University of Rome La Sapienza, Sant'Andrea Hospital, Rome, Italy.
University of Rome La Sapienza, Sant'Andrea Hospital, Rome, Italy.
Arthroscopy. 2018 Apr;34(4):1009-1014. doi: 10.1016/j.arthro.2017.09.042. Epub 2017 Dec 26.
To evaluate the effect of progressive lesions of the anterior cruciate ligament (ACL) and anterolateral ligament (ALL) on anterior tibial translation (ATT) as evaluated through the Lachman test and internal tibial rotation (ITR) during a dynamic pivot-shift test in a cadaveric model.
A total of 7 specimens were tested using a navigation system (2.2 OrthoPilot ACL navigation system). The anterior stability of the knee was measured through the Lachman test and dynamic rotational stability was measured through the pivot-shift test in 3 different conditions: intact knee; ACL-deficient knee; and finally, ACL- and ALL-deficient knee. The resulting measurements from the navigation system recorded the real-time changes in both translation and internal rotation during the Lachman and pivot-shift maneuvers.
Mean ATT was 7.57 ± 0.53 mm in the intact knee, 14 ± 2.44 mm in the ACL-deficient knee, and 14 ± 2.44 mm in the ACL- and ALL-deficient knee. Mean ITR during the pivot-shift test was 10.14° ± 2.26° in the intact knee, 12.14° ± 2.19° in the ACL-deficient knee, and 18.86° ± 2.73° in the ACL- and ALL-deficient knee. There was a statistically significant difference in static ATT between the intact and ACL-deficient knees (P = .039) but no difference through the addition of an ALL lesion (P = .068). For dynamic rotational control testing, there was no significant difference in ATT between groups but a significant difference in ITR was found (F = 25.17, P = .00034).
During the pivot-shift test, a combined lesion of the ACL and ALL has a significant effect on ITR whereas an isolated lesion of the ACL has no effect on either ATT or ITR. During the Lachman test, an isolated lesion of the ACL has a significant effect on ATT but an additional lesion of the ALL does not affect ATT.
Dynamic rotational control as tested by the pivot-shift test is greatly influenced by a combined lesion of the ACL and ALL. In clinical cases of a pivot shift, addressing the anterolateral structures may be considered.
在尸体模型中通过动态枢轴转移试验，评估前交叉韧带（ACL）和前外侧韧带（ALL）进行性损伤对 Lachman 试验和胫骨内旋（ITR）评估的胫骨前移位（ATT）的影响。
使用导航系统（2.2 OrthoPilot ACL 导航系统）对 7 个标本进行了测试。通过 Lachman 试验测量膝关节的前稳定性，通过枢轴转移试验测量动态旋转稳定性，共分为 3 种不同的情况：完整膝关节；ACL 缺失膝关节；以及最终 ACL 和 ALL 缺失膝关节。导航系统记录的实时测量值记录了 Lachman 和枢轴转移操作过程中平移和内旋的实时变化。
完整膝关节的平均 ATT 为 7.57±0.53mm，ACL 缺失膝关节为 14±2.44mm，ACL 和 ALL 缺失膝关节为 14±2.44mm。在枢轴转移试验中，完整膝关节的平均 ITR 为 10.14°±2.26°，ACL 缺失膝关节为 12.14°±2.19°，ACL 和 ALL 缺失膝关节为 18.86°±2.73°。完整膝关节和 ACL 缺失膝关节之间的静态 ATT 存在统计学差异（P=0.039），但加入 ALL 病变后无差异（P=0.068）。对于动态旋转控制测试，各组之间 ATT 无显著差异，但 ITR 存在显著差异（F=25.17，P=0.00034）。
在枢轴转移试验中，ACL 和 ALL 的联合损伤对 ITR 有显著影响，而 ACL 的单独损伤对 ATT 或 ITR 均无影响。在 Lachman 试验中，ACL 的单独损伤对 ATT 有显著影响，但 ALL 的附加损伤不影响 ATT。
通过枢轴转移试验测试的动态旋转控制受 ACL 和 ALL 的联合损伤影响较大。在临床上出现枢轴移位时，可能需要考虑处理前外侧结构。
