King Alexander H, Krych Aaron J, Prince Matthew R, Pareek Ayoosh, Stuart Michael J, Levy Bruce A
Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, U.S.A.
Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, U.S.A..
Arthroscopy. 2016 Sep;32(9):1814-9. doi: 10.1016/j.arthro.2016.01.038. Epub 2016 Apr 6.
To compare clinical and functional outcomes of surgically treated medial and lateral knee dislocations.
A retrospective review of the medical records of patients who presented with knee dislocations was conducted. We identified patients who underwent surgical treatment of KDIII-M (anterior cruciate ligament/posterior cruciate ligament/medial collateral ligament) or KDIII-L (anterior cruciate ligament/posterior cruciate ligament/lateral collateral ligament) knee dislocation as documented by the Schenck classification. Minimum 2-year follow-up with Lysholm and International Knee Documentation Committee (IKDC) outcome scores was required for inclusion. Postoperative range of motion, ligamentous examination, and conversion to total knee arthroplasty were also collected. Data were analyzed using univariate and multivariate statistical models with P < .05 considered significant.
A total of 56 patients met the inclusion criteria, 24 with the KDIII-M injury pattern (43%) and 32 with the KDIII-L injury pattern (57%), with a mean age of 34 years (range, 16 to 62 years) and a mean follow-up of 6.5 years (range, 2 to 20 years). Patients undergoing medial repairs had worse outcomes for both the Lysholm score (P = .008) and IKDC score (P = .003). In addition, female sex was linked to worse outcomes (Lysholm score, 58.8 ± 21.5 v 77.8 ± 21.1, P < .01; IKDC score, 54.9 ± 23.7 v 75.2 ± 20.2, P < .01). No differences in outcome were found between patients with and patients without peroneal nerve injury (Lysholm score, P = .81; IKDC score, P = .77). No difference in laxity testing was found between the 2 groups.
In patients undergoing multiligament knee reconstruction, our data suggest that those who undergo medial repair for knee dislocations are not as likely to achieve positive results as those who undergo reconstruction or lateral reconstruction/repair, regardless of the status of the peroneal nerve. In addition, medial reconstruction had comparable outcomes to those in patients treated with lateral reconstruction/repair. Lastly, female patients showed less favorable clinical outcomes than male patients.
Level III, retrospective comparative study.
比较手术治疗的膝关节内侧和外侧脱位的临床及功能结果。
对膝关节脱位患者的病历进行回顾性研究。我们确定了经申克分类记录为KDIII-M（前交叉韧带/后交叉韧带/内侧副韧带）或KDIII-L（前交叉韧带/后交叉韧带/外侧副韧带）膝关节脱位并接受手术治疗的患者。纳入标准为至少随访2年，并记录Lysholm评分和国际膝关节文献委员会（IKDC）结果评分。还收集了术后活动范围、韧带检查以及转为全膝关节置换术的情况。采用单因素和多因素统计模型进行数据分析，P < 0.05为有统计学意义。
共有56例患者符合纳入标准，其中24例为KDIII-M损伤模式（43%），32例为KDIII-L损伤模式（57%），平均年龄34岁（范围16至62岁），平均随访6.5年（范围2至20年）。接受内侧修复的患者在Lysholm评分（P = .008）和IKDC评分（P = .003）方面的结果均较差。此外，女性患者的结果较差（Lysholm评分，58.8±21.5对77.8±21.1，P < .01；IKDC评分，54.9±23.7对75.2±20.2，P < .01）。腓总神经损伤患者与未损伤患者的结果无差异（Lysholm评分，P = .81；IKDC评分，P = .77）。两组间的松弛度测试无差异。
在接受多韧带膝关节重建的患者中，我们的数据表明，无论腓总神经状况如何，膝关节脱位接受内侧修复的患者与接受重建或外侧重建/修复的患者相比，不太可能获得阳性结果。此外，内侧重建的结果与接受外侧重建/修复的患者相当。最后，女性患者的临床结果不如男性患者。
III级，回顾性比较研究。
