Oehme Stephan, Moewis Philippe, Boeth Heide, Bartek Benjamin, von Tycowicz Christoph, Ehrig Rainald, Duda Georg N, Jung Tobias
Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany.
Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Julius Wolff Institute Berlin, Berlin, Germany.
Front Bioeng Biotechnol. 2024 Jan 25;12:1322136. doi: 10.3389/fbioe.2024.1322136. eCollection 2024.
Passive tibiofemoral anterior-posterior (AP) laxity has been extensively investigated after posterior cruciate ligament (PCL) single-bundle reconstruction. However, the PCL also plays an important role in providing rotational stability in the knee. Little is known in relation to the effects of PCL single-bundle reconstruction on passive tibiofemoral rotational laxity. Gait biomechanics after PCL reconstruction are even less understood. The aim of this study was a comprehensive prospective biomechanical analysis of the effect of PCL single-bundle reconstruction on passive tibiofemoral rotational laxity, passive anterior-posterior laxity, and gait pattern. Eight patients undergoing PCL single-bundle reconstruction (seven male, one female, mean age 35.6 ± 6.6 years, BMI 28.0 ± 3.6 kg/m) were analyzed preoperatively and 6 months postoperatively. Three of the eight patients received additional posterolateral corner (PLC) reconstruction. Conventional stress radiography was used to evaluate passive translational tibiofemoral laxity. A previously established rotometer device with a C-arm fluoroscope was used to assess passive tibiofemoral rotational laxity. Functional gait analysis was used to examine knee kinematics during level walking. The mean side-to-side difference (SSD) in passive posterior translation was significantly reduced postoperatively (12.1 ± 4.4 mm vs. 4.3 ± 1.8 mm; < 0.01). A significant reduction in passive tibiofemoral rotational laxity at 90° knee flexion was observed postoperatively (27.8° ± 7.0° vs. 19.9° ± 7.5°; = 0.02). The range of AP tibiofemoral motion during level walking was significantly reduced in the reconstructed knees when compared to the contralateral knees at 6-month follow-up (16.6 ± 2.4 mm vs. 13.5 ± 1.6 mm; < 0.01). PCL single-bundle reconstruction with optional PLC reconstruction reduces increased passive tibiofemoral translational and rotational laxity in PCL insufficient knees. However, increased passive tibiofemoral translational laxity could not be fully restored and patients showed altered knee kinematics with a significantly reduced range of tibiofemoral AP translation during level walking at 6-month follow-up. The findings of this study indicate a remaining lack of restoration of biomechanics after PCL single-bundle reconstruction in the active and passive state, which could be a possible cause for joint degeneration after PCL single-bundle reconstruction.
在后交叉韧带（PCL）单束重建术后，胫股关节被动前后向（AP）松弛度已得到广泛研究。然而，PCL在提供膝关节旋转稳定性方面也起着重要作用。关于PCL单束重建对胫股关节被动旋转松弛度的影响知之甚少。PCL重建后的步态生物力学更是了解甚少。本研究的目的是对PCL单束重建对胫股关节被动旋转松弛度、被动前后向松弛度和步态模式的影响进行全面的前瞻性生物力学分析。对8例行PCL单束重建的患者（7例男性，1例女性，平均年龄35.6±6.6岁，BMI 28.0±3.6kg/m）在术前和术后6个月进行分析。8例患者中有3例接受了额外的后外侧角（PLC）重建。采用传统应力X线摄影评估胫股关节被动平移松弛度。使用先前建立的带有C形臂荧光透视仪的旋转测量装置评估胫股关节被动旋转松弛度。采用功能步态分析检查平地行走时的膝关节运动学。术后被动后向平移的平均左右差异（SSD）显著降低（12.1±4.4mm对4.3±1.8mm；P<0.01）。术后观察到膝关节屈曲90°时胫股关节被动旋转松弛度显著降低（27.8°±7.0°对19.9°±7.5°；P=0.02）。在6个月随访时，与对侧膝关节相比，重建膝关节在平地行走时胫股关节AP运动范围显著减小（16.6±2.4mm对13.5±1.6mm；P<0.01）。选择性PLC重建的PCL单束重建可减少PCL功能不全膝关节中增加的胫股关节被动平移和旋转松弛度。然而，增加的胫股关节被动平移松弛度不能完全恢复，患者在6个月随访时平地行走时膝关节运动学改变，胫股关节AP平移范围显著减小。本研究结果表明，PCL单束重建后在主动和被动状态下生物力学仍缺乏恢复，这可能是PCL单束重建后关节退变的一个可能原因。
