Lee Dhong Won, Jang Hyoung Won, Lee Yong Seuk, Oh Soo Jin, Kim Jae Young, Song Han Eui, Kim Jin Goo
Department of Orthopedic Surgery, Seoul Paik Hospital, Inje University, Seoul, Korea.
Department of Orthopedic Surgery, Chung Hospital, Seongnam, Korea.
Am J Sports Med. 2014 Aug;42(8):1822-31. doi: 10.1177/0363546514536680. Epub 2014 Jun 18.
Numerous posterior cruciate ligament (PCL) reconstruction techniques have evolved and have revealed satisfactory outcomes; however, the optimal operative method for PCL reconstruction remains controversial.
Transtibial PCL reconstruction with a remnant preservation technique would result in successful clinical, radiological, functional, and morphological outcomes. In addition, it was hypothesized that the results of combined PCL and posterolateral corner (PLC) reconstruction would be comparable with those of isolated PCL reconstruction.
Case series; Level of evidence, 4.
A total of 168 patients who underwent arthroscopic PCL reconstruction with or without reconstruction of the PLC between March 2006 and June 2011 were retrospectively reviewed. Ninety-two patients who met the inclusion criteria were enrolled, and 47 of 92 patients who underwent combined PCL and PLC reconstruction were evaluated as a subgroup. The PLC was reconstructed using the single fibular sling method. The patients were assessed by means of the Lysholm score, International Knee Documentation Committee (IKDC) subjective knee score, and Tegner activity score. Stability was evaluated using a KT-2000 arthrometer and Telos device. Proprioception was assessed using the Biodex System. Follow-up magnetic resonance imaging (MRI) was performed in 34 patients, and second-look arthroscopic surgery was conducted in 36 patients.
The minimum follow-up duration was 24 months in all patients. Clinical outcomes and posterior instability improved significantly. The mean Lysholm score improved from 56.7 ± 7.1 to 89.3 ± 7.3, the mean IKDC subjective knee score improved from 53.3 ± 9.6 to 86.2 ± 6.1, and the mean Tegner activity score was 2.5 ± 0.8 preoperatively and 5.1 ± 1.3 postoperatively (all P < .001). The mean side-to-side difference on posterior stress radiography with the Telos device improved significantly, decreasing from 12.1 ± 2.5 mm to 2.7 ± 1.3 mm (P < .001). The mean side-to-side difference on varus stress radiography was reduced from 5.9 ± 0.8 mm preoperatively to 1.3 ± 1.0 mm after combined PCL and PLC reconstruction (P < .001). Postoperative proprioception recovered to a level similar to that of the uninvolved side, and MRI and second-look arthroscopic surgery showed a high rate of complete healing and synovialization in patients who underwent either isolated PCL reconstruction or combined PLC and PCL reconstruction.
Transtibial PCL reconstruction with remnant preservation resulted in satisfactory clinical, functional, radiological, and morphological outcomes. The results of combined posterolateral rotatory instability were comparable with those for isolated PCL reconstruction with adequate PLC reconstruction.
众多后交叉韧带（PCL）重建技术不断发展，且已显示出令人满意的结果；然而，PCL重建的最佳手术方法仍存在争议。
采用保留残端技术的经胫骨PCL重建将带来成功的临床、影像学、功能和形态学结果。此外，还假设PCL与后外侧角（PLC）联合重建的结果将与单纯PCL重建的结果相当。
病例系列；证据等级，4级。
回顾性分析2006年3月至2011年6月期间共168例行关节镜下PCL重建术（伴或不伴PLC重建）的患者。92例符合纳入标准的患者被纳入研究，其中92例中47例行PCL与PLC联合重建的患者被作为一个亚组进行评估。采用单纤维吊索法重建PLC。通过Lysholm评分、国际膝关节文献委员会（IKDC）主观膝关节评分和Tegner活动评分对患者进行评估。使用KT-2000关节测径仪和Telos装置评估稳定性。使用Biodex系统评估本体感觉。34例患者进行了随访磁共振成像（MRI）检查，36例患者进行了二次关节镜手术。
所有患者的最短随访时间为24个月。临床结果和后向不稳明显改善。Lysholm评分均值从56.7±7.1提高到89.3±7.3，IKDC主观膝关节评分均值从53.3±9.6提高到86.2±6.1，Tegner活动评分术前均值为2.5±0.8，术后为5.1±1.3（所有P<.001）。使用Telos装置进行后向应力X线摄影时，平均左右侧差异显著改善，从12.1±2.5mm降至2.7±1.3mm（P<.001）。内翻应力X线摄影的平均左右侧差异从术前的5.9±0.8mm降至PCL与PLC联合重建后的1.3±1.0mm（P<.001）。术后本体感觉恢复到与未受累侧相似的水平，MRI和二次关节镜手术显示，单纯PCL重建或PLC与PCL联合重建的患者中，完全愈合和滑膜化率较高。
采用保留残端技术的经胫骨PCL重建带来了令人满意的临床、功能、影像学和形态学结果。后外侧旋转不稳联合重建的结果与单纯PCL重建且PLC重建充分的结果相当。
