Arthroscopy and Joint Research Institute, Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul 120-752, Korea.
Am J Sports Med. 2013 Jul;41(7):1613-20. doi: 10.1177/0363546513485927. Epub 2013 Apr 29.
There have been no previous studies showing clinical outcomes according to treatment options of posterior cruciate ligament (PCL) injury with mild grade 2 or less posterior translation (<7 mm) combined with posterolateral rotatory instability.
To compare the clinical outcomes of posterolateral corner (PLC) reconstruction with or without simultaneous PCL reconstruction in PCL injuries with mild posterior translation.
Cohort study; Level of evidence, 3.
A total of 46 patients with a PCL injury with mild posterior translation combined with posterolateral rotatory instability were retrospectively reviewed. Twenty-two patients had undergone isolated PLC reconstruction (group A), and 24 patients had undergone simultaneous reconstruction of the PCL and PLC (group B). Each patient was assessed for knee instability with the dial test at 30° and 90° as well as with varus and posterior stress radiography and were evaluated with the Lysholm knee score and International Knee Documentation Committee (IKDC) subjective and objective grading.
In all cases, the minimum follow-up period was 24 months. At the final follow-up evaluation, no significant side-to-side difference was found on varus stress radiography (group A, 1.55 ± 0.78 mm vs group B, 1.35 ± 1.00 mm; P = .458) or the dial test (at 30°: group A, 4.00° ± 1.83° vs group B, 4.04° ± 1.30°; P = .929; at 90°: group A, 3.64° ± 1.18° vs group B, 3.67° ± 1.37°; P = .937). However, group B showed a significant improvement compared with group A on posterior stress radiography (group A, 0.16 ± 0.44 mm vs group B, -1.44 ± 0.74 mm; P < .001), Lysholm knee score (group A, 18.36 ± 8.73 vs group B, 23.42 ± 7.44; P = .040), IKDC subjective score (group A, 25.51 ± 7.11 vs group B, 33.08 ± 5.89; P < .001), and IKDC objective score (group A preoperatively: grade C = 19 patients, grade D = 3; group B preoperatively: grade C = 20, grade D = 4; group A postoperatively: grade B = 11, grade C = 11; group B postoperatively: grade A = 12, grade B = 9, grade C = 3) (P < .001).
Simultaneous reconstruction of the PCL and PLC is recommended when addressing PCL injuries with mild grade 2 or less posterior translation combined with posterolateral rotary instability.
此前尚无研究显示对于合并有后外侧旋转不稳定且后向平移程度为轻度 2 级或以下（<7mm）的后交叉韧带（PCL）损伤，根据治疗选择的临床结果。
比较同时行后外侧角（PLC）重建和单纯行 PLC 重建治疗合并有轻度后向平移的 PCL 损伤的临床结果。
队列研究；证据等级，3 级。
回顾性分析了 46 例合并有轻度后向平移且伴后外侧旋转不稳定的 PCL 损伤患者。22 例患者接受了单纯 PLC 重建（A 组），24 例患者接受了 PCL 和 PLC 同期重建（B 组）。每位患者均采用Dial 试验在 30°和 90°评估膝关节不稳定，采用内翻和后向应力位 X 线片评估，采用 Lysholm 膝关节评分和国际膝关节文献委员会（IKDC）主观和客观评分进行评估。
所有患者的随访时间均至少为 24 个月。末次随访时，在所有病例中，内翻应力位 X 线片（A 组，1.55±0.78mm 比 B 组，1.35±1.00mm；P=.458）或Dial 试验（30°：A 组，4.00°±1.83°比 B 组，4.04°±1.30°；P=.929；90°：A 组，3.64°±1.18°比 B 组，3.67°±1.37°；P=.937）均未发现明显的侧别差异。然而，B 组在其后向应力位 X 线片（A 组，0.16±0.44mm 比 B 组，-1.44±0.74mm；P <.001）、Lysholm 膝关节评分（A 组，18.36±8.73 比 B 组，23.42±7.44；P=.040）、IKDC 主观评分（A 组，25.51±7.11 比 B 组，33.08±5.89；P <.001）和 IKDC 客观评分（A 组术前：C 级=19 例，D 级=3 例；B 组术前：C 级=20 例，D 级=4 例；A 组术后：B 级=11 例，C 级=11 例；B 组术后：A 级=12 例，B 级=9 例，C 级=3 例）方面明显优于 A 组（P <.001）。
对于合并有轻度后向平移程度为 2 级或以下且伴后外侧旋转不稳定的 PCL 损伤，建议同时行 PCL 和 PLC 重建。
