Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA.
Department of Orthopaedic Sports Medicine, Technical University, Munich, Germany.
Am J Sports Med. 2019 Oct;47(12):2952-2959. doi: 10.1177/0363546519868961. Epub 2019 Aug 27.
In cases of acute combined posteromedial and anterior cruciate ligament (ACL) injuries, primary repair of the superficial medial collateral ligament (sMCL) and posterior oblique ligament (POL) with suture tape augmentation may be a reasonable alternative to standard tendon reconstruction techniques.
PURPOSE/HYPOTHESIS: The purpose was to examine the rotational and valgus laxity with ACL strain following sMCL and POL repair with suture tape augmentation at various degrees of knee flexion. It was hypothesized that this technique would restore knee laxity and kinematics comparable with those of the intact state.
Controlled laboratory study.
Ten cadaveric knee specimens (mean ± SD, 57.9 ± 5.9 years) were obtained. Specimens were tested with the tibia fixed and the femur mobile on an X-Y table. Each specimen was tested in 4 conditions according to the state of the sMCL and POL: native, deficient, repaired with suture tape augmentation, and reconstructed with tendon allografts. Valgus laxity was tested with 40-N force applied in the lateral direction of the femur, and rotational motion was tested with 5-N torque applied to the tibia. ACL strain during valgus stress was also measured. Each condition was tested in 0°, 15°, 30°, 45°, and 60° of knee flexion.
Dissection of the sMCL and POL led to significantly increased valgus laxity in all flexion angles, with a significant increase in ACL strain at 30° ( < .001) and 45° ( < .001). Ligament repair with suture tape augmentation demonstrated similar valgus and rotational laxity as compared with intact specimens, with the exception of increased internal rotation at 30° ( = .005). Ligament reconstruction resulted in significantly increased valgus opening at 45° ( = .048) and significantly increased internal rotation at 30° ( < .001) as compared with the native state. Direct comparison between surgical techniques showed no significant differences.
At time zero, ligament repair of the posteromedial knee with suture tape augmentation restored close-to-native valgus and rotatory laxity, as well as native ACL strain for cases of complete sMCL and POL avulsion.
Ligament repair of the sMCL and POL with suture tape augmentation may be a reasonable alternative to tendon reconstruction techniques in cases of acute combined posteromedial and ACL injuries with valgus and rotatory instability.
在急性前交叉韧带（ACL）合并后内侧和前交叉韧带损伤的情况下，用缝线带增强对浅层内侧副韧带（sMCL）和后斜韧带（POL）进行初步修复可能是替代标准肌腱重建技术的合理选择。
目的/假设：本研究的目的是在不同膝关节屈曲角度下，检查 ACL 应变后 sMCL 和 POL 修复用缝线带增强的旋转和外翻松弛情况。假设该技术将恢复与正常状态相当的膝关节松弛度和运动学。
对照实验室研究。
获得 10 个尸体膝关节标本（平均±标准差，57.9±5.9 岁）。标本在 X-Y 台上用胫骨固定、股骨移动进行测试。根据 sMCL 和 POL 的状态，每个标本在 4 种条件下进行测试：正常、缺失、用缝线带修复和用同种异体肌腱重建。在股骨外侧施加 40-N 力测试外翻松弛度，在胫骨施加 5-N 扭矩测试旋转运动。还测量了 ACL 在外翻应力下的应变。每种条件均在膝关节 0°、15°、30°、45°和 60°下进行测试。
sMCL 和 POL 的解剖导致所有屈曲角度的外翻松弛明显增加，在 30°（<.001）和 45°（<.001）时 ACL 应变明显增加。缝线带修复与完整标本相比具有相似的外翻和旋转松弛度，但在 30°时内旋增加（=.005）。与正常状态相比，韧带重建在 45°时外翻开口明显增加（=.048），在 30°时内旋明显增加（<.001）。两种手术技术的直接比较无统计学差异。
在时间为零时，用缝线带增强对后内侧膝关节的 sMCL 和 POL 进行韧带修复，可为完全 sMCL 和 POL 撕脱的急性前交叉韧带合并损伤病例恢复接近正常的外翻和旋转松弛度以及正常的 ACL 应变。
在伴有外翻和旋转不稳定的急性前交叉韧带合并后内侧和 ACL 损伤的情况下，用缝线带增强对 sMCL 和 POL 进行韧带修复可能是替代肌腱重建技术的合理选择。
