Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California, U.S.A.
Arthroscopy. 2022 Mar;38(3):911-924. doi: 10.1016/j.arthro.2021.06.023. Epub 2021 Aug 3.
To compare the kinematics of anterolateral structure (ALS) reconstruction (ALSR) and lateral extra-articular tenodesis (LET) in ACL-ALS-deficient knees with anterior cruciate ligament (ACL) reconstruction.
Ten fresh-frozen cadaveric knees with the following conditions were tested: (1) intact, (2) ACL-ALS deficiency, (3) ACL reconstruction (ACLR), (4) ACLR combined with ALSR (ACL-ALSR) or LET (ACLR+LET). Anterior translation and tibial internal rotation were measured with 90-N anterior load and 5 N·m internal torque at 0°, 30°, 60°, and 90°. The anterolateral translation and internal rotation were also measured during a simulated pivot-shift test at 0°, 15°, 30°, and 45°. The knee kinematic changes in all reconstructions were compared with each other, with intact knees as the baseline.
Isolated ACLR failed to restore native knee kinematics in ACL-ALS-deficient knees. Both ACL-ALSR and ACLR+LET procedures decreased the anterior instability of the ACLR. However, ACLR+LET caused overconstraints in internal rotation at 30° (-3.73° ± 2.60°, P = .023), 60° (-4.96° ± 2.22°, P = .001) and 90° (-6.14° ± 1.60°, P < .001). ACL-ALSR also overconstrained the knee at 60° (-3.65° ± 1.90°, P < .001) and 90° (-3.18° ± 2.53°, P < .001). For a simulated pivot-shift test, both combined procedures significantly reduced the ACLR instability, with anterolateral translation and internal rotation being overconstrained in ACLR+LET at 30° (-3.32 mm ± 3.89 mm, P = .005; -2.58° ± 1.61°, P < .001) and 45° (-3.02 mm ± 3.95 mm, P = .012; -3.44° ± 2.86°, P < .001). However, the ACL-ALSR overconstrained only the anterolateral translation at 30° (-1.51 mm ± 2.39 mm, P = .046) and internal rotation at 45° (-2.09° ± 1.70°, P < .001). There were no significant differences between the two combined procedures at most testing degrees in each testing state, except for the internal rotation at 30° (P = .007) and 90° (P = .032) in internal rotation torque.
ACL reconstruction alone did not restore intact knee kinematics in knees with concurrent ACL tears and severe ALS injury (ACL-ALS-deficient status). Both ACL-ALSR and ACLR+LET procedures restored knee stability at some flexion degrees, with less overconstraints in internal rotation resulting from ACL-ALSR.
For patients with combined ACL tears and severe ALS deficiency, isolated ACLR probably results in residual rotational and pivot-shift instability. Both ACL-ALSR and ACLR+LET show promise for the improvement of knee stability, whereas ACL-ALSR has less propensity for knee overconstraint.
比较前外侧结构（ALS）重建（ALSR）和外侧关节外肌腱固定术（LET）在伴有前交叉韧带（ACL）和 ALS 损伤的 ACL-ALS 缺陷膝关节中的运动学。
测试了以下条件的 10 个新鲜冷冻尸体膝关节：（1）完整，（2）ACL-ALS 缺陷，（3）ACL 重建（ACLR），（4）ACL 重建结合 ALSR（ACL-ALSR）或 LET（ACLR+LET）。在 90-N 前负荷和 5 N·m 内扭矩下，在 0°、30°、60°和 90°测量前向平移和胫骨内旋。在模拟枢轴移位试验中，在 0°、15°、30°和 45°时还测量了前外侧平移和内旋。将所有重建的膝关节运动学变化与完整膝关节进行比较。
单独的 ACLR 无法恢复 ACL-ALS 缺陷膝关节的正常膝关节运动学。ACL-ALSR 和 ACLR+LET 两种手术都降低了 ACLR 的前不稳定。然而，ACLR+LET 在 30°（-3.73°±2.60°，P=.023）、60°（-4.96°±2.22°，P=.001）和 90°（-6.14°±1.60°，P<.001）时导致内旋转过度约束。ACL-ALSR 在 60°（-3.65°±1.90°，P<.001）和 90°（-3.18°±2.53°，P<.001）时也过度限制了膝关节。对于模拟枢轴移位试验，两种联合手术都显著降低了 ACLR 的不稳定性，在 ACLR+LET 中，在 30°（-3.32mm±3.89mm，P=.005；-2.58°±1.61°，P<.001）和 45°（-3.02mm±3.95mm，P=.012；-3.44°±2.86°，P<.001）时，前外侧平移和内旋过度约束。然而，ACL-ALSR 仅在 30°（-1.51mm±2.39mm，P=.046）和 45°（-2.09°±1.70°，P<.001）时过度限制了前外侧平移和内旋。在每个测试状态的大多数测试角度，两种联合手术之间没有显著差异，除了在内部旋转扭矩的 30°（P=.007）和 90°（P=.032）。
单独的 ACLR 不能恢复伴有 ACL 撕裂和严重 ALS 损伤（ACL-ALS 缺陷状态）的膝关节的正常膝关节运动学。ACL-ALSR 和 ACLR+LET 两种手术都在某些屈曲角度恢复了膝关节的稳定性，ACL-ALSR 导致的内旋转过度约束较少。
对于伴有 ACL 撕裂和严重 ALS 缺乏的患者，单独的 ACLR 可能导致残留的旋转和枢轴移位不稳定。ACL-ALSR 和 ACLR+LET 均有望改善膝关节稳定性，而 ACL-ALSR 对内旋转的过度约束倾向较小。
