OPND Clinic Neuss-Düsseldorf, Neuss, Germany.
Trauma Committee of the AGA (Society for Arthroscopy and Joint Surgery), Zurich, Switzerland.
Arch Orthop Trauma Surg. 2023 Dec;143(12):7123-7132. doi: 10.1007/s00402-023-05015-5. Epub 2023 Sep 11.
Combined PCL injuries involving the posteromedial/-lateral corner (PMC/PLC) usually require surgical management. Literature shows controversy regarding the standards of treatment. Suture-augmented repair leads to excellent results in acute knee dislocations but has not been investigated clinically in combined PCL injuries. The purpose of this multicentre study was to evaluate the clinical outcome of this technique in acute combined PCL injuries.
MATERIALS & METHODS: N = 33 patients with acute combined PCL injuries involving the PMC/PLC were treated by one-stage suture repair with ligament bracing of the PCL and suture repair of the accompanying PMC/PLC injuries with/without ligament bracing or primary augmentation by semitendinosus autograft. Outcome was assessed by IKDC questionnaire, Lysholm Score, Tegner Activity Scale and KOOS. Additional PCL stress-radiography was performed.
N = 31 patients with combined PCL injuries (female: male = 7:24; age 39.1 ± 13.8 years) with a follow-up of 16.8 ± 9.6 months were finally evaluated. 18 had PMC injuries, 13 PLC injuries. 32.2% presented with accompanying meniscal tears (70% medial meniscus). 19.4% showed cartilage injuries grade III-IV. Complications included one infection and four knee stiffnesses. Three had symptomatic postoperative instability, all affiliated to the PLC group. The IKDC was 69.8 ± 16.5, Lysholm score 85 ± 14.4 and KOOS 89.7 ± 8.1. Median loss of activity (Tegner) was 0.89 ± 1.31. Comparing PMC and PLC, all scores showed a tendency towards more favourable outcomes in the PMC group (n.s.). Stress-radiography showed an overall side-to-side difference of 3.7 ± 3.8 mm. Subgroup evaluation showed statistically significant better results (p = 0.035) of PMC (2.5 ± 1.5 mm) versus PLC (5.8 ± 5.6 mm).
One-stage suture repair with ligament bracing is a viable technique for acute combined PCL injuries and predominantly leads to good and excellent clinical outcomes. Patients with PLC injuries show a tendency towards inferior outcomes and higher instability rates compared to PMC injuries. These results may help in therapy planning and counselling patients with these rare injury pattern.
Level II.
涉及后内侧/后外侧角（PMC/PLC）的联合 PC 损伤通常需要手术治疗。文献表明，治疗标准存在争议。在急性膝关节脱位中，缝线增强修复可带来优异的效果，但在联合 PC 损伤中尚未进行临床研究。本多中心研究的目的是评估该技术在急性联合 PC 损伤中的临床效果。
33 例急性联合 PC 损伤伴 PMC/PLC 患者采用一期缝线修复联合 PC 韧带支撑，伴或不伴韧带支撑的 PMC/PLC 损伤缝线修复，或半腱肌自体移植物初步增强。采用 IKDC 问卷、Lysholm 评分、Tegner 活动量表和 KOOS 评估结果。另外还进行了 PCL 应力量线检查。
最终评估了 31 例合并 PC 损伤的患者（女性：男性=7:24；年龄 39.1±13.8 岁），随访 16.8±9.6 个月。18 例存在 PMC 损伤，13 例存在 PLC 损伤。32.2%的患者伴有半月板撕裂（70%为内侧半月板）。19.4%存在 III-IV 级软骨损伤。并发症包括 1 例感染和 4 例膝关节僵硬。3 例有术后症状性不稳定，均与 PLC 组相关。IKDC 为 69.8±16.5，Lysholm 评分为 85±14.4，KOOS 为 89.7±8.1。平均活动损失（Tegner）为 0.89±1.31。比较 PMC 和 PLC，n.s.，所有评分均显示 PMC 组的结果有更好的趋势。应力量线检查显示总体侧侧差异为 3.7±3.8mm。亚组评估显示，PMC（2.5±1.5mm）与 PLC（5.8±5.6mm）相比，统计学上有更好的结果（p=0.035）。
一期缝线修复联合韧带支撑是治疗急性联合 PC 损伤的可行技术，主要可带来良好和优秀的临床效果。与 PMC 损伤相比，PLC 损伤的患者有较差的预后和更高的不稳定率的趋势。这些结果可能有助于制定这些罕见损伤类型的治疗计划和为患者提供咨询。
II 级。
