Mehl Julian, Siebenlist Sebastian
Sektion Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland.
Unfallchirurgie (Heidelb). 2024 Jan;127(1):27-34. doi: 10.1007/s00113-023-01363-4. Epub 2023 Aug 23.
In recent years biomechanical and clinical studies have shown that the three-dimensional bony alignment of the lower extremities has a relevant influence on the ligamentous structures of the knee and consequently on the stability of the knee joint. Therefore, in the case of pathological ligamentous damage of the knee joint, a possible malalignment must always be thoroughly evaluated and if necessary, included in the treatment planning. Varus malalignment plays an important role especially with respect to the cruciate ligaments as well as the posterolateral ligamentous structures and has been identified as a significant risk factor for failure after surgical reconstruction of these ligamentous structures. Similar data have also been published for valgus malalignment particularly with respect to its negative influence on the anterior cruciate ligament and the medial capsuloligamentous complex. Alignment deviations in the sagittal plane, especially the inclination of the tibial articular surface (slope), have been extensively investigated in several recent studies. It has been demonstrated that the tibial slope has a relevant influence on the anteroposterior stability of the knee joint and hence on the cruciate ligaments. First clinical studies on the surgical correction of the axis in selected patients showed very promising results with the potential of protecting ligament reconstructions against repeated failure; however, further data especially regarding the importance and the exact indications for an additional alignment correction are necessary.
近年来，生物力学和临床研究表明，下肢的三维骨骼对线对膝关节的韧带结构有显著影响，进而影响膝关节的稳定性。因此，在膝关节韧带发生病理性损伤的情况下，必须始终对可能存在的对线不良进行全面评估，如有必要，应将其纳入治疗计划。内翻对线不良尤其在交叉韧带以及后外侧韧带结构方面起着重要作用，并且已被确定为这些韧带结构手术重建后失败的重要风险因素。关于外翻对线不良，特别是其对前交叉韧带和内侧关节囊韧带复合体的负面影响，也有类似的数据发表。矢状面的对线偏差，尤其是胫骨关节面的倾斜度（坡度），在最近的几项研究中得到了广泛研究。已经证明，胫骨坡度对膝关节的前后稳定性有显著影响，从而对交叉韧带也有影响。对部分患者进行轴线手术矫正的初步临床研究显示出非常有前景的结果，有可能保护韧带重建避免反复失败；然而，还需要更多数据，特别是关于额外对线矫正的重要性和确切适应症的数据。
