Department of Orthopaedic Surgery, The Armed Forces Daegu Hospital, Gyeongsan, Republic of Korea.
Department of Orthopaedic Surgery and Intitue of Health Science, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, 79 Gangnam-ro, Jinju, 52727, Republic of Korea.
Knee Surg Sports Traumatol Arthrosc. 2018 Sep;26(9):2669-2678. doi: 10.1007/s00167-017-4672-x. Epub 2017 Aug 14.
This is a meta-analysis comparing biomechanical outcomes to determine whether an isolated posterior cruciate ligament (PCL) reconstruction can restore normal knee kinematics in a combined PCL/posterolateral complex (PLC) injury and whether double-bundle (DB) PCL reconstruction is superior in controlling posterior and rotational laxity compared with single-bundle (SB) PCL reconstruction in a PCL/PLC-deficient knee.
A number of electronic databases were searched for relevant articles published through August 2016 that compared biomechanical outcomes of PCL reconstruction in patients who underwent reconstruction for combined PCL/PLC deficiencies. Data were searched, extracted, analysed, and assessed for quality according to Cochrane Collaboration guidelines, and biomechanical outcomes were evaluated using various outcome values. The results are presented as relative ratios for binary outcomes and standard mean differences for continuous outcomes with 95% confidence intervals.
Five biomechanical studies were included in this meta-analysis. There were significant differences in laxities such as posterior tibial translation (PTT), external rotation, varus rotation, and PTT coupled with external rotation in the isolated PCL reconstruction group compared with the native PCL group. Furthermore, there were no significant differences in laxities such as PTT, external rotation, or varus rotation between the SB and DB PCL reconstruction groups.
Isolated PCL reconstruction, whether SB or DB, could not restore normal knee kinematics in the PCL/PLC-deficient knee. In such cases, residual laxity after isolated PCL reconstruction can be controlled successfully with PLC reconstruction. Therefore, simultaneous PCL and PLC reconstruction is recommended for patients with combined PCL/PLC injury.
这是一项荟萃分析，旨在比较生物力学结果，以确定孤立的后交叉韧带（PCL）重建是否可以恢复合并 PCL/后外侧复合体（PLC）损伤患者的正常膝关节运动学，以及在 PCL/PLC 缺陷膝关节中，与单束（SB）PCL 重建相比，双束（DB）PCL 重建在控制后向和旋转松弛方面是否更具优势。
检索了多个电子数据库，以查找 2016 年 8 月之前发表的比较 PCL 重建患者的生物力学结果的相关文章，这些患者接受了合并 PCL/PLC 缺陷的重建。根据 Cochrane 协作组的指南进行了数据搜索、提取、分析和质量评估，并使用各种结果值评估了生物力学结果。结果以二项结果的相对比值和连续结果的标准均数差表示，置信区间为 95%。
这项荟萃分析纳入了 5 项生物力学研究。在孤立的 PCL 重建组中，与正常 PCL 组相比，松弛度（如胫骨后移（PTT）、外旋、内翻旋转和 PTT 合并外旋）存在显著差异。此外，SB 和 DB PCL 重建组之间的松弛度（如 PTT、外旋或内翻旋转）没有显著差异。
无论是 SB 还是 DB，孤立的 PCL 重建都不能恢复 PCL/PLC 缺陷膝关节的正常运动学。在这种情况下，孤立的 PCL 重建后残留的松弛度可以通过 PLC 重建成功控制。因此，建议对合并 PCL/PLC 损伤的患者同时进行 PCL 和 PLC 重建。
