Institute of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Beijing, China.
Institute of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Beijing, China.
Arthroscopy. 2020 Apr;36(4):1121-1131. doi: 10.1016/j.arthro.2019.10.035. Epub 2020 Jan 22.
To assess the role of anatomic reconstruction of the posterolateral corner (PLC) of the knee arthroscopically in cadaveric knees with simulated isolated grade III posterolateral instability.
A total of 12 nonpaired, fresh-frozen cadaveric knees were biomechanically subjected to a 10-Nm varus moment, 5-Nm external and internal rotation torques, and 134-N posterior tibial load at 0°, 15°, 30°, 60°, and 90° of knee flexion (0° for varus loading only). Testing was performed with an intact and sectioned PLC and after anatomic reconstruction of the PLC by an arthroscopic technique. Kinematics of each knee under various loading conditions was determined with a robotic universal force/moment sensor testing system.
After sectioning, significant increases were found in varus rotation at 0°, 15°, 30°, 60°, and 90° of knee flexion; in external rotation at 15°, 30°, 60°, and 90° of knee flexion; in internal rotation at 60° of knee flexion only; and in posterior translation at 15° and 30° of knee flexion. After reconstruction, full recovery of knee stability was observed in varus rotation, external rotation, internal rotation, and posterior translation at all selected flexion angles without any overconstraint of knee kinematics.
Anatomic reconstruction of the PLC can be performed arthroscopically with isolated grade III posterolateral instability of the knee, and nearly normal stability of the knee can be restored.
PLC reconstruction by an anatomic, all-arthroscopic technique achieves optimal stability control and kinematics of the knee.
评估关节镜下膝关节后外侧角（PLC）解剖重建在模拟孤立性 III 级后外侧不稳定中的作用。
对 12 个非配对的新鲜冷冻尸体膝关节进行生物力学测试，施加 10-Nm 的内翻力矩、5-Nm 的内外旋扭矩和 134-N 的胫骨后向负荷，在 0°、15°、30°、60°和 90°的膝关节屈曲位（仅在施加内翻力矩时为 0°）进行测试。在 PLC 完整和切断以及通过关节镜技术进行解剖重建后，对每个膝关节在各种加载条件下的运动学进行测试。
切断后，在膝关节 0°、15°、30°、60°和 90°的屈曲位，内翻旋转明显增加；在膝关节 15°、30°、60°和 90°的屈曲位，外旋旋转明显增加；在膝关节 60°的屈曲位，内旋旋转明显增加；在膝关节 15°和 30°的屈曲位，后向平移明显增加。重建后，在所有选定的屈曲角度下，膝关节的内翻旋转、外旋旋转、内旋旋转和后向平移均恢复了正常稳定性，没有出现过度限制膝关节运动学的情况。
对于孤立性 III 级膝关节后外侧不稳定，可以通过关节镜进行 PLC 解剖重建，从而恢复膝关节的接近正常的稳定性。
通过解剖、全关节镜技术进行 PLC 重建可实现膝关节的最佳稳定性控制和运动学效果。
