Fanelli Gregory C, Sousa Paul L, Edson Craig J
Department of Orthopaedic Surgery, Sports Medicine and Arthroscopy, Geisinger Orthopaedics, Geisinger Medical Center, 115 Woodbine Lane, Danville, PA, 17822-5212, USA,
Clin Orthop Relat Res. 2014 Sep;472(9):2712-7. doi: 10.1007/s11999-014-3707-6.
Surgical treatment of knee dislocations is intended to correct the anatomic injury and restore knee stability and patient function. Several studies have shown successful results with surgical treatment of knee dislocations with up to 10 years of followup, but longer-term studies are uncommon.
QUESTIONS/PURPOSES: We evaluated patients treated surgically for knee dislocations at 10-year followup to assess (1) knee stability; (2) return to preinjury level of function; (3) development of arthrosis; and (4) range of motion (ROM) loss.
This study was a retrospective review of 127 combined PCL, ACL, and medial and/or lateral side reconstructions performed by a single surgeon (GCF) between 1990 and 2008. Of these, 44 were available for clinical and functional evaluation (35%) at a minimum 5-year followup. Inclusion criteria were combined PCL/ACL plus medial and/or lateral side reconstruction. Evaluation methods included arthrometer measurements, stress radiography, knee ligament rating and activity scales (Lysholm and Tegner), plain radiographs with osteoarthritic assessment, and physical examination.
Of the 44 patients, there were nine ACL/PCL medial, 22 ACL/PCL lateral, and 13 ACL/PCL mediolateral reconstructions. Followup was at a minimum of 5 years (mean, 10 years; range, 5-22 years). The mean age at the time of injury was 31 years with a range of 13 to 65 years. The mean arthrometer-measured side-to-side differences were as follows: PCL screen, 1.9 mm; corrected posterior, 2.4 mm; corrected anterior, 0.8 mm; and anterior displacement at 30° of knee flexion, 1.7 mm. Stress radiographic measurements at 90° of knee flexion revealed a mean side-to-side difference of 1.9 mm. Mean Lysholm, and Tegner scores were 84 of 100 and 4.1 of 9, respectively. Ninety-three percent (41 of 44) of patients returned to their preinjury level of activity or one Tegner grade lower. Ten of the 44 knees (23%) developed degenerative joint disease. The mean flexion loss was 12.5°, and flexion contractures were not seen in any of the patients.
We found that a high proportion of patients treated for these severe injuries achieved static and functional stability, allowing the return to physically demanding work and recreational activities, but that nearly one-fourth of them will develop arthritis at a mean of 10 years. We cannot extrapolate our results to an elite athlete population, but our results probably apply well to working class populations.
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
膝关节脱位的手术治疗旨在纠正解剖损伤，恢复膝关节稳定性和患者功能。多项研究表明，膝关节脱位手术治疗在长达10年的随访中取得了成功结果，但长期研究并不常见。
问题/目的：我们在10年随访时评估接受膝关节脱位手术治疗的患者，以评估（1）膝关节稳定性；（2）恢复至伤前功能水平；（3）关节病的发展；以及（4）活动范围（ROM）丧失。
本研究是对1990年至2008年间由单一外科医生（GCF）进行的127例PCL、ACL以及内侧和/或外侧联合重建手术的回顾性分析。其中，44例在至少5年随访时可进行临床和功能评估（35%）。纳入标准为PCL/ACL联合内侧和/或外侧重建。评估方法包括关节测量仪测量、应力位X线片、膝关节韧带评分和活动量表（Lysholm和Tegner）、带有骨关节炎评估的普通X线片以及体格检查。
44例患者中，有9例为ACL/PCL内侧重建，22例为ACL/PCL外侧重建，13例为ACL/PCL内外侧联合重建。随访时间至少为5年（平均10年；范围5 - 22年）。受伤时的平均年龄为31岁，范围为13至65岁。关节测量仪测量的平均两侧差异如下：PCL筛查，1.9毫米；校正后，2.4毫米；校正前，0.8毫米；以及膝关节屈曲30°时的前向移位，1.7毫米。膝关节屈曲90°时的应力位X线片测量显示平均两侧差异为1.9毫米。Lysholm和Tegner评分的平均值分别为100分中的84分和9分中的4.1分。93%（44例中的41例）的患者恢复至伤前活动水平或降低一个Tegner等级。44个膝关节中有10个（23%）出现退行性关节病。平均屈曲丧失为12.5°，且所有患者均未出现屈曲挛缩。
我们发现，接受这些严重损伤治疗 的患者中，很大一部分实现了静态和功能稳定性，能够恢复到对体力要求较高的工作和娱乐活动，但其中近四分之一的患者在平均10年后会发展为关节炎。我们不能将我们的结果外推至精英运动员群体，但我们的结果可能很适用于工人阶级群体。
IV级，治疗性研究。有关证据水平的完整描述，请参阅作者指南。
