Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A.; Department of Orthopaedic Sports Medicine, Technical University Munich, Munich, Germany.
Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A.; Department of Orthopaedic Surgery, Hospital Universitário, Canoas, Brazil.
Arthroscopy. 2018 Jan;34(1):251-260. doi: 10.1016/j.arthro.2017.08.258. Epub 2017 Nov 2.
To investigate knee kinematics in response to physical examinations to determine the effect of anterolateral capsular injury and lateral extra-articular tenodesis (LET) in anterior cruciate ligament (ACL)-deficient and -reconstructed knees.
Seven human lower limb cadavers were used in this study (mean age, 60 years; age range, 56-63 years). Physical examinations were performed, including the pivot-shift test, Lachman test, anterior drawer at 90°, and internal and external tibial rotation at 30°, 60°, and 90° of knee flexion. ACL injury and reconstruction and LET, all with and without an injured anterolateral capsule, were investigated. Tibial translation and rotation relative to the femur were measured by an electromagnetic tracking system during the physical examination.
Anterior translation of the lateral knee compartment and internal tibial rotation during the pivot-shift test were highest in combined ACL-deficient and anterolateral capsule-deficient knees (12.3 ± 7.4 mm and 16.3° ± 8.5°, respectively). With the presence of an anterolateral capsular injury, a combined ACL reconstruction and LET reduced the anterior translation of the lateral knee compartment during the pivot-shift test significantly (P = .042), whereas anatomic ACL reconstruction did not. Internal tibial rotation displayed overconstraint when a LET was performed, especially when the anterolateral capsule was intact.
ACL reconstruction in combination with a LET was able to reduce anterior tibial translation and internal tibial rotation in response to different physical examinations. However, combined ACL reconstruction and LET led to overconstraint of internal tibial rotation when the anterolateral capsule was intact. CLINICAL RELEVANCE: On the basis of our results, LET with ACL reconstruction restores stability in a combined ACL-injured and anterolateral capsule-injured knee. However, LET with ACL reconstruction overconstrains the knee in an isolated ACL injury.
研究膝关节运动学对体格检查的反应，以确定前交叉韧带（ACL）损伤和重建膝关节中外侧关节囊损伤和外侧额外关节固定术（LET）的影响。
本研究使用了 7 个人体下肢标本（平均年龄 60 岁；年龄范围 56-63 岁）。进行了体格检查，包括枢轴转移试验、Lachman 试验、90°前抽屉试验以及 30°、60°和 90°膝关节屈曲时的内外胫骨旋转。研究了 ACL 损伤和重建以及 LET，包括有无受伤的外侧关节囊。通过电磁跟踪系统测量体格检查过程中胫骨相对于股骨的平移和旋转。
在 ACL 损伤和外侧关节囊损伤的联合膝关节中，枢轴转移试验中外侧膝关节间隙的前向平移和胫骨内旋最大（分别为 12.3 ± 7.4mm 和 16.3° ± 8.5°）。在前外侧关节囊损伤存在的情况下，ACL 重建和 LET 联合显著降低了枢轴转移试验中外侧膝关节间隙的前向平移（P =.042），而解剖 ACL 重建则没有。当进行 LET 时，胫骨内旋显示出过度约束，尤其是当外侧关节囊完整时。
ACL 重建联合 LET 能够减少不同体格检查时的胫骨前向平移和胫骨内旋。然而，当外侧关节囊完整时，ACL 重建联合 LET 会导致胫骨内旋过度约束。临床相关性：根据我们的结果，ACL 损伤和重建联合 LET 可恢复 ACL 损伤和外侧关节囊损伤的膝关节稳定性。然而，ACL 重建联合 LET 在 ACL 单独损伤时会过度限制膝关节。
