Department of Orthopaedic Surgery, KonKuk University Medical Center, 120-1, Neungdong-ro, Gwangjin-gu, Seoul, 05030, South Korea.
Knee Surg Sports Traumatol Arthrosc. 2020 Mar;28(3):725-732. doi: 10.1007/s00167-019-05367-9. Epub 2019 Apr 17.
To evaluate the mid-term outcomes of anatomic medial complex reconstruction in cases of serious medial knee instability.
Between 2010 and 2013, 23 patients who underwent anatomic medial complex reconstruction with a minimum 5-year follow-up were included. The Lysholm score, International Knee Documentation Committee subjective knee form (IKDC SKF), and Tegner activity scale scores were evaluated. Clinical and functional tests included valgus and sagittal stress tests, isokinetic muscle strength test, single leg hop for distance test (SLDT), and single leg vertical jump test (SLVT).
The mean follow-up duration was 77.2 ± 10.8 months. At final follow-up, the Lysholm score improved from 49.7 ± 10.2 to 93.4 ± 12.4; the IKDC SKF score, from 46.2 ± 8.7 to 90.5 ± 13.9; and median Tegner activity, from 5 (4-7) to 7 (4-10) (P < 0.001). The mean side-to-side difference on valgus stress radiographs was significantly reduced to 1.2 ± 0.7 mm postoperatively compared to 8.5 ± 1.6 mm preoperatively (P < 0.001). The mean side-to-side differences on anterior and posterior stress radiographs were significantly improved in concomitant ACL and PCL reconstructions, respectively (P < 0.001). Preoperatively, 17 patients (73.9%) had anteromedial rotatory instability (AMRI), but none had AMRI at the last follow-up. The extensor peak torque and Limb Symmetry Index (LSI, %) improved from 128.2 ± 42.9 to 225 ± 39.4 N m/kg and from 61.4 ± 19.6 to 88.7 ± 21.7%, respectively (P < 0.001). The LSI (%) for SLDT and SLVT improved from 56.8 ± 19.5 to 87.3 ± 14.2% and from 68.1 ± 21.1 to 91.1 ± 12.8%, respectively (P < 0.001). No patient had a restricted range of movement.
Although posteromedial corner injuries that need medial complex reconstruction are extremely rare, proper anatomic medial complex reconstruction of the medial collateral and posterior oblique ligaments achieved satisfactory clinical and functional outcomes at mid-term follow-up in cases with chronic symptomatic valgus and rotatory laxity.
Case series, level IV.
评估严重内侧膝关节不稳定患者行解剖内侧复合体重建的中期结果。
2010 年至 2013 年，我们纳入了 23 例接受解剖内侧复合体重建且随访时间至少 5 年的患者。评估了 Lysholm 评分、国际膝关节文献委员会主观膝关节评分（IKDC SKF）和 Tegner 活动量表评分。临床和功能测试包括外翻和矢状面应力试验、等速肌力测试、单腿跳远距离测试（SLDT）和单腿垂直跳跃测试（SLVT）。
平均随访时间为 77.2±10.8 个月。末次随访时，Lysholm 评分从 49.7±10.2 提高至 93.4±12.4；IKDC SKF 评分从 46.2±8.7 提高至 90.5±13.9；Tegner 活动中位数从 5（4-7）提高至 7（4-10）（P<0.001）。与术前的 8.5±1.6mm 相比，术后的外翻位应力位 X 线片的侧-侧差值明显减少至 1.2±0.7mm（P<0.001）。在合并 ACL 和 PCL 重建的患者中，前侧和后侧应力位 X 线片的侧-侧差值分别显著改善（P<0.001）。术前，17 例（73.9%）患者存在前内侧旋转不稳定（AMRI），但末次随访时无一例出现 AMRI。伸肌峰值扭矩和肢体对称性指数（LSI，%）分别从 128.2±42.9 提高至 225±39.4N·m/kg 和从 61.4±19.6 提高至 88.7±21.7%（P<0.001）。SLDT 和 SLVT 的 LSI（%）分别从 56.8±19.5 提高至 87.3±14.2%和从 68.1±21.1 提高至 91.1±12.8%（P<0.001）。无患者出现活动受限。
尽管需要内侧复合体重建的后内侧角损伤极为罕见，但对于慢性症状性外翻和旋转松弛的患者，进行适当的解剖内侧复合体重建，包括内侧副韧带和后斜韧带，可获得满意的中期临床和功能结果。
病例系列，IV 级。
