Hôpital Pitié Salpétrière, Pierre and Marie Curie University, 47 Boulevard de l'Hôpital, 75013, Paris, France.
Cabinet Goethe, 23 Avenue Niel, 75017, Paris, France.
Knee Surg Sports Traumatol Arthrosc. 2017 Oct;25(10):3046-3052. doi: 10.1007/s00167-016-4085-2. Epub 2016 Mar 29.
Aim of this study was to determine the characteristics, clinical and radiological diagnostic methods of PCL isolated and combined knee injuries.
One hundred and twelve patients with a recurrent posterior knee laxity were surgically treated. Clinical examination, MRI, Telos™ stress dynamic X-rays, KT-1000 measurements and the IKDC questionnaire were used to diagnose and evaluate these injuries.
Median follow-up was 4.5 years (2-11 years). Thirty-two patients (28.6 %) had an isolated posterior laxity, 53 (47.3 %) a posterior posterolateral laxity, 21 (18.7 %) a posterior posteromedial laxity and six (5.4 %) patients had a complex posterior and mediolateral laxity. Road traffic accidents and sports injuries were the main causes of trauma. The mean preoperative value of posterior tibial translation was 13.5 mm (SD 1.4) and the mean postoperative value was 4.4 mm (SD 1.7) as measured with the Telos device. In the cases with a concomitant ACL rupture, the mean preoperative value of anterior tibial translation was 6.5 mm (SD 1.3) and the mean postoperative value was 1.7 mm (SD 0.8). The mean pre- and postoperative IKDC scores were 74.5 (SD 4.2) and 87.9 (SD 3.1), respectively. Meniscal and/or cartilage injuries were found in 80 patients (71.4 %).
Recurrent posterior knee laxity can be restored with the one-stage PCL reconstruction using a quadriceps graft and reconstruction of the posteromedial-posterolateral lesions using the LaPrade techniques. The benefits of this study include enabling surgeons to accurately manage these injuries from a clinical perspective, and treating them with a specific surgical algorithm.
III.
本研究旨在确定单独和联合膝关节损伤的 PCL 特征、临床和放射学诊断方法。
对 112 例复发性膝关节后向松弛患者进行手术治疗。临床检查、MRI、Telos™ 动态应力 X 线片、KT-1000 测量和 IKDC 问卷用于诊断和评估这些损伤。
中位随访时间为 4.5 年（2-11 年）。32 例（28.6%）患者存在单纯后向松弛，53 例（47.3%）患者存在后外侧松弛，21 例（18.7%）患者存在后内侧松弛，6 例（5.4%）患者存在复杂的后向和内外侧松弛。道路交通伤和运动伤是主要的外伤原因。使用 Telos 装置测量，术前胫骨后向平移的平均测量值为 13.5mm（标准差 1.4），术后为 4.4mm（标准差 1.7）。在合并 ACL 撕裂的病例中，术前胫骨前向平移的平均测量值为 6.5mm（标准差 1.3），术后为 1.7mm（标准差 0.8）。术前和术后 IKDC 评分分别为 74.5（标准差 4.2）和 87.9（标准差 3.1）。80 例（71.4%）患者发现半月板和/或软骨损伤。
使用股四头肌移植物进行一期 PCL 重建，并采用 LaPrade 技术重建后内侧-后外侧病变，可以恢复复发性膝关节后向松弛。本研究的优势在于能够从临床角度准确地管理这些损伤，并采用特定的手术算法进行治疗。
III 级。
