Department of Orthopaedics and Traumatology, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, SP, Brazil; Knee Institute, Hospital do Coração, São Paulo, SP, Brazil; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
Department of Orthopaedics and Traumatology, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, SP, Brazil; Knee Institute, Hospital do Coração, São Paulo, SP, Brazil.
Arthroscopy. 2019 Jun;35(6):1676-1685.e3. doi: 10.1016/j.arthro.2019.01.016. Epub 2019 Apr 30.
To report the subjective outcomes and objective stability in a series of chronically grade III posterolateral injured knees treated with a hamstring-based anatomic posterolateral corner (PLC) reconstruction technique using autografts.
An outcome study of patients with a chronic complete tear of all ligamentous structures of the PLC (>5 mm of varus gapping at 30, ≥10° of external tibial rotation during the dial test, ≥4 mm of increased lateral compartment opening during varus stress radiographs) was performed. The patients were evaluated subjectively with Lysholm, International Knee Documentation Committee (IKDC), and Tegner scores and objectively with varus stress radiographs at 20° of knee flexion, IKDC objective scores, and recurvatum evaluation. Institutional review board approval: CEP/UNIFESP n: 1251/2016.
Twenty-nine of 33 patients were available for follow up at an average of 31.9 ± 12.3 months (range, 24-59 months) postoperatively. Twenty-five patients underwent multiple-ligament reconstruction without prior osteotomy. No patient had an isolated PLC knee reconstruction. The average comparative preoperative and postoperative outcomes were, respectively: Lysholm: 49.7 ± 10.3, 81.2 ± 12.8, P < .001, 89.7% met minimal detectable change; IKDC: 36.7 ± 8.3, 70.4 ± 19.8, P < .001, 82.8% met minimal clinically important difference; Tegner, 6.6 ± 1.3, 5.5 ± 1.6, P < .001; and varus stress radiograph: 7.1 ± 3.1 mm, 1.8 ± 1.8 mm, P < .001. A significant improvement, P < .001, was found between preoperative and postoperative IKDC objective scores for varus opening at 0° and 30° and external rotation measured by the dial test at 30°. Recurvatum was also improved: preoperatively, 52% had a low-grade and 48% had a high-grade recurvatum, whereas postoperatively, 100% were classified as low grade, P < .001.
The presented anatomic PLC reconstruction, concomitant to other surgical procedures and ligament reconstructions, is a valid technique in a multiligamentous knee injury involving the PLC, improving subjective outcomes and objective stability in patients with a chronic PLC knee injury, similar to historical controls.
Level IV, therapeutic case series.
报告采用自体肌腱进行解剖后外侧角（PLC）重建技术治疗慢性 III 级后外侧损伤膝关节的一系列主观结果和客观稳定性。
对慢性完全性 PLC 所有韧带结构撕裂（在 30°时出现内翻间隙 >5mm，在Dial 试验时出现外旋 >10°，在外翻位应力位片时出现外侧间室开口增加 >4mm）的患者进行了一项结局研究。患者的主观评估采用 Lysholm、国际膝关节文献委员会（IKDC）和 Tegner 评分，客观评估采用膝关节屈曲 20°时的外翻位应力位片、IKDC 客观评分和后向伸直畸形评估。机构审查委员会批准：CEP/UNIFESP n：1251/2016。
33 例患者中有 29 例在术后平均 31.9 ± 12.3 个月（24-59 个月）时可获得随访。25 例患者行多韧带重建，未行先行截骨术。无患者行单纯 PLC 膝关节重建。平均术前和术后比较结果分别为：Lysholm：49.7 ± 10.3，81.2 ± 12.8，P<0.001，89.7%达到最小可检测变化；IKDC：36.7 ± 8.3，70.4 ± 19.8，P<0.001，82.8%达到最小临床重要差异；Tegner：6.6 ± 1.3，5.5 ± 1.6，P<0.001；外翻位应力位片：7.1 ± 3.1mm，1.8 ± 1.8mm，P<0.001。IKDC 客观评分显示，在 0°和 30°时的外翻间隙和Dial 试验时的外旋测量，术前和术后之间存在显著改善（P<0.001）。后向伸直畸形也得到改善：术前，52%为轻度，48%为重度，术后 100%均为轻度，P<0.001。
在涉及 PLC 的多韧带膝关节损伤中，同时进行其他手术和韧带重建，提出的解剖后外侧角重建是一种有效的技术，可改善慢性 PLC 膝关节损伤患者的主观结局和客观稳定性，与历史对照相似。
IV 级，治疗性病例系列。
