King Alexander H, Krych Aaron J, Prince Matthew R, Sousa Paul L, Stuart Michael J, Levy Bruce A
Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Knee Surg Sports Traumatol Arthrosc. 2015 Oct;23(10):3008-11. doi: 10.1007/s00167-015-3671-z. Epub 2015 Jun 14.
A paucity of data exists on the effects of articular cartilage and meniscal injury in the setting of knee dislocations. The purpose of this study is to determine whether concomitant intra-articular injuries at the time of multiligament reconstruction for knee dislocation are associated with inferior outcomes.
The records of patients who underwent surgical treatment for multiligament knee injury between 1992 and 2012 were retrospectively reviewed. Patients included had a PCL-based multiligament knee injury or a minimum of three disrupted ligaments, both indicative of knee dislocation. A logistic regression model was used to determine whether articular cartilage injuries (grade 2 involving ≥50 % of the condylar width or greater, or any grade III/IV lesions) and meniscus tears are predictors of IKDC outcome scores collected at a minimum of 2 years postoperatively.
Of the 121 patients who met inclusion criteria, 2-year minimum follow-up was available on 95 patients (79 %). The cohort was 77 % male and had a median age of 32 years (16-62) at the time of surgery and was followed for an average of 6 years. Articular cartilage injury was present in 40 % of knees: medial femoral condyle (20 %); medial tibial plateau (9 %); lateral femoral condyle (5 %); lateral tibial plateau (4 %); patella (18 %); trochlear (5 %). Meniscal injury was present in 56 % of patients (isolated medial, 22 %; isolated lateral, 22 %; combined, 12 %). IKDC scores were significantly lower for patients with any cartilage damage (p = 0.03), combined medial and lateral meniscus tears (p = 0.02), medial-sided articular cartilage damage (p = 0.03), medial femoral condyle (p = 0.04) and trochlear (p = 0.03) lesions.
Articular cartilage damage and meniscus tears are frequently associated with a knee dislocation. This study showed IKDC scores were significantly lower for patients with cartilage damage or combined medial and lateral meniscus tears at mid-term follow-up of 6 years.
IV.
关于膝关节脱位时关节软骨和半月板损伤的影响，现有数据较少。本研究的目的是确定膝关节脱位进行多韧带重建时合并的关节内损伤是否与较差的预后相关。
回顾性分析1992年至2012年间接受多韧带膝关节损伤手术治疗的患者记录。纳入的患者患有基于后交叉韧带的多韧带膝关节损伤或至少三条韧带断裂，这两者均提示膝关节脱位。采用逻辑回归模型来确定关节软骨损伤（2级累及髁宽度≥50%或更严重，或任何III/IV级损伤）和半月板撕裂是否是术后至少2年收集的国际膝关节文献委员会（IKDC）结果评分的预测因素。
121例符合纳入标准的患者中，95例（79%）有至少2年的随访资料。该队列中男性占77%，手术时的中位年龄为32岁（16 - 62岁），平均随访6年。40%的膝关节存在关节软骨损伤：股骨内侧髁（20%）；胫骨内侧平台（9%）；股骨外侧髁（5%）；胫骨外侧平台（4%）；髌骨（18%）；滑车（5%）。56%的患者存在半月板损伤（孤立内侧，22%；孤立外侧，22%；联合，12%）。任何软骨损伤的患者（p = 0.03）、内侧和外侧半月板联合撕裂的患者（p = 0.02）、内侧关节软骨损伤的患者（p = 0.03）、股骨内侧髁（p = 0.04）和滑车（p = 0.03）损伤的患者，其IKDC评分显著更低。
关节软骨损伤和半月板撕裂常与膝关节脱位相关。本研究表明，在6年的中期随访中，软骨损伤或内侧和外侧半月板联合撕裂的患者IKDC评分显著更低。
IV级。
