Dejour H, Walch G, Deschamps G, Chambat P
Rev Chir Orthop Reparatrice Appar Mot. 1987;73(3):157-70.
Arthrosis following rupture of the anterior cruciate ligament has been analysed in two series. The first series was derived from a review of 150 cases of reconstruction of the anterior cruciate ligament with a follow-up of 3 years or more. Arthrosis was seen to have developed in 13.3%. The second series was concerned with 64 cases of unilateral arthrosis treated by upper tibial valgus osteotomy in whom there had been a previous rupture of the anterior cruciate ligament. The "tolerance time"--that is the time between the original ligamentous injury and the time of osteotomy--for the development of arthrosis was very variable, ranging in cases with a "natural history" from 10 to 50 years with a mean of 35 years. It is important to recognise the radiological signs of the onset of arthrosis. These are osteophytosis of the intercondylar notch, osteophyte formation at the posterior part of the medial tibial plateau, and, in particular, narrowing of the medial joint line with posterior subluxation of the medial femoral condyle, well seen in lateral radiographs whilst standing on one lower limb. Early arthroses, appearing after 10 years, may occur as a "natural arthrosis", but it develops much more frequently after surgical treatment that had failed to correct anterior laxity and particularly when it had been performed on knees that were already pre-arthrotic. The main factor in arthrosis is anterior laxity measured radiologically by an "active Lachman" radiograph. Removal of the medial meniscus, which, in itself, is liable to produce arthrosis is even more harmful in anterior cruciate laxity since it doubles the degree of anterior subluxation of the tibia seen on unilateral weight-bearing. The development of varus deformity, which characterises progressive arthrosis, has its origin in wear of the posterior part of the medial tibial plateau caused by anterior cruciate laxity. Other factors play an important part such as associated lateral laxity, constitutional genu varum and weakness of the hamstring muscles which oppose the subluxating action of the quadriceps.
对前交叉韧带断裂后的关节病进行了两个系列的分析。第一个系列来自对150例前交叉韧带重建病例的回顾，随访时间为3年或更长。发现13.3%的病例出现了关节病。第二个系列涉及64例因上胫腓骨外翻截骨术治疗的单侧关节病病例，这些病例之前都有过前交叉韧带断裂。关节病发生的“耐受时间”——即从最初的韧带损伤到截骨术的时间——差异很大，在有“自然病程”的病例中，从10年到50年不等，平均为35年。认识到关节病开始的放射学征象很重要。这些征象包括髁间切迹的骨赘形成、胫骨内侧平台后部的骨赘形成，特别是内侧关节间隙变窄伴股骨内侧髁后脱位，单腿站立时在侧位X线片上看得很清楚。10年后出现的早期关节病可能作为“自然关节病”发生，但在未能纠正前侧松弛的手术治疗后更频繁地发生，尤其是在已经存在关节病前期的膝关节上进行手术时。关节病的主要因素是通过“主动拉赫曼”X线片放射学测量的前侧松弛。切除内侧半月板本身就容易导致关节病，在前交叉韧带松弛的情况下甚至更有害，因为它会使单腿负重时胫骨前侧半脱位的程度加倍。内翻畸形的发展是进行性关节病的特征，其起源于前交叉韧带松弛导致的胫骨内侧平台后部磨损。其他因素也起重要作用，如相关的外侧松弛、先天性膝内翻和对抗股四头肌半脱位作用的腘绳肌无力。
