Tardy Nicolas, Mouton Caroline, Boisrenoult Philippe, Theisen Daniel, Beaufils Philippe, Seil Romain
Centre Hospitalier de Versailles, 177 rue de Versailles, 78157, Le Chesnay, France,
Knee Surg Sports Traumatol Arthrosc. 2014 Sep;22(9):2173-80. doi: 10.1007/s00167-013-2655-0. Epub 2013 Sep 5.
Injuries of the posterolateral corner (PLC) are rare and severe knee injuries, resulting in posterolateral rotatory instability and an increase in external rotation. Surgical reconstruction techniques reproducing the normal anatomy showed promising results. In vivo evaluations of static rotational knee laxity at 30° of knee flexion have not been reported so far. The purpose of this study was to evaluate static rotational knee laxity after anatomic PLC reconstructions.
This is a retrospective clinical cohort study. Twenty patients with PLC reconstructions with an average follow-up time of 39 ± 22 months and no history of knee trauma or surgery of the contralateral knee were included in the study. They underwent a routine clinical examination and static rotational laxity measurements at 30° of knee flexion in the prone position. Side-to-side differences were recorded and compared to a group of matched controls.
The postoperative IKDC score was graded A for 8 patients, B for 16, C for 6 and D for one patient. The primary goal of the surgical procedure which consists in reducing excessive external tibiofemoral rotation could be reached in 18 of the 20 patients (90%). Anatomic PLC reconstructions yielded a comparable rotational profile in operated and healthy knees in 7 patients (35%). Thirteen patients (65%) presented a significantly altered rotational profile in comparison with a healthy control group. Unexpected increases in internal rotation were found in 8 patients (40%).
Anatomic PLC reconstructions reduced excessive external tibiofemoral rotation in a vast majority of patients. Static rotational laxity measurements allowed for a determination of the patients' individual rotational profile after PLC reconstructions. This profile was normalised in only one-third of the patients. The understanding of this finding needs further investigation as well as the clinical impact of rotational profile alterations on knee function.
Diagnostic studies, Level III.
后外侧角（PLC）损伤是罕见且严重的膝关节损伤，会导致后外侧旋转不稳定以及外旋增加。重现正常解剖结构的手术重建技术显示出良好的效果。目前尚未有关于屈膝30°时膝关节静态旋转松弛度的体内评估报道。本研究的目的是评估解剖学PLC重建术后的膝关节静态旋转松弛度。
这是一项回顾性临床队列研究。研究纳入了20例接受PLC重建的患者，平均随访时间为39±22个月，且对侧膝关节无创伤或手术史。他们接受了常规临床检查，并在俯卧位屈膝30°时进行了静态旋转松弛度测量。记录左右侧差异并与一组匹配的对照组进行比较。
术后国际膝关节文献委员会（IKDC）评分中，8例患者为A级，16例为B级，6例为C级，1例为D级。20例患者中有18例（90%）达到了手术的主要目标，即减少胫股关节过度外旋。7例患者（35%）在手术侧和健康侧膝关节中获得了可比的旋转特征。与健康对照组相比，13例患者（65%）呈现出明显改变的旋转特征。8例患者（40%）出现了意外的内旋增加。
解剖学PLC重建在绝大多数患者中减少了胫股关节过度外旋。静态旋转松弛度测量有助于确定PLC重建术后患者的个体旋转特征。仅三分之一的患者该特征恢复正常。对这一发现的理解以及旋转特征改变对膝关节功能的临床影响需要进一步研究。
诊断性研究，III级。
