Aggarwal Aditya K, Goel Akshay, Radotra Bishan D
Department of Orthopaedic Surgery, Post graduate Institute of Medical Education and Research, Chandigarh, India.
J Orthop Surg (Hong Kong). 2013 Apr;21(1):15-8. doi: 10.1177/230949901302100106.
To evaluate the tibial articular cartilage and histology of the posterior cruciate ligament (PCL) in osteoarthritic knees so as to determine predictors of PCL degeneration.
23 advanced osteoarthritic knees (mean patient age, 61 years) treated with total knee arthroplasty (TKA) were prospectively studied. The Knee Society Score was assessed. Osteoarthritic changes on radiographs were graded as mild, moderate, or severe. Tibial articular cartilage erosion was assessed. The appearance of both cruciate ligaments was classified as normal, abnormal (thinner and sclerotic), or ruptured. Both ligaments were examined histologically for degenerative changes. Each degenerative change of the PCL was graded by 2 histopathologists twice separately. Higher scores indicated more severe degeneration.
Of the 23 knees, the gross appearance of the anterior cruciate ligaments (ACLs) was normal in 6, abnormal in 11, and ruptured in 6. Histologically, the PCLs were normal in 4, minimally degenerated in 2, mildly in 8, moderately in 5, and severely in 4. The predominant degenerative change was the presence of loose fibrous tissue. ACL appearance correlated positively with PCL degeneration (r=0.883, p=0.001). The mean Knee Society Score was 24 (range, 0-43), and the mean function score was 30 (range, 5-55). PCL degeneration correlated positively with the Knee Society Score (r=0.565, p=0.02) but not with the function score (r=0.061, p=0.447). Anteroposterior instability correlated positively with PCL degeneration (r=0.691, p=0.01). Erosion in the lateral tibiofemoral compartment and ACL insufficiency were indicators of PCL degeneration (despite a normal appearance). Inter-observer reliability and intra-observer reproducibility were 0.82 and 0.87, respectively.
The Knee Society Score, anteroposterior instability, ACL appearance, and erosion in the lateral tibiofemoral compartment are predictors of PCL degeneration and can help decide on the optimal type of TKA implant (PCL-retaining vs. PCL-sacrificing design).
评估骨关节炎膝关节中胫骨关节软骨及后交叉韧带（PCL）的组织学情况，以确定PCL退变的预测因素。
对23例接受全膝关节置换术（TKA）的晚期骨关节炎膝关节（患者平均年龄61岁）进行前瞻性研究。评估膝关节协会评分。X线片上的骨关节炎改变分为轻度、中度或重度。评估胫骨关节软骨侵蚀情况。将两条交叉韧带的外观分为正常、异常（变薄和硬化）或断裂。对两条韧带进行组织学检查以观察退变情况。PCL的每项退变由2名组织病理学家分别进行两次评分。分数越高表明退变越严重。
在23个膝关节中，前交叉韧带（ACL）外观正常的有6个，异常的有11个，断裂的有6个。组织学上，PCL正常的有4个，轻度退变的有2个，中度退变的有8个，重度退变的有5个，极重度退变的有4个。主要的退变改变是存在疏松纤维组织。ACL外观与PCL退变呈正相关（r=0.883，p=0.001）。膝关节协会平均评分为24分（范围0-43分），平均功能评分为30分（范围5-55分）。PCL退变与膝关节协会评分呈正相关（r=0.565，p=0.02），但与功能评分无相关性（r=0.061，p=0.447）。前后向不稳定与PCL退变呈正相关（r=0.691，p=0.01）。外侧胫股关节间隙侵蚀和ACL功能不全是PCL退变的指标（尽管外观正常）。观察者间可靠性和观察者内重复性分别为0.82和0.87。
膝关节协会评分、前后向不稳定、ACL外观及外侧胫股关节间隙侵蚀是PCL退变的预测因素，有助于决定TKA植入物的最佳类型（保留PCL与牺牲PCL设计）。
