Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
Center for Diagnostic and Interventional Radiology and Nuclear Medicine, Charité-University Medicine Berlin, Berlin, Germany.
Knee Surg Sports Traumatol Arthrosc. 2019 Feb;27(2):389-396. doi: 10.1007/s00167-018-5035-y. Epub 2018 Jul 2.
Restoration of posterior tibial translation (PTT) after reconstruction of the posterior cruciate ligament (PCL) is deemed necessary to restore physiological knee kinematics. However, current surgical techniques have failed to show a complete reduction of posterior laxity. It was hypothesized that early postoperative PTT increases over time.
The study comprised of 46 patients (10 female, 36 male; 30 ± 9 years), who underwent PCL reconstruction in a single-surgeon series. Patients were evaluated by bilateral stress radiographs in a prospective manner preoperatively; at 3, 6, 12 and 24 months; and at a final follow-up (FFU) of at least 5 years. Covariants included age, gender, BMI, tibial slope (TS) and the number of operated ligaments. Two blinded observers reviewed all radiographs, evaluating the TS and the posterior tibial translation.
All patients were evaluated at a mean final follow-up of 102 (range 65-187) months. Mean side-to-side difference of the PTT significantly improved from preoperative to 3-month postoperative values (10.9 ± 3.1 vs. 3.6 ± 3.8 mm; P < 0.0001). The PTT increased to 4.6 ± 3.7 mm at 6 months, to 4.8 ± 3.3 mm at 12 months, to 4.8 ± 3.2 mm at 24 months, to 5.4 ± 3.4 mm at FFU. Consequently, there was a significant increase of PTT between 3-month and final follow-up (3.6 ± 3.8 vs. 5.4 ± 3.4 mm; P = 0.02). Flattening of the TS resulted in a significantly higher PTT compared to subjects with a high TS at 24 months and FFU. There was no significant influence by BMI, age, gender and the number of operated ligaments.
Early results after PCL reconstruction seem promising as posterior tibial translation is significantly improved. However, there is a significant increase in PTT from early postoperative values to the final follow-up of at least 5 years. This is particularly notable in patients with flattening of the TS. As a consequence, surgeons and patients need to be aware that initial posterior stability should not be equated with the final outcome.
Cohort study, Level III.
重建后交叉韧带（PCL）后恢复胫骨后移（PTT）被认为是恢复生理膝关节运动学所必需的。然而，目前的手术技术未能完全减少后部松弛。假设术后早期 PTT 会随着时间的推移而增加。
本研究包括 46 名患者（10 名女性，36 名男性；30±9 岁），他们在一位外科医生的系列手术中接受了 PCL 重建。患者前瞻性地通过双侧应力射线照相进行术前评估；术后 3、6、12 和 24 个月；以及至少 5 年的最终随访（FFU）。协变量包括年龄、性别、BMI、胫骨斜率（TS）和手术韧带数量。两名盲法观察者审查了所有射线照片，评估了 TS 和胫骨后移。
所有患者的平均最终随访时间为 102 个月（范围 65-187 个月）。PTT 的侧间差值从术前到术后 3 个月显著改善（10.9±3.1 对 3.6±3.8mm；P<0.0001）。PTT 在 6 个月时增加到 4.6±3.7mm，在 12 个月时增加到 4.8±3.3mm，在 24 个月时增加到 4.8±3.2mm，在 FFU 时增加到 5.4±3.4mm。因此，3 个月和最终随访时 PTT 显著增加（3.6±3.8 对 5.4±3.4mm；P=0.02）。与 TS 较高的患者相比，TS 变平的患者在 24 个月和 FFU 时的 PTT 明显更高。BMI、年龄、性别和手术韧带数量无显著影响。
PCL 重建后的早期结果似乎很有希望，因为胫骨后移明显改善。然而，从术后早期到至少 5 年的最终随访，PTT 显著增加。在 TS 变平的患者中尤其明显。因此，外科医生和患者需要意识到初始的后部稳定性不应等同于最终结果。
队列研究，III 级。
