UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, 3200 South Water St, Pittsburgh, PA, 15203, USA.
Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA.
Knee Surg Sports Traumatol Arthrosc. 2022 Jan;30(1):131-138. doi: 10.1007/s00167-021-06476-0. Epub 2021 Feb 10.
To determine if anterior cruciate ligament (ACL) reconstruction (ACLR) with lateral extraarticular tenodesis (LET) is beneficial for restoring knee kinematics with concomitant meniscal pathology causing rotatory knee instability.
Twenty patients with an ACL tear were randomized to either isolated ACLR or ACLR with LET. Patients were divided into four groups based on the surgery performed and the presence of meniscal tear (MT): ACLR without MT, ACLR with MT, ACLR with LET without MT, and ACLR with LET with MT. Kinematic data normalized to the contralateral, healthy knee were collected using dynamic biplanar radiography superimposed with high-resolution computed tomography scans of patients' knees during downhill running. Anterior tibial translation (ATT) and tibial rotation (TR) as well as patient-reported outcome measures (PROMs) were analyzed at 6- and 12-months postoperatively.
At 6 months, ACLR with LET resulted in significantly decreased ATT at heel strike compared to ACLR (ACLR without MT: 0.3 ± 0.8 mm and ACLR with MT: 1.4 ± 3.1 mm vs. ACLR with LET without MT: - 2.5 ± 3.4 mm and ACLR with LET with MT: - 1.5 ± 1.2 mm ATT, p = 0.02). At 6 months, at toe off ACLR with LET better restored ATT to that of the contralateral, healthy knee in patients with meniscal pathology, while in patients without meniscal pathology, ACLR with LET resulted in significantly decreased ATT (1.0 ± 2.6 mm ATT vs. - 2.6 ± 1.7 mm ATT, p = 0.04). There were no significant differences in kinematics or PROMs between groups at 12 months.
For combined ACL and meniscus injury, ACLR with LET restores native knee kinematics at toe off but excessively decreases ATT at heel strike in the early post-operative period (6 months) without altering knee kinematics in the long term. Future large-scale clinical studies are needed to better understand the function of LET and ultimately improve patient outcomes.
III.
确定前交叉韧带（ACL）重建（ACLR）联合外侧关节外固定术（LET）是否有益于恢复伴有半月板撕裂导致旋转性膝关节不稳定的膝关节运动学。
将 20 例 ACL 撕裂患者随机分为 ACLR 组或 ACLR 联合 LET 组。根据手术方式和半月板撕裂（MT）的存在，将患者分为四组：无 MT 的 ACLR 组、有 MT 的 ACLR 组、无 MT 的 ACLR 联合 LET 组和有 MT 的 ACLR 联合 LET 组。在患者下坡跑步时，使用动态双平面射线照相术叠加膝关节高分辨率计算机断层扫描，对膝关节进行运动学数据的采集，并对健侧膝关节进行归一化处理。术后 6 个月和 12 个月，分析胫骨前移（ATT）和胫骨旋转（TR）以及患者报告的结果测量指标（PROMs）。
术后 6 个月，与 ACLR 相比，ACL 联合 LET 组在足跟触地时的 ATT 明显减少（无 MT 的 ACLR 组：0.3±0.8mm 和有 MT 的 ACLR 组：1.4±3.1mm 对比无 MT 的 ACLR 联合 LET 组：-2.5±3.4mm 和有 MT 的 ACLR 联合 LET 组：-1.5±1.2mm ATT，p=0.02）。术后 6 个月，在足趾离地时，ACL 联合 LET 组在有半月板病理的患者中更好地恢复了 ATT 至健侧膝关节的正常水平，而在无半月板病理的患者中，ACL 联合 LET 组导致 ATT 明显减少（1.0±2.6mm ATT 对比-2.6±1.7mm ATT，p=0.04）。术后 12 个月，各组之间的运动学或 PROMs 无显著差异。
对于 ACL 和半月板联合损伤，ACL 联合 LET 可在术后早期（6 个月）恢复膝关节的正常运动学，但在足跟触地时过度减少 ATT，而在长期内不会改变膝关节的运动学。需要进行更大规模的临床研究，以更好地了解 LET 的功能，并最终改善患者的结局。
III 级。
