Bohe Olivia, Greve Frederik, Höger Svenja, Mehl Julian, Siebenlist Sebastian, Willinger Lukas
Department of Sports Orthopedics Technical University of Munich Munich Germany.
Department of Trauma Surgery Technical University of Munich Munich Germany.
J Exp Orthop. 2024 Dec 18;11(4):e70118. doi: 10.1002/jeo2.70118. eCollection 2024 Oct.
Ruptures of the posterior cruciate ligament (PCL) are often accompanied by posterolateral corner (PLC) and posteromedial corner (PMC) injuries. This study investigates the incidence and impact of PMC and PLC injuries on posterior tibial translation (PTT). It was hypothesized that PMC injuries are more common and impactful than previously reported.
In this retrospective study, all patients with a PCL injury between January 2016 and December 2023 and received magnetic resonance imaging (MRI) within 30 days of trauma were included. Patients with atraumatic PCL instability, missing MRI or additional anterior cruciate ligament (ACL) rupture were excluded. Posttraumatic MRI was analyzed for peripheral injuries. Preoperative stress radiographs for PTT were measured, and the side-to-side difference was calculated. The statistical significance level was set at < 0.05.
Ninety-two patients were included, predominantly male (71.7%) with a mean age of 35.8 ± 15.6 years at injury. The mean time from injury to MRI was 7.3 ± 7.9 days. There were 16 patients (27.4%) with isolated PCL injuries. The prevalence of medial injuries (37.0% superficial medial collateral ligament [sMCL], 66.3% deep medial collateral ligament and 51.1% posterior oblique ligament [POL]) was comparable to lateral injuries (22.8% LCL, 55.4% PLC and 13.0% popliteus tendon). Injuries of the PMC (sMCL ± POL) occurred in 53 patients (57.6%) and of the PLC (POP ± PLC ± LCL) in 59 (64.1%) patients. PTT was significantly increased in the presence of a peripheral-associated injury compared to isolated PCL injury ( < 0.01). With a combined injury of PMC + PLC the PTT was significantly larger than in the case of a unilateral injury ( < 0.05 compared to PLC; < 0.05 compared to PMC).
PCL injuries are commonly associated with PMC and/or PLC injuries. A PTT of >10 mm is equally caused by PLC and PMC-associated injuries. Knowledge about the severity and localization of peripheral-associated injuries is therefore essential for therapeutic decision-making.
Level III retrospective cohort study.
后交叉韧带（PCL）断裂常伴有后外侧角（PLC）和后内侧角（PMC）损伤。本研究调查了PMC和PLC损伤的发生率及其对胫骨后移（PTT）的影响。研究假设是，PMC损伤比先前报道的更为常见且影响更大。
在这项回顾性研究中，纳入了2016年1月至2023年12月期间所有PCL损伤且在创伤后30天内接受磁共振成像（MRI）检查的患者。排除无创伤性PCL不稳定、MRI缺失或合并前交叉韧带（ACL）断裂的患者。对创伤后的MRI进行外周损伤分析。测量术前PTT的应力X线片，并计算两侧差异。统计学显著性水平设定为<0.05。
纳入92例患者，以男性为主（71.7%），受伤时平均年龄为35.8±15.6岁。从受伤到进行MRI检查的平均时间为7.3±7.9天。有16例患者（27.4%）为单纯PCL损伤。内侧损伤（浅内侧副韧带[sMCL]为37.0%、深内侧副韧带为66.3%、后斜韧带[POL]为51.1%）的发生率与外侧损伤（外侧副韧带[LCL]为22.8%、PLC为55.4%、腘肌腱为13.0%）相当。53例患者（57.6%）发生了PMC（sMCL±POL）损伤，59例患者（64.1%）发生了PLC（腘肌腱±PLC±LCL）损伤。与单纯PCL损伤相比，存在外周相关损伤时PTT显著增加（<0.01）。PMC+PLC联合损伤时的PTT显著大于单侧损伤时（与PLC相比<0.05；与PMC相比<0.05）。
PCL损伤常与PMC和/或PLC损伤相关。PTT>10mm同样由PLC和PMC相关损伤引起。因此，了解外周相关损伤的严重程度和部位对于治疗决策至关重要。
III级回顾性队列研究。
