Cinotti Gianluca, Ripani Francesca Romana, Perciballi Beatrice, La Torre Giuseppe, Giannicola Giuseppe
Department of Anatomical, Histological, Forensic Medicine and Orthopaedic Sciences, University La Sapienza, Piazzale Aldo Moro, Rome, Italy.
Aereospace Medicine Department, Italian Air Force, Rome, Italy.
Knee Surg Relat Res. 2024 Jan 10;36(1):2. doi: 10.1186/s43019-023-00208-z.
In cruciate retaining total knee arthroplasty, posterior cruciate ligament damage may occur during tibial cutting. A prospective randomized study was conducted to investigate whether a novel tibial cutting technique was more effective than the currently used techniques.
Patients undergoing cruciate retaining total knee arthroplasty were recruited in a prospective, randomized, controlled trial. In 25 patients (group 1) the tibial cut was performed using a double tibial cut technique; in 25 (group 2) and 25 (group 3) patients, the bone island and en bloc resection techniques were performed, respectively. Posterior cruciate ligament integrity and femoral rollback were assessed at the end of surgery. The Oxford Knee Score, WOMAC score and range of motion were assessed postoperatively.
Posterior cruciate ligament was completely preserved in 92% of patients in group 1 and in 64% in group 2 and 3, respectively (p = 0.03). The Oxford Knee Score and WOMAC scores did not differ between groups (p = 0.4). The mean knee flexion was 126.4°, 121.5° and 123.9° in groups 1, 2 and 3, respectively (p = 0.04). The femoral rollback at 120° flexion was 80.7%, 72.2% and 75.4% in groups 1, 2 and 3, respectively (p = 0.01).
The double cut technique preserves the posterior cruciate ligament at significantly higher rates than the bone island or en bloc resection techniques. Better posterior cruciate ligament preservation may improve the femoral rollback and knee flexion.
Prospective randomized controlled trial, Level I.
在保留交叉韧带的全膝关节置换术中，胫骨截骨时可能会发生后交叉韧带损伤。进行了一项前瞻性随机研究，以调查一种新型胫骨截骨技术是否比目前使用的技术更有效。
在一项前瞻性、随机、对照试验中招募了接受保留交叉韧带全膝关节置换术的患者。25例患者（第1组）采用双胫骨截骨技术进行胫骨截骨；25例（第2组）和25例（第3组）患者分别采用骨岛和整块切除技术。在手术结束时评估后交叉韧带的完整性和股骨后滚。术后评估牛津膝关节评分、WOMAC评分和活动范围。
第1组92%的患者后交叉韧带得以完全保留，第2组和第3组分别为64%（p = 0.03）。各组之间牛津膝关节评分和WOMAC评分无差异（p = 0.4）。第1、2、3组的平均膝关节屈曲度分别为126.4°、121.5°和123.9°（p = 0.04）。在120°屈曲时，第1、2、3组的股骨后滚分别为80.7%、72.2%和75.4%（p = 0.01）。
双截骨技术保留后交叉韧带的比例明显高于骨岛或整块切除技术。更好地保留后交叉韧带可能会改善股骨后滚和膝关节屈曲。
前瞻性随机对照试验，I级。
