在同时进行部分内侧半月板切除术的情况下，采用外侧成形术的前交叉韧带重建可恢复前后向松弛度。
Anterior cruciate ligament reconstruction with lateral plasty restores anterior-posterior laxity in the case of concurrent partial medial meniscectomy.
作者信息
Di Paolo Stefano, Grassi Alberto, Pizza Nicola, Lucidi Gian Andrea, Dal Fabbro Giacomo, Macchiarola Luca, Zaffagnini Stefano
机构信息
Dipartimento di Scienze per la Qualità della Vita QUVI, Università di Bologna, Bologna, Italy.
Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, via Pupilli 1, 40136, Bologna, Italy.
出版信息
Knee Surg Sports Traumatol Arthrosc. 2022 May;30(5):1646-1653. doi: 10.1007/s00167-021-06689-3. Epub 2021 Aug 11.
PURPOSE
To evaluate the in vivo knee laxity in the presence of a partial medial meniscectomy before and after a single-bundle ACL reconstruction with a lateral plasty (SBLP) and to compare it with the knee laxity after a single-bundle ACL reconstruction (SB).
METHODS
One-hundred and one patients with ACL tear were enrolled in the study and grouped according to the surgical technique and the meniscus treatment: regarding the SBLP technique (n = 55), 31 patients underwent isolated ACL reconstruction ("SBLP Isolated ACL Group"), while 24 patients underwent combined ACL reconstruction and partial medial meniscectomy ("SBLP ACL + MM Group"); regarding the SB technique (n = 46), 33 patients underwent isolated ACL reconstruction ("SB Isolated ACL Group"), while 13 patients underwent combined ACL reconstruction and partial medial meniscectomy ("SB ACL + MM Group"). Anterior-posterior clinical laxity at 30° (AP30) and 90° (AP90) of knee flexion was quantified before and after surgery through a surgical navigation system dedicated to kinematic assessment.
RESULTS
In the ACL-deficient status, the antero-posterior laxity was significantly higher in the presence of a combined MM in both the AP30 and the AP90, with no differences between the two surgical techniques. After the ACL reconstruction, both AP30 and AP90 translations decreased significantly (p < 0.0001) compared to the ACL-deficient status. No differences were found for AP30 and AP90 between SBLP Isolated ACL and SBLP + MM groups, while a significantly higher AP90 translation was found for the SB + MM group compared to the SB Isolated ACL group. Moreover, the AP90 translation in the SB ACL + MM group was significantly higher than the one of the other three groups, i.e., SBLP ACL + MM, SB, and SBLP Isolated ACL group.
CONCLUSION
The ACL reconstruction with lateral plasty reduced the AP knee laxity caused by the medial meniscectomy in the context of an ACL surgery.
LEVEL OF EVIDENCE
Level II.
目的
评估在单束前交叉韧带重建联合外侧成形术（SBLP）前后，存在部分内侧半月板切除术时的体内膝关节松弛度，并将其与单束前交叉韧带重建（SB）后的膝关节松弛度进行比较。
方法
101例前交叉韧带撕裂患者纳入本研究，并根据手术技术和半月板治疗情况进行分组：关于SBLP技术（n = 55），31例患者接受单纯前交叉韧带重建（“SBLP单纯前交叉韧带组”），而24例患者接受联合前交叉韧带重建和部分内侧半月板切除术（“SBLP前交叉韧带+内侧半月板组”）；关于SB技术（n = 46），33例患者接受单纯前交叉韧带重建（“SB单纯前交叉韧带组”），而13例患者接受联合前交叉韧带重建和部分内侧半月板切除术（“SB前交叉韧带+内侧半月板组”）。通过专门用于运动学评估的手术导航系统，在手术前后对膝关节屈曲30°（AP30）和90°（AP90）时的前后临床松弛度进行量化。
结果
在前交叉韧带缺陷状态下，联合内侧半月板切除时，AP30和AP90的前后松弛度均显著更高，两种手术技术之间无差异。前交叉韧带重建后，与前交叉韧带缺陷状态相比，AP30和AP90的平移均显著降低（p < 0.0001）。SBLP单纯前交叉韧带组和SBLP + 内侧半月板组之间的AP30和AP90未发现差异，而SB + 内侧半月板组与SB单纯前交叉韧带组相比，AP90平移显著更高。此外，SB前交叉韧带 + 内侧半月板组的AP90平移显著高于其他三组，即SBLP前交叉韧带 + 内侧半月板组、SB组和SBLP单纯前交叉韧带组。
结论
在进行前交叉韧带手术时，联合外侧成形术的前交叉韧带重建减少了内侧半月板切除术引起的膝关节前后松弛度。
证据级别
二级。
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