Yingfang Ao, Institute of Sports Medicine, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing, China 100191.
Am J Sports Med. 2014 Feb;42(2):373-81. doi: 10.1177/0363546513508536. Epub 2013 Nov 27.
The fibular collateral ligament (FCL) is the primary restraint to varus rotation of the knee joint. Arthroscopic techniques are widely used and minimally invasive, but anatomic arthroscopic reconstruction of an isolated FCL injury has not been reported.
Anatomic reconstruction of an isolated FCL injury can be performed arthroscopically and will restore the knee to near-normal stability.
Controlled laboratory study.
A total of 12 nonpaired, fresh-frozen cadaveric knees were biomechanically subjected to a 10-N·m varus moment and 5-N·m external and internal rotation torques at 0°, 15°, 30°, 60°, 90°, and 120° of knee flexion, respectively (0° only for varus loading). Testing was performed with an intact and sectioned FCL and also after an anatomic reconstruction of the FCL by arthroscopic technique. Kinematics of each knee under various loading conditions was determined with a robotic universal force/moment sensor testing system.
After sectioning, significant increases were found in varus rotation at 0°, 15°, 30°, 60°, 90°, and 120° of knee flexion; in external rotation at 15°, 30°, and 60° of knee flexion; and in internal rotation at 30°, 60°, and 90° of knee flexion. After reconstruction, full recovery of knee stability was observed in varus rotation at 0°, 15°, 30°, and 60°; in external rotation at 0°, 15°, 30°, 60°, 90°, and 120°; and in internal rotation at 0°, 15°, 30°, 60°, 90°, and 120°. When the sectioned and intact FCL knee conditions were compared, significant increases of 3.4° at 90° of flexion and 3.4° at 120° of flexion were found (P < .001, both conditions); when the reconstructed and sectioned FCL knee conditions were compared, significant decreases of 1.7° at 90° of flexion and 1.7° at 120° of knee flexion were found (P = .033 and .043, respectively).
An anatomic reconstruction of the FCL can be performed by an arthroscopically assisted mini-open technique with an isolated FCL injury, and near-normal stability of the knee can be restored.
Anatomic reconstruction of the FCL by an arthroscopically assisted mini-open technique is a viable, less invasive option to treat nonrepairable isolated FCL injury.
腓侧副韧带（FCL）是膝关节内翻旋转的主要限制结构。关节镜技术被广泛应用且具有微创性，但尚未有报道对单纯 FCL 损伤进行关节镜下解剖重建。
单纯 FCL 损伤的关节镜下解剖重建可以完成，并可使膝关节恢复接近正常的稳定性。
对照实验研究。
12 个非配对的新鲜冷冻尸体膝关节分别在 0°、15°、30°、60°、90°和 120°的膝关节屈曲位，施加 10N·m 的内翻矩和 5N·m 的外旋和内旋扭矩（仅在 0°时施加内翻矩），分别进行生物力学测试（0°时仅进行内翻矩加载）。在完整和切断 FCL 以及通过关节镜技术进行解剖重建后，使用机器人通用力/力矩传感器测试系统来确定膝关节在各种加载条件下的运动学。
切断 FCL 后，在膝关节 0°、15°、30°、60°、90°和 120°的屈曲位，内翻旋转明显增加；在膝关节 15°、30°和 60°的屈曲位，外旋旋转明显增加；在膝关节 30°、60°和 90°的屈曲位，内旋旋转明显增加。重建后，在膝关节 0°、15°、30°和 60°的内翻旋转、膝关节 0°、15°、30°、60°、90°和 120°的外旋旋转、膝关节 0°、15°、30°、60°、90°和 120°的内旋旋转中，均观察到膝关节稳定性完全恢复。与切断 FCL 和完整 FCL 的膝关节相比，在膝关节 90°屈曲时增加了 3.4°，在膝关节 120°屈曲时增加了 3.4°（P<0.001，两种情况下均增加）；与切断 FCL 和重建 FCL 的膝关节相比，在膝关节 90°屈曲时减少了 1.7°，在膝关节 120°屈曲时减少了 1.7°（P=0.033 和 0.043，两种情况下均减少）。
对单纯 FCL 损伤，可采用关节镜辅助小切口技术进行 FCL 的解剖重建，从而恢复膝关节接近正常的稳定性。
采用关节镜辅助小切口技术对 FCL 进行解剖重建是治疗不可修复的单纯 FCL 损伤的可行、微创选择。
