Krych Aaron J, Sousa Paul L, King Alexander H, Engasser William M, Stuart Michael J, Levy Bruce A
Department of Orthopedic Surgery and Sports Medicine Center, Mayo Clinic, Rochester, MN, USA.
Knee Surg Sports Traumatol Arthrosc. 2015 Oct;23(10):3019-25. doi: 10.1007/s00167-015-3540-9. Epub 2015 Feb 21.
Knee dislocations can cause significant damage to intra-articular knee structures, but currently there are limited data reporting articular cartilage and meniscal injuries in this setting. The purpose of this study is to (1) report the rate of concomitant intra-articular injuries at the time of multiligament reconstruction for knee dislocation, (2) determine whether the pattern of ligament injury is associated with the presence of chondral and meniscal injuries, and (3) assess the relationship between timing of surgery and incidence of chondral and meniscal injuries.
The records of patients who sustained a knee dislocation between 1992 and 2013 were retrospectively reviewed. Patients included for further review had a PCL-based multiligament knee injury or a minimum of three disrupted ligaments, both indicative of knee dislocation. Patient demographics, ligament injury patterns, meniscal tears and chondral injuries at arthroscopy, and interval from injury to surgery were recorded. Early surgical intervention was defined as <3 months, delayed was between 3 and 12 months, and chronic was >12 months. Data analysis compared ligament injury pattern with chondral and meniscal injuries, as well as the rates of intra-articular injury by timing of surgery.
One-hundred and twenty-one patients (122 knees) were included (93 males, 28 females) with a median age at time of surgery of 31 years (range 15-62). Ninety-three knees (76 %) had associated chondral or meniscal injury. Sixty-seven knees (55 %) presented with meniscal tears (26 isolated medial, 27 isolated lateral, and 14 combined medial/lateral), while 52 knees (48 %) had chondral damage, most commonly in the medial compartment. Schenck classification as well as side of injury did not demonstrate consistent relationships with intra-articular injury. A higher incidence of damage to the lateral femoral condyle (20 % vs 3 %; p = 0.02), lateral tibial plateau (20 % vs 2 %; p < 0.01), and patella (40 % vs 13 %; p = 0.01) was found in the chronic group compared to the early group. The chronic group contained significantly more patients with bicompartmental and tricompartmental chondral lesions (25 % vs 6 %; p = 0.03 and 10 % vs 0 %; p = 0.02, respectively).
Meniscal tears and chondral damage occur frequently in patients with a knee dislocation. A longer interval from injury to surgical reconstruction is associated with higher rates of articular cartilage lesions, especially in multiple compartments.
IV.
膝关节脱位可对膝关节内结构造成严重损伤，但目前关于此情况下关节软骨和半月板损伤的报道数据有限。本研究的目的是：（1）报告膝关节脱位多韧带重建时合并关节内损伤的发生率；（2）确定韧带损伤模式是否与软骨和半月板损伤的存在相关；（3）评估手术时机与软骨和半月板损伤发生率之间的关系。
回顾性分析1992年至2013年间发生膝关节脱位患者的病历。纳入进一步分析的患者为基于后交叉韧带的膝关节多韧带损伤或至少三条韧带断裂，均提示膝关节脱位。记录患者的人口统计学资料、韧带损伤模式、关节镜检查时的半月板撕裂和软骨损伤情况，以及受伤至手术的间隔时间。早期手术干预定义为<3个月，延迟手术为3至12个月，慢性手术为>12个月。数据分析比较韧带损伤模式与软骨和半月板损伤情况，以及按手术时机划分的关节内损伤发生率。
纳入121例患者（122膝）（男性93例，女性28例），手术时的中位年龄为31岁（范围15 - 62岁）。93膝（76%）合并软骨或半月板损伤。67膝（55%）出现半月板撕裂（26例单纯内侧，27例单纯外侧，14例内外侧联合），52膝（48%）有软骨损伤，最常见于内侧间室。Schenck分类以及损伤侧与关节内损伤未显示出一致的关系。与早期组相比，慢性组中股骨外侧髁损伤发生率更高（20%对3%；p = 0.02），胫骨外侧平台损伤发生率更高（20%对2%；p < 0.01），髌骨损伤发生率更高（40%对13%；p = 0.01）。慢性组中双间室和三间室软骨损伤的患者明显更多（分别为25%对6%；p = 0.03和10%对0%；p = 0.02）。
膝关节脱位患者中半月板撕裂和软骨损伤很常见。受伤至手术重建的间隔时间越长，关节软骨损伤的发生率越高，尤其是在多个间室。
IV级。
