Ferretti Andrea, Monaco Edoardo, Fabbri Mattia, Maestri Barbara, De Carli Angelo
II School of Medicine, Sant'Andrea Hospital, Kirk Kilgour Sports Injury Center, University of Rome "La Sapienza," Rome, Italy.
II School of Medicine, Sant'Andrea Hospital, Kirk Kilgour Sports Injury Center, University of Rome "La Sapienza," Rome, Italy.
Arthroscopy. 2017 Jan;33(1):147-154. doi: 10.1016/j.arthro.2016.05.010. Epub 2016 Jun 21.
To report on the prevalence of injuries of the lateral compartment occurring in cases of apparently isolated acute anterior cruciate ligament (ACL) tears and to present a classification system of anterolateral complex injuries based on the data obtained.
Sixty patients operated on for an acute apparently isolated ACL tear, revealed by clinical examination and confirmed by magnetic resonance imaging, were prospectively selected. The lateral compartment was exposed and injuries were detected. Based on the data obtained, lesions of the anterolateral complex were classified as follows: Type I: multilevel rupture with individual layers torn at different levels with macroscopic hemorrhage involving the area of the anterolateral ligament (ALL) and extended to the anterolateral capsule. Type II: multilevel rupture with individual layers torn at different levels with macroscopic hemorrhage extended from the area of the ALL and capsule to the posterolateral capsule. Type III: complete transverse tear involving the area of the ALL near its insertion to the lateral tibial plateau, distal to the lateral meniscus. Type IV: bony avulsion (Segond fracture). The pivot-shift test was repeated intraoperatively after repair of lateral tears before the ACL reconstruction.
Although magnetic resonance imaging was able to detect only bony injuries (Segond fracture), macroscopic tears of the lateral capsule were clearly identified at surgery in 54 of 60 patients and classified as follows: Type I: 19/60 Type II: 16/60 Type III: 13/60 Type IV: 6/60 In all cases, repair resulted in a marked reduction or apparent disappearance of the pivot-shift phenomenon. Statistical analysis showed a positive correlation between lesions of the lateral compartment, regardless of the type described, and a pivot shift graded 2 or 3.
Because injuries of secondary restraints often occur in cases of acute ACL tears, recognition and repair of such lesions could be considered to help ACL reconstruction to better control rotational stability.
Level IV, therapeutic case series.
报告明显孤立性急性前交叉韧带（ACL）撕裂病例中外侧间室损伤的发生率，并根据所获数据提出一种前外侧复合体损伤的分类系统。
前瞻性选取60例经临床检查发现并经磁共振成像证实为急性明显孤立性ACL撕裂而接受手术的患者。暴露外侧间室并检测损伤情况。根据所获数据，将前外侧复合体损伤分为以下类型：I型：多层撕裂，各层在不同水平撕裂，伴有涉及前外侧韧带（ALL）区域的肉眼可见出血，并延伸至前外侧关节囊。II型：多层撕裂，各层在不同水平撕裂，肉眼可见出血从ALL和关节囊区域延伸至后外侧关节囊。III型：完全横行撕裂，累及ALL在其附着于外侧胫骨平台处、半月板外侧远端附近的区域。IV型：骨撕脱（Segond骨折）。在ACL重建术前修复外侧撕裂后，术中重复进行轴移试验。
尽管磁共振成像仅能检测到骨损伤（Segond骨折），但在60例患者中有54例在手术中明确发现外侧关节囊的肉眼可见撕裂，并分类如下：I型：19/60；II型：16/60；III型：13/60；IV型：6/60。在所有病例中，修复均使轴移现象明显减轻或明显消失。统计分析表明，无论所描述的类型如何，外侧间室损伤与2级或3级轴移之间存在正相关。
由于急性ACL撕裂病例中常发生继发稳定结构损伤，因此可考虑识别并修复此类损伤，以帮助ACL重建更好地控制旋转稳定性。
IV级，治疗性病例系列。
