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后斜韧带修复在膝关节前交叉韧带重建联合内侧副韧带修复中的临床效果:一项回顾性对比研究

Clinical Effect of Posterior Obliqueligament Repair in Anterior Cruciate Ligament Reconstruction Combined With Medial Collateral Ligament Repair: A Retrospective Comparative Study.

作者信息

Ao Qi, Chen Jindong, Xie Yingguang, Wang Yonghua, Wang Xiaoxi, Liu Feng, Bai Zhigang, Zhao Shuaifei, Du Xiaoyan, Zhang Liang, Gao Xiaoyu, Suyalatu Xin

机构信息

Ordos School of Clinical Medicine Orthopedics Department, Inner Mongolia Medical University, Ordos, Inner Mongolia, China.

Orthopedics Department, Tengzhou Central People's Hospital, Tengzhou, Shandong, China.

出版信息

J Cell Mol Med. 2025 Jul;29(14):e70690. doi: 10.1111/jcmm.70690.

DOI:10.1111/jcmm.70690
PMID:40702870
Abstract

The stability of the knee joint following anterior cruciate ligament (ACL) restoration combined with medial collateral ligament (MCL) injury repair is crucial. It is yet unknown how posterior oblique ligament (POL) suturing functions in these procedures. This study aimed to assess the impact of POL repair on knee joint stability in patients undergoing ACL reconstruction with MCL repair. We hypothesised that POL repair would further enhance knee joint stability compared to conservative treatment in patients with combined ACL and MCL injuries. A total of 104 patients with ACL and grade III MCL injuries were enrolled and divided into the experimental group (n = 53, POL repair) and the control group (n = 51, conservative treatment for POL injury). Knee stability was assessed using Ligs Digital Arthrometer (measuring tibial displacement and medial separation) and the Dial test (measuring external tibial rotation). Knee function was evaluated with IKDC, Lysholm, VAS and ROM scores at baseline and 12-month follow-up. Both groups showed significant improvements in tibial displacement (ACL SSD) and medial separation (MCL SSD) after surgery compared to baseline (p < 0.05). However, intergroup comparisons indicated no statistically significant changes in knee stability metrics (p > 0.05). Functional scores (IKDC, Lysholm, ROM and VAS) improved considerably in both groups from baseline, with no significant differences between groups (p > 0.05). The Dial test revealed a substantial decrease of external tibial rotation in both groups postoperatively, with no intergroup variations. While ACL reconstruction and MCL repair significantly improved knee joint stability, POL suturing did not have a significant impact on the overall knee stability in patients with ACL and MCL injuries.

摘要

前交叉韧带(ACL)修复联合内侧副韧带(MCL)损伤修复后膝关节的稳定性至关重要。目前尚不清楚后斜韧带(POL)缝合在这些手术中的作用。本研究旨在评估POL修复对接受ACL重建联合MCL修复患者膝关节稳定性的影响。我们假设,与ACL和MCL联合损伤患者的保守治疗相比,POL修复将进一步提高膝关节稳定性。共纳入104例ACL和III级MCL损伤患者,分为实验组(n = 53,POL修复)和对照组(n = 51,POL损伤保守治疗)。使用Ligs数字关节测量仪(测量胫骨位移和内侧分离)和Dial试验(测量胫骨外旋)评估膝关节稳定性。在基线和12个月随访时,用IKDC、Lysholm、VAS和ROM评分评估膝关节功能。与基线相比,两组术后胫骨位移(ACL SSD)和内侧分离(MCL SSD)均有显著改善(p < 0.05)。然而,组间比较表明膝关节稳定性指标无统计学显著变化(p > 0.05)。两组功能评分(IKDC、Lysholm、ROM和VAS)从基线开始均有显著改善,组间无显著差异(p > 0.05)。Dial试验显示两组术后胫骨外旋均显著降低,组间无差异。虽然ACL重建和MCL修复显著改善了膝关节稳定性,但POL缝合对ACL和MCL损伤患者的整体膝关节稳定性没有显著影响。

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本文引用的文献

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A Flat Reconstruction of the Medial Collateral Ligament and Anteromedial Structures Restores Native Knee Kinematics: A Biomechanical Robotic Investigation.内侧副韧带和前内侧结构的平面重建可恢复膝关节 native 运动学:一项基于机器人的生物力学研究。
Am J Sports Med. 2024 Nov;52(13):3306-3313. doi: 10.1177/03635465241280984. Epub 2024 Oct 3.
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Posteromedial Corner Injuries of the Knee: Imaging Findings.膝关节后内侧角损伤:影像学表现。
Semin Musculoskelet Radiol. 2024 Jun;28(3):318-326. doi: 10.1055/s-0044-1779718. Epub 2024 May 20.
3
High incidence of RAMP lesions and a nonnegligible incidence of anterolateral ligament and posterior oblique ligament rupture in acute ACL injury.
急性 ACL 损伤中 RAM 损伤的发生率较高,前外侧韧带和后斜韧带撕裂的发生率也不容忽视。
Knee Surg Sports Traumatol Arthrosc. 2024 Aug;32(8):1992-2002. doi: 10.1002/ksa.12219. Epub 2024 Apr 30.
4
The Anterior Fibers of the Superficial MCL and the ACL Restrain Anteromedial Rotatory Instability.浅层前十字韧带和前交叉韧带的前纤维限制前内旋转不稳定。
Am J Sports Med. 2023 Sep;51(11):2928-2935. doi: 10.1177/03635465231187043. Epub 2023 Jul 28.
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The validity of the Ligs digital arthrometer at different loads to evaluate complete ACL ruptures.Ligs数字关节测量仪在不同负荷下评估前交叉韧带完全断裂的有效性。
Front Bioeng Biotechnol. 2023 Mar 14;11:1049100. doi: 10.3389/fbioe.2023.1049100. eCollection 2023.
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A novel digital arthrometer to measure anterior tibial translation.一种新型数字关节角度计测量胫骨前平移。
J Orthop Surg Res. 2023 Feb 13;18(1):101. doi: 10.1186/s13018-022-03497-4.
7
From Anatomy to Complex Reconstruction: A Modern Review on the Medial Collateral Ligament of the Knee.从解剖到复杂重建:膝关节内侧副韧带的现代综述
Arch Bone Jt Surg. 2022 Oct;10(10):818-826. doi: 10.22038/ABJS.2022.66697.3179.
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Medial Collateral Ligament and Posterior Oblique Ligament Reconstruction for Valgus Instability After Total Knee Arthroplasty.全膝关节置换术后外翻不稳定的内侧副韧带和后斜韧带重建术
Arthrosc Tech. 2022 Aug 6;11(9):e1531-e1539. doi: 10.1016/j.eats.2022.04.003. eCollection 2022 Sep.
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Evidence for isokinetic and functional testing in return to sport decisions following ACL surgery.前交叉韧带手术后恢复运动决策中进行等速运动和功能测试的证据。
PM R. 2022 May;14(5):678-690. doi: 10.1002/pmrj.12815. Epub 2022 May 10.
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Midterm Outcomes, Complications, and Return to Sports After Medial Collateral Ligament and Posterior Oblique Ligament Reconstruction for Medial Knee Instability: A Systematic Review.内侧副韧带和后斜韧带重建治疗膝关节内侧不稳定的中期结果、并发症及恢复运动情况:一项系统评价
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