Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, USA.
Sahlgrenska Sports Medicine Center, Gothenburg, Sweden.
BMC Musculoskelet Disord. 2023 Jun 19;24(1):502. doi: 10.1186/s12891-023-06638-w.
The aim of this study was to investigate differences in concomitant injury patterns and their treatment in patients undergoing early (≤ 12 weeks) and delayed (> 12 weeks) primary multiligament posterior cruciate ligament (PCL) reconstruction (PCL-R).
This study was a retrospective chart review of patients undergoing primary multiligament PCL-R at a single institution between 2008 and 2020. Multiligament PCL-R was defined as PCL-R and concurrent surgical treatment of one or more additional knee ligament(s). Exclusion criteria included isolated PCL-R, PCL repair, and missing data for any variable. Patients were dichotomized into early (≤ 12 weeks) and delayed (> 12 weeks) PCL-R groups based on the time elapsed between injury and surgery. Between-group comparison of variables were conducted with the Chi-square, Fisher's exact, and independent samples t-tests.
A total of 148 patients were eligible for analysis, with 57 (38.5%) patients in the early and 91 (61.1%) patients in the delayed multiligament PCL-R groups. Concomitant LCL/PLC reconstruction (LCL-R/PLC-R) was performed in 55 (60%) of delayed multiligament PCL-Rs and 23 (40%) of early PCL-Rs (p = 0.02). Despite similar rates of meniscus injury, concomitant meniscus surgery was significantly more prevalent in the early (n = 25, 44%) versus delayed (n = 19, 21%) multiligament PCL-R group (p = 0.003), with a significantly greater proportion of medial meniscus surgeries performed in the early (n = 16, 28%) compared to delayed (n = 13, 14%) PCL-R group (p = 0.04). The prevalence of knee cartilage injury was significantly different between the early (n = 12, 24%) and delayed (n = 41, 46%) multiligament PCL-R groups (p = 0.01), with more frequent involvement of the lateral (n = 17, 19% vs. n = 3, 5%, respectively; p = 0.04) and medial (n = 31, 34% vs. n = 6, 11%, respectively; p = 0.005) femoral condyles in the delayed compared to the early PCL-R group.
Given higher rates of chondral pathology and medial meniscus surgery seen in delayed multiligament PCL-R, early management of PCL-based multiligament knee injury is recommended to restore knee stability and potentially prevent the development of further intraarticular injury.
Level III.
本研究旨在探讨在接受早期（≤12 周）和延迟（>12 周）初次多韧带后十字韧带（PCL）重建（PCL-R）的患者中，伴随损伤模式及其治疗的差异。
这是一项对 2008 年至 2020 年期间在一家机构接受初次多韧带 PCL-R 的患者进行的回顾性图表分析。多韧带 PCL-R 定义为 PCL-R 与同时对一个或多个额外的膝关节韧带进行手术治疗。排除标准包括单纯 PCL-R、PCL 修复和任何变量的缺失数据。根据受伤与手术之间的时间间隔，患者被分为早期（≤12 周）和延迟（>12 周）PCL-R 组。使用卡方检验、Fisher 确切检验和独立样本 t 检验对变量进行组间比较。
共有 148 例患者符合分析条件，其中 57 例（38.5%）为早期多韧带 PCL-R 患者，91 例（61.1%）为延迟多韧带 PCL-R 患者。55 例（60%）延迟多韧带 PCL-R 和 23 例（40%）早期 PCL-R 行侧副韧带/PLC 重建（LCL-R/PLC-R）（p=0.02）。尽管半月板损伤的发生率相似，但早期（n=25，44%）多韧带 PCL-R 组与延迟（n=19，21%）多韧带 PCL-R 组中同时行半月板手术更为常见（p=0.003），早期组中内侧半月板手术的比例显著更高（n=16，28%），而延迟组中内侧半月板手术的比例（n=13，14%）（p=0.04）。早期（n=12，24%）与延迟（n=41，46%）多韧带 PCL-R 组之间的膝关节软骨损伤发生率存在显著差异（p=0.01），外侧（n=17，19%与 n=3，5%，分别；p=0.04）和内侧（n=31，34%与 n=6，11%，分别；p=0.005）股骨髁的发生率更高在延迟 PCL-R 组中比在早期 PCL-R 组中。
鉴于延迟多韧带 PCL-R 中更高的软骨病理和内侧半月板手术发生率，建议早期管理基于 PCL 的多韧带膝关节损伤，以恢复膝关节稳定性并可能预防进一步的关节内损伤。
III 级。
