Treme Gehron P, Salas Christina, Ortiz Gabriel, Gill George Keith, Johnson Paul J, Menzer Heather, Richter Dustin L, Qeadan Fares, Wascher Daniel C, Schenck Robert C
Department of Orthopaedics & Rehabilitation, The University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA.
Center for Biomedical Engineering, The University of New Mexico, Albuquerque, New Mexico, USA.
Orthop J Sports Med. 2019 Apr 15;7(4):2325967119838251. doi: 10.1177/2325967119838251. eCollection 2019 Apr.
Injury to the posterolateral corner (PLC) of the knee requires reconstruction to restore coronal and rotary stability. Two commonly used procedures are the Arciero reconstruction technique (ART) and the LaPrade reconstruction technique (LRT). To the authors' knowledge, these techniques have not been biomechanically compared against one another.
To identify if one of these reconstruction techniques better restores stability to a PLC-deficient knee and if concomitant injury to the proximal tibiofibular joint or anterior cruciate ligament affects these results.
Controlled laboratory study.
Eight matched-paired cadaveric specimens from the midfemur to toes were used. Each specimen was tested in 4 phases: intact PLC (phase 1), PLC sectioned (phase 2), PLC reconstructed (ART or LRT) (phase 3), and tibiofibular (phase 4A) or anterior cruciate ligament (phase 4B) sectioning with PLC reconstructed. Varus angulation and external rotation at 0º, 20º, 30º, 60º, and 90º of knee flexion were quantified at each phase.
In phase 3, both reconstructions were effective at restoring laxity back to the intact state. However, in phase 4A, both reconstructions were ineffective at stabilizing the joint owing to tibiofibular instability. In phase 4B, both reconstructions had the potential to restrict varus angulation motion. There were no statistically significant differences found between reconstruction techniques for varus angulation or external rotation at any degree of flexion in phase 3 or 4.
The LRT and ART are equally effective at restoring stability to knees with PLC injuries. Neither reconstruction technique fully restores stability to knees with combined PLC and proximal tibiofibular joint injuries.
Given these findings, surgeons may select their reconstruction technique based on their experience and training and the specific needs of their patients.
膝关节后外侧角（PLC）损伤需要进行重建以恢复冠状面和旋转稳定性。两种常用的手术方法是阿西埃罗重建技术（ART）和拉普拉德重建技术（LRT）。据作者所知，这些技术尚未在生物力学方面进行相互比较。
确定这些重建技术中的一种是否能更好地恢复PLC损伤膝关节的稳定性，以及胫腓近端关节或前交叉韧带的合并损伤是否会影响这些结果。
对照实验室研究。
使用8对匹配的尸体标本，从股骨中段到脚趾。每个标本分4个阶段进行测试：PLC完整（阶段1）、PLC切断（阶段2）、PLC重建（ART或LRT）（阶段3），以及在PLC重建的情况下切断胫腓关节（阶段4A）或前交叉韧带（阶段4B）。在膝关节屈曲0°、20°、30°、60°和90°时，对内翻角度和外旋进行量化。
在阶段3，两种重建方法都能有效地将松弛度恢复到完整状态。然而，在阶段4A，由于胫腓关节不稳定，两种重建方法在稳定关节方面均无效。在阶段4B，两种重建方法都有可能限制内翻角度运动。在阶段3或4的任何屈曲角度下，两种重建技术在内翻角度或外旋方面均未发现统计学上的显著差异。
LRT和ART在恢复PLC损伤膝关节的稳定性方面同样有效。两种重建技术都不能完全恢复PLC合并胫腓近端关节损伤膝关节的稳定性。
鉴于这些发现，外科医生可以根据自己的经验、培训以及患者的具体需求来选择重建技术。
