Mouton Caroline, Ibañez Maximiliano, Hoffmann Felix, Monllau Joan Carles, Seil Romain
Department of Orthopaedic Surgery Centre Hospitalier Luxembourg-Clinique d'Eich Luxembourg Luxembourg.
Luxembourg Institute of Research in Orthopaedics, Sports Medicine and Science (LIROMS) Luxembourg Luxembourg.
J Exp Orthop. 2024 Jul 5;11(3):e12052. doi: 10.1002/jeo2.12052. eCollection 2024 Jul.
This original case series aims to describe an uncommon triad of clinical signs in patients presenting with persistent pain and inability to resume physical activities after knee hyperextension trauma.
Patient history, clinical examination, arthroscopic findings and investigations of 12 patients who consulted with the senior author are presented.
Twelve patients (seven males/five females) presented with persistent pain after knee hyperextension trauma either in sport or a traffic accident. They had a median age of 18.5 and a median body mass index of 23 kg/m. All had medical visits and at least one magnetic resonance imaging (MRI) before visiting the senior author's institution but the cause of their problems could not be explained. The clinical examination of the injured knee appeared normal except for an uncommon triad of clinical signs with the knee close to extension: (1) a grade 1+ anterior-posterior laxity around 10-20° of knee flexion with a firm end-point (pseudo-Lachman sign), (2) a grade 1+ tibiofemoral step-off sign with a posterior drawer at 10-20° of knee flexion and (3) an increased knee hyperextension compared to the contralateral side. Arthroscopy of eight patients confirmed the pseudo-Lachman sign with a grade I posterior drawer close to knee extension, normal posterior laxity at 90° of knee flexion and an intact anterior cruciate ligament.
Patients displayed an increased hyperextension and posterior laxity close to knee extension which normalised at 90° of knee flexion. In patients with a history of knee hyperextension trauma associated with persistent pain, inability to resume physical activities, inconclusive MRIs and a standard clinical examination, clinicians should consider extending their investigations with the knee close to extension to identify this clinical triad consistent with a lesion to the posteromedial bundle of the posterior cruciate ligament.
Level IV.
本原始病例系列旨在描述膝关节过度伸展创伤后出现持续性疼痛且无法恢复体力活动的患者中一种罕见的三联征临床体征。
介绍了12例咨询资深作者的患者的病史、临床检查、关节镜检查结果及相关检查情况。
12例患者（7例男性/5例女性）在运动或交通事故中膝关节过度伸展创伤后出现持续性疼痛。他们的中位年龄为18.5岁，中位体重指数为23kg/m²。所有患者在就诊于资深作者所在机构之前均进行过医学检查且至少进行过一次磁共振成像（MRI）检查，但问题的原因无法解释。受伤膝关节的临床检查除了在膝关节接近伸直时出现一种罕见的三联征临床体征外看起来正常：（1）在膝关节屈曲10 - 20°时前后向松弛度为1+级，有坚实的终点（假性拉赫曼征）；（2）在膝关节屈曲10 - 20°时有1+级胫股台阶征伴后抽屉试验阳性；（3）与对侧相比膝关节伸直增加。8例患者的关节镜检查证实了假性拉赫曼征，在膝关节接近伸直时有I级后抽屉试验阳性，膝关节屈曲90°时后向松弛度正常且前交叉韧带完整。
患者在膝关节接近伸直时伸直增加且后向松弛度增加，在膝关节屈曲90°时恢复正常。对于有膝关节过度伸展创伤史、伴有持续性疼痛、无法恢复体力活动、MRI检查结果不明确且标准临床检查无异常的患者，临床医生应考虑在膝关节接近伸直时进行进一步检查，以识别与后交叉韧带后内侧束损伤相符的这种临床三联征。
IV级。
