Bram Joshua T, White Alexander E, Cusano Antonio, Halvorsen Heidi, Zhuang Sophia, Levy Bruce, Marx Robert G
Hospital for Special Surgery, New York, New York, U.S.A..
Hospital for Special Surgery, New York, New York, U.S.A.
Arthroscopy. 2025 May;41(5):1557-1577.e3. doi: 10.1016/j.arthro.2024.08.046. Epub 2024 Sep 12.
To perform a systematic review and network meta-analysis of in vitro cadaveric, biomechanical studies evaluating described techniques for posterolateral corner (PLC) reconstruction, including fibular- and tibiofibular-based techniques.
The PubMed/MEDLINE, Embase, and Cochrane Library databases were searched in December 2023 for cadaveric studies evaluating PLC reconstruction. After a descriptive summary, a series of frequentist network meta-analyses comparing (1) nonanatomic fibular-based (single femoral tunnel), (2) anatomic fibular-based (double femoral tunnel), and (3) anatomic tibiofibular-based PLC reconstructions with the intact knee were performed for both external rotation (ER) and varus laxity from 0° to 90° of knee flexion. Pooled treatment estimates were calculated as mean differences (MDs) with 95% confidence intervals (CIs) using random-effects models.
A total of 31 studies were included. Nonanatomic fibular-based reconstructions showed increased ER laxity compared with the intact state between 30° and 90° of flexion (MD, 1.66° [95% CI, -0.27° to 3.59°] at 0° [P = .093]; MD, 2.29° [95% CI, 0.44° to 4.13°] at 30° [P = .015]; MD, 3.04° [95% CI, 0.95° to 5.12°] at 60° [P = .004]; and MD, 4.30° [95% CI, 1.41° to 7.19°] at 90° [P = .004]). The anatomic fibular- and tibiofibular-based reconstructions restored ER stability at all flexion values (except at 0° for tibiofibular based). All 3 reconstructions restored varus stability compared with the intact state in all scenarios except the anatomic fibular-based techniques at 0° (MD, 0.85° [95% CI, 0.06° to 1.63°]; P = .034). Across the assessed ER and varus laxity states, the anatomic fibular-based reconstruction was ranked "best" in 5 of 8 scenarios.
PLC reconstructions using nonanatomic fibular-based techniques showed increased residual laxity in ER from 30° to 90° of knee flexion. Conversely, anatomic fibular- and tibiofibular-based reconstructions showed ER and varus laxity similar to that in the intact knee state across most of the assessed knee flexion values.
Various techniques have been described for PLC reconstruction. However, no study has comprehensively compared the biomechanical properties of these reconstructions with one another.
对评估后外侧角（PLC）重建所述技术（包括基于腓骨和胫腓骨的技术）的体外尸体生物力学研究进行系统评价和网状Meta分析。
2023年12月检索了PubMed/MEDLINE、Embase和Cochrane图书馆数据库，以查找评估PLC重建的尸体研究。在进行描述性总结后，针对膝关节从0°至90°屈曲时的外旋（ER）和内翻松弛度，进行了一系列频率学派网状Meta分析，比较（1）非解剖学腓骨基（单股骨隧道）、（2）解剖学腓骨基（双股骨隧道）和（3）解剖学胫腓骨基PLC重建与完整膝关节的情况。使用随机效应模型计算合并治疗估计值，以均数差（MDs）及其95%置信区间（CIs）表示。
共纳入31项研究。非解剖学腓骨基重建在30°至90°屈曲时与完整状态相比显示ER松弛度增加（0°时MD为1.66°[95%CI，-0.27°至3.59°] [P = 0.093]；30°时MD为2.29°[95%CI，0.44°至4.13°] [P = 0.015]；60°时MD为3.04°[95%CI，0.95°至5.12°] [P = 0.004]；90°时MD为4.30°[95%CI，1.41°至7.19°] [P = 0.004]）。解剖学腓骨基和胫腓骨基重建在所有屈曲值时均恢复了ER稳定性（胫腓骨基在0°时除外）。与完整状态相比，所有3种重建在所有情况下均恢复了内翻稳定性，但解剖学腓骨基技术在0°时除外（MD为0.85°[95%CI，0.06°至1.63°]；P = 0.034）。在评估的ER和内翻松弛度状态中，解剖学腓骨基重建在8种情况中的5种中排名“最佳”。
使用非解剖学腓骨基技术的PLC重建在膝关节30°至90°屈曲时ER的残余松弛度增加。相反，解剖学腓骨基和胫腓骨基重建在大多数评估的膝关节屈曲值时显示出与完整膝关节状态相似的ER和内翻松弛度。
已描述了多种用于PLC重建的技术。然而，尚无研究全面比较这些重建的生物力学特性。
