Department of Trauma and Reconstructive Surgery, Asklepios Clinic St. Georg, Hamburg, Germany.
Department of Trauma, Hand and Reconstructive Surgery, Westphalian Wilhelms University Muenster, Muenster, Germany.
Knee Surg Sports Traumatol Arthrosc. 2021 Mar;29(3):732-741. doi: 10.1007/s00167-020-05987-6. Epub 2020 May 5.
This study aimed to compare the biomechanical properties of the popliteus bypass against the Larson technique for the reconstruction of a combined posterolateral corner and posterior cruciate ligament injury.
In 18 human cadaver knees, the kinematics for 134 N posterior loads, 10 Nm varus loads, and 5 Nm external rotational loads in 0°, 20°, 30°, 60,° and 90° of knee flexion were measured using a robotic and optical tracking system. The (1) posterior cruciate ligament, (2) meniscofibular/-tibial fibers, (3) popliteofibular ligament (PFL), (4) popliteotibial fascicle, (5) popliteus tendon, and (6) lateral collateral ligament were cut, and the measurements were repeated. The knees underwent posterior cruciate ligament reconstruction, and were randomized into two groups. Group PB (Popliteus Bypass; n = 9) underwent a lateral collateral ligament and popliteus bypass reconstruction and was compared to Group FS (Fibular Sling; n = 9) which underwent the Larson technique.
Varus angulation, posterior translation, and external rotation increased after dissection (p < 0.01). The varus angulation was effectively reduced in both groups and did not significantly differ from the intact knee. No significant differences were found between the groups. Posterior translation was reduced by both techniques (p < 0.01), but none of the groups had restored stability to the intact state (p < 0.02), with the exception of group PB at 0°. No significant differences were found between the two groups. The two techniques revealed major differences in their abilities to reduce external rotational instability. Group PB had less external rotational instability compared to Group FS (p < 0.03). Only Group PB had restored rotational instability compared to the state of the intact knee (p < 0.04) at all degrees of flexion.
The popliteus bypass for posterolateral reconstruction has superior biomechanical properties related to external rotational stability compared to the Larson technique. Therefore, the popliteus bypass may have a positive influence on the clinical outcome. This needs to be proven through clinical trials.
本研究旨在比较腘肌旁路与 Larson 技术在重建合并后外侧角和后十字韧带损伤中的生物力学特性。
在 18 个人体尸体膝关节中，使用机器人和光学跟踪系统测量了 134 N 后向负荷、10 Nm 内翻负荷和 5 Nm 外旋负荷在 0°、20°、30°、60°和 90°膝关节屈曲时的运动学。（1）后十字韧带、（2）半月板腓侧/胫骨纤维、（3）腓肠豆腓骨韧带、（4）腓肠豆胫骨束、（5）腘肌肌腱和（6）外侧副韧带被切断，重复测量。膝关节接受后十字韧带重建，并随机分为两组。PB 组（腘肌旁路；n = 9）行外侧副韧带和腘肌旁路重建，与行 Larson 技术的 FS 组（腓骨吊带；n = 9）进行比较。
切断后，内翻角度、后向平移和外旋增加（p < 0.01）。两组均有效减少了内翻角度，且与完整膝关节无显著差异。两组间无显著差异。两种技术均减少了后向平移（p < 0.01），但均未使任何一组恢复到完整状态的稳定性（p < 0.02），除了 PB 组在 0°时。两组间无显著差异。两种技术在减少外旋不稳定方面存在显著差异。与 FS 组相比，PB 组的外旋不稳定程度较低（p < 0.03）。只有 PB 组在所有屈曲角度下恢复了与完整膝关节相比的旋转不稳定（p < 0.04）。
与 Larson 技术相比，腘肌旁路在后外侧重建中具有更好的生物力学特性，与外旋稳定性有关。因此，腘肌旁路可能对临床结果产生积极影响。这需要通过临床试验来证明。
