Sessa Pasquale, Fioravanti Giulio, Giannicola Giuseppe, Cinotti Gianluca
Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, University "La Sapienza" Rome, Italy.
Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, University "La Sapienza" Rome, Italy.
Knee. 2015 Jan;22(1):51-5. doi: 10.1016/j.knee.2014.10.006. Epub 2014 Nov 7.
In cruciate retaining total knee arthroplasty (TKA), a partial avulsion of PCL may occur when en-bloc tibial osteotomy is performed. We evaluated the effects of a tibial cut performed with different degrees of posterior slope on PCL insertion and whether the results are affected by the sagittal inclination of the patient's tibial plateau.
We selected 83 MRIs of knees showing mild or no degenerative changes. The effects of a simulated tibial cut performed with a posterior slope of 0°, 3°, 5° and parallel to the patient's tibial plateau inclination on PCL insertion in the proximal tibia were investigated. The results were correlated with the degree of posterior inclination of the tibial plateau.
Every angle we used for the tibial cut caused a PCL avulsion greater than 50%. The percentage of PCL avulsion significantly increased with increasing the posterior slope of the tibial cut. Patients with sagittal tibial plateau inclination <5° showed greater PCL avulsion than those with sagittal inclination >8°.
Most of the PCL insertion is likely to be sacrificed when resection of the proximal tibia is performed en-block. The risk of PCL avulsion is reduced in patients showing a marked posterior inclination of the tibial plateau, but even in this group of patients a surgical technique aimed at sparing most of the PCL insertion is necessary.
在保留交叉韧带的全膝关节置换术（TKA）中，进行整块胫骨截骨时可能会发生后交叉韧带（PCL）部分撕脱。我们评估了不同后倾角度的胫骨截骨对PCL附着的影响，以及结果是否受患者胫骨平台矢状位倾斜度的影响。
我们选择了83例显示轻度或无退变改变的膝关节MRI。研究了模拟的0°、3°、5°后倾角度以及与患者胫骨平台倾斜度平行的胫骨截骨对PCL在胫骨近端附着的影响。结果与胫骨平台后倾程度相关。
我们用于胫骨截骨的每个角度均导致PCL撕脱超过50%。PCL撕脱百分比随胫骨截骨后倾角度增加而显著增加。胫骨平台矢状位倾斜度<5°的患者比矢状位倾斜度>8°的患者PCL撕脱更严重。
进行整块胫骨近端切除时，大部分PCL附着可能会被牺牲。胫骨平台后倾明显的患者PCL撕脱风险降低，但即使在这组患者中，也需要一种旨在保留大部分PCL附着的手术技术。
