Dejour H, Walch G, Peyrot J, Eberhard P
Clinique de chirurgie orthopédique et traumatologique; Centre Hospitalier Lyon-Sud, Pierre Bénite.
Rev Chir Orthop Reparatrice Appar Mot. 1988;74(1):35-43.
A study has been made in a series of 45 patients, 36 of whom were re-examined and 11 of whom replied to a questionnaire, of the fate of knees that had suffered a rupture of the posterior cruciate ligament which had not had a primary or secondary repair. The follow-up was between 5 and 44 years, with a mean of 15 years. In the 36 who were reviewed, 21 showed an isolated posterior laxity, 8 a postero-lateral laxity and 7 a postero-medial laxity. Even though the posterior cruciate ligament is the strongest ligament in the knee, an isolated rupture of the ligament is often well tolerated after a mean period of adaptation of 12 months. This functional tolerance is remarkable since it allows a return to sporting activity, even at high level. However, the disturbance of the kinematics of the knee resulting from the loss of the posterior cruciate ligament leads, after an average of 25 years, to osteoarthritis, either medial tibio-femoral or generalised depending on the morphological features of the patient. These findings have stimulated us to repair fresh lesions in young persons, especially in the presence of combined lesions but care needs to be exercised about the indications for surgery in chronic laxities during the first year of adaptation.
对45例患者进行了一项研究，其中36例接受了复查，11例回复了问卷，研究对象为后交叉韧带断裂且未进行一期或二期修复的膝关节的转归情况。随访时间为5至44年，平均15年。在接受复查的36例患者中，21例表现为单纯后向松弛，8例表现为后外侧松弛，7例表现为后内侧松弛。尽管后交叉韧带是膝关节中最强的韧带，但在平均12个月的适应期后，韧带的单纯断裂通常能被很好地耐受。这种功能耐受性很显著，因为它允许患者恢复体育活动，甚至是高水平的体育活动。然而，后交叉韧带缺失导致的膝关节运动学紊乱，平均25年后会导致骨关节炎，根据患者的形态学特征，可为胫股内侧骨关节炎或全身性骨关节炎。这些发现促使我们对年轻人的新鲜损伤进行修复，尤其是存在合并损伤的情况，但在适应期的第一年，对于慢性松弛的手术指征需要谨慎对待。
