Shelbourne K Donald, Benner Rodney W, Ringenberg Jonathan D, Gray Tinker
Orthopaedic Surgeon, Shelbourne Knee Center,
Indiana University School of Medicine, Indianapolis, IN, USA.
Orthop Res Rev. 2017 Apr 5;9:13-22. doi: 10.2147/ORR.S113617. eCollection 2017.
The optimal management of posterior cruciate ligament (PCL) injuries is debated by orthopedic surgeons. A natural history study (NHS) of acute, isolated PCL tears in patients with a mean follow-up of 14.3 years was previously published. The purpose of this study was to compare and contrast the results of the NHS study with those of other studies with similar follow-up time after operative and nonoperative management of isolated PCL tears.
With reviewing the literature, six operative management and six nonoperative management studies were found for treating isolated PCL injuries. We analyzed the subjective and objective outcomes of these 12 studies and compared them to the results of the NHS to determine optimal management of PCL injuries.
Final follow-up times ranged from a mean of 6.2 to 15 years in the nonoperative studies and 6.3 to 12 years in the operative studies. Side-to-side differences in laxity following surgical management ranged from 1.1 to 7 mm on KT-1000 arthrometer testing and 2.8 to 4.7 mm on Telos stress testing. Tegner scores at final follow-up ranged from 6.6 to 7.7 in nonoperative studies and 5.7 to 7.4 in operative studies. International Knee Documentation Committee scores were 73.4, 82.7, and 84 in nonoperative studies and 65 and 87 in the operative studies. Lysholm scores were 85.2 in the nonoperative study and ranged from 81 to 92.1 in operative studies. Osteoarthritis was reported with ranges from 17% to 88% in nonoperative studies and 13.3% to 63.6% in operative studies.
We found that the subjective and objective results in the NHS compare favorably to those of outcomes for PCL reconstruction. Unless a technique is found that can completely restore knee stability, it is unlikely that simply reducing posterior laxity will improve outcomes or prevent the development of osteoarthritis.
骨科医生对于后交叉韧带（PCL）损伤的最佳治疗方法存在争议。此前曾发表过一项针对急性孤立性PCL撕裂患者的自然史研究（NHS），平均随访时间为14.3年。本研究的目的是将NHS研究的结果与其他对孤立性PCL撕裂进行手术和非手术治疗后具有相似随访时间的研究结果进行比较和对比。
通过文献回顾，发现了六项治疗孤立性PCL损伤的手术治疗研究和六项非手术治疗研究。我们分析了这12项研究的主观和客观结果，并将其与NHS的结果进行比较，以确定PCL损伤的最佳治疗方法。
非手术治疗研究的最终随访时间平均为6.2至15年，手术治疗研究为6.3至12年。手术治疗后膝关节松弛度的左右差异在KT - 1000关节测量仪测试中为1.1至7毫米，在Telos应力测试中为2.8至4.7毫米。非手术治疗研究最终随访时的Tegner评分在6.6至7.7之间，手术治疗研究为5.7至7.4。国际膝关节文献委员会评分在非手术治疗研究中为73.4、82.7和84，在手术治疗研究中为65和87。Lysholm评分在非手术治疗研究中为85.2，在手术治疗研究中为81至92.1。非手术治疗研究中报告的骨关节炎发生率在17%至88%之间，手术治疗研究中为13.3%至63.6%。
我们发现NHS中的主观和客观结果与PCL重建的结果相比具有优势。除非找到一种能够完全恢复膝关节稳定性的技术，否则单纯减少后方松弛度不太可能改善治疗结果或预防骨关节炎的发生。
