UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan.
Am J Sports Med. 2021 Jun;49(7):1803-1812. doi: 10.1177/03635465211003298. Epub 2021 Apr 19.
Lateral extra-articular tenodesis (LET) in combination with anterior cruciate ligament (ACL) reconstruction (ACLR) has been proposed to improve residual rotatory knee instability in patients having ACL deficiency.
PURPOSE/HYPOTHESIS: The purpose was to compare the effects of isolated ACLR (iACLR) versus LET in combination with ACLR (ACLR+LET) on in vivo kinematics during downhill running. It was hypothesized that ACLR+LET would reduce the internal rotation of the reconstructed knee in comparison with iACLR.
Controlled laboratory study.
A total of 18 patients with ACL deficiency were included. All participants were randomly assigned to receive ACLR+ LET or iACLR during surgery. Six months and 12 months after surgery, knee joint motion during downhill running was measured using dynamic biplane radiography and a validated registration process that matched patient-specific 3-dimensional bone models to synchronized biplane radiographs. Anterior tibial translation (ATT; positive value means "anterior translation") and tibial rotation (TR) relative to the femur were calculated for both knees. The side-to-side differences (SSDs) in kinematics were also calculated (operated knee-contralateral healthy knee). The SSD value was compared between ACLR+LET and iACLR groups using a Mann-Whitney test.
At 6 months after surgery, the SSD of ATT in patients who had undergone ACLR+LET (-1.9 ± 2.0 mm) was significantly greater than that in patients who had undergone iACLR (0.9 ± 2.3 mm) at 0% of the gait cycle (foot strike) ( = .031). There was no difference in ATT 12 months after surgery. Regarding TR, there were no differences between ACLR+LET and iACLR at either 6 months ( value range, .161-.605) or 12 months ( value range, .083-.279) after surgery.
LET in combination with ACLR significantly reduced ATT at the instant of foot strike during downhill running at 6 months after surgery. However, this effect was not significant at 12 months after surgery. The addition of LET to ACLR had no effect on TR at both 6 and 12 months after surgery.
LET in combination with ACLR may stabilize sagittal knee motion during downhill running in the early postoperation phase, but according to this study, it has no effect on 12-month in vivo kinematics.
NCT02913404 (ClinicalTrials.gov identifier).
外侧关节外腱固定术（LET）联合前交叉韧带（ACL）重建术（ACLR）已被提出，以改善 ACL 缺失患者的残留旋转性膝关节不稳定。
目的/假设：本研究旨在比较单独 ACLR（iACLR）与 LET 联合 ACLR（ACLR+LET）对下坡跑步时膝关节体内运动学的影响。假设与 iACLR 相比，ACLR+LET 可减少重建膝关节的内旋。
对照实验室研究。
共纳入 18 例 ACL 缺陷患者。所有参与者在手术中均随机分配接受 ACLR+LET 或 iACLR。术后 6 个月和 12 个月，使用动态双平面射线照相术和经过验证的配准过程测量下坡跑步时膝关节运动，该过程将患者特定的 3 维骨骼模型与同步双平面射线照相术匹配。计算双侧膝关节的胫骨前移（ATT；正值表示“前移”）和胫骨相对于股骨的旋转（TR）。还计算了运动学的侧间差异（SSDs）（手术侧-对侧健康侧）。使用 Mann-Whitney U 检验比较 ACLR+LET 和 iACLR 组之间的 SSD 值。
术后 6 个月，接受 ACLR+LET 的患者的 ATT SSD（-1.9±2.0mm）在步态周期的 0%（足触地）显著大于接受 iACLR 的患者（0.9±2.3mm）（ =.031）。术后 12 个月时，ATT 无差异。关于 TR，术后 6 个月（ 值范围，.161-.605）和 12 个月（ 值范围，.083-.279）时，ACLR+LET 和 iACLR 之间均无差异。
术后 6 个月，LET 联合 ACLR 显著减少下坡跑步时足触地瞬间的 ATT。然而，术后 12 个月时，这种效果并不显著。在术后 6 个月和 12 个月时，LET 联合 ACLR 对 TR 均无影响。
LET 联合 ACLR 可能在术后早期稳定下坡跑步时的矢状面膝关节运动，但根据本研究，它对术后 12 个月的体内运动学没有影响。
NCT02913404（ClinicalTrials.gov 标识符）。
