Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Berlin Institute of Health at Charité, Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany.
Sci Rep. 2022 Aug 2;12(1):13232. doi: 10.1038/s41598-022-17328-3.
Passive translational tibiofemoral laxity has been extensively examined in posterior cruciate ligament (PCL) insufficient patients and belongs to the standard clinical assessment. However, objective measurements of passive rotational knee laxity, as well as range of tibiofemoral motion during active movements, are both not well understood. None of these are currently quantified in clinical evaluations of patients with PCL insufficiency. The objective of this study was to quantify passive translational and rotational knee laxity as well as range of anterior-posterior and rotational tibiofemoral motion during level walking in a PCL insufficient patient cohort as a basis for any later clinical evaluation and therapy. The laxity of 9 patient knees with isolated PCL insufficiency or additionally posterolateral corner (PLC) insufficiency (8 males, 1 female, age 36.78 ± 7.46 years) were analysed and compared to the contralateral (CL) knees. A rotometer device with a C-arm fluoroscope was used to assess the passive tibiofemoral rotational laxity while stress radiography was used to evaluate passive translational tibiofemoral laxity. Functional gait analysis was used to examine the range of anterior-posterior and rotational tibiofemoral motion during level walking. Passive translational laxity was significantly increased in PCL insufficient knees in comparison to the CL sides (15.5 ± 5.9 mm vs. 3.7 ± 1.9 mm, p < 0.01). Also, passive rotational laxity was significantly higher compared to the CL knees (26.1 ± 8.2° vs. 20.6 ± 5.6° at 90° knee flexion, p < 0.01; 19.0 ± 6.9° vs. 15.5 ± 5.9° at 60° knee flexion, p = 0.04). No significant differences were observed for the rotational (16.3 ± 3.7° vs. 15.2 ± 3.6°, p = 0.43) and translational (17.0 ± 5.4 mm vs. 16.1 ± 2.8 mm, p = 0.55) range of anterior-posterior and rotational tibiofemoral motion during level walking conditions for PCL insufficient knees compared to CL knees respectively. The present study illustrates that patients with PCL insufficiency show a substantial increased passive tibiofemoral laxity, not only in tibiofemoral translation but also in tibiofemoral rotation. Our data indicate that this increased passive multiplanar knee joint laxity can be widely compensated during level walking. Further studies should investigate progressive changes in knee joint laxity and kinematics post PCL injury and reconstruction to judge the individual need for therapy and effects of physiotherapy such as quadriceps force training on gait patterns in PCL insufficient patients.
被动平移胫骨股骨松弛在膝关节后十字韧带（PCL）不足的患者中得到了广泛的研究，属于标准的临床评估。然而，被动旋转膝关节松弛的客观测量，以及主动运动期间胫骨股骨的运动范围，都还没有得到很好的理解。目前在 PCL 不足患者的临床评估中，这些都没有被量化。本研究的目的是量化 PCL 不足患者队列在平地上行走时的被动平移和旋转膝关节松弛，以及前后向和旋转胫骨股骨运动范围，为以后的任何临床评估和治疗提供基础。分析了 9 例单侧 PCL 不足或同时伴有后外侧角（PLC）不足（8 名男性，1 名女性，年龄 36.78±7.46 岁）患者的膝关节松弛情况，并与对侧（CL）膝关节进行了比较。使用带有 C 臂透视仪的旋转计装置评估被动胫骨股骨旋转松弛度，同时使用应力射线照相术评估被动胫骨股骨平移松弛度。功能性步态分析用于检查平地上行走时胫骨股骨的前后向和旋转运动范围。与 CL 侧相比，PCL 不足的膝关节被动平移松弛度明显增加（15.5±5.9mm 与 3.7±1.9mm，p<0.01）。此外，与 CL 膝关节相比，被动旋转松弛度也明显升高（90°膝关节屈曲时为 26.1±8.2°，与 20.6±5.6°相比，p<0.01；60°膝关节屈曲时为 19.0±6.9°，与 15.5±5.9°相比，p=0.04）。与 CL 膝关节相比，PCL 不足的膝关节在平地上行走时的旋转（16.3±3.7°与 15.2±3.6°，p=0.43）和平移（17.0±5.4mm 与 16.1±2.8mm，p=0.55）范围没有显著差异。本研究表明，PCL 不足的患者不仅在胫骨股骨平移方面，而且在胫骨股骨旋转方面都表现出明显增加的被动胫骨股骨松弛度。我们的数据表明，这种增加的多平面膝关节被动松弛度可以在平地上行走时得到广泛补偿。进一步的研究应调查 PCL 损伤和重建后膝关节松弛度和运动学的进展变化，以判断治疗的个体需求以及股四头肌力量训练等物理治疗对 PCL 不足患者步态模式的影响。
