Moser Lukas B, Koch Matthias, Hess Silvan, Prabhakar Ponnaian, Rasch Helmut, Amsler Felix, Hirschmann Michael T
Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), Bruderholz, CH-4101 Basel, Switzerland.
Research Group Michael T. Hirschmann, Regenerative Medicine & Biomechanics, Department of Clinical Research, University of Basel, CH-4001 Basel, Switzerland.
J Clin Med. 2022 Feb 15;11(4):1013. doi: 10.3390/jcm11041013.
The purpose of this study was to define a cut-off value for the posterior drawer position in stress radiography that confirms an insufficiency of the posterior cruciate ligament (PCL) in cruciate-retaining (CR) total knee arthroplasty (TKA). In this retrospective study, 20 symptomatic patients with flexion instability and suspected PCL insufficiency in CR TKA were included. Asymptomatic patients served as an age- and sex-matched control group. All of the patients had undergone stress radiography, and the posterior translation was measured in a posterior drawer position at 30° and 90° flexion. The two groups were compared using t-tests and chi-square tests. The stress radiographs showed significantly more posterior translation in the symptomatic group ( < 0.01). Stress radiographs at 90° flexion more effectively discriminated between the patients with and without PCL insufficiency compared with those carried out at 30° flexion. Sensitivity and specificity testing revealed the best sensitivity (90.5%) and the best specificity (94.7%) at 90° posterior drawer radiographs at a cut-off value of 10 mm. Stress radiographs including the posterior drawer position at 90° flexion should be part of the diagnostic algorithm in patients with suspected flexion instability. A posterior translation of more than 10 mm in CR TKA strongly indicates an insufficiency of the PCL.
本研究的目的是确定应力X线片中后抽屉位的临界值，以证实十字韧带保留型（CR）全膝关节置换术（TKA）中后交叉韧带（PCL）功能不全。在这项回顾性研究中，纳入了20例有症状的CR TKA患者，这些患者存在屈曲不稳定且怀疑PCL功能不全。无症状患者作为年龄和性别匹配的对照组。所有患者均接受了应力X线检查，并在30°和90°屈曲的后抽屉位测量后移。两组采用t检验和卡方检验进行比较。应力X线片显示，有症状组的后移明显更多（<0.01）。与30°屈曲时的应力X线片相比，90°屈曲时的应力X线片能更有效地鉴别有无PCL功能不全。敏感性和特异性测试显示，在90°后抽屉位X线片上，临界值为10 mm时，敏感性最佳（90.5%），特异性最佳（94.7%）。包括90°屈曲时后抽屉位的应力X线片应成为疑似屈曲不稳定患者诊断流程的一部分。CR TKA中后移超过10 mm强烈提示PCL功能不全。
