术方法，即使用石膏固定和带有胫骨支撑的支具，旨在防止膝关节后向移位，在中期随访时，大多数患者获得了满意的功能和 MRI 结果。在急性 PCL 损伤患者中，随访 MRI 上 PCL 连续性呈低信号强度是预后良好的预测因素。
IV 级，治疗性病例系列。
