Lobenhoffer P, Gögüs A, Koch H
Unfallchirurgische Klinik, Medizinische Hochschule Hannover.
Orthopade. 1993 Nov;22(6):414-20.
Operative treatment of chronic combined posterior/posterolateral knee instability is difficult. If the osseous anatomy of the leg causes a varus loading of the knee, we perform a high tibial valgus osteotomy as first step. Since 1988 we have been using a special drill guide system for reconstruction of the posterior cruciate ligament. The tunnels are drilled with the instruments placed through the notch and with image intensifier control. We prefer a bone-tendon-bone-patellar tendon autograft or allograft for replacement of the posterior cruciate ligament. The procedure is combined with a biceps tenodesis as described by Clancy. Rerouting of the biceps tendon over the origin of the lateral collateral ligament puts tension on the posterolateral corner and augments the collateral ligament. It was possible to review 16 out of 18 cases treated in this way at an average of 18 months after surgery. Preoperatively, all had a 2 to 3+ posterior drawer and a reversed pivot shift. At follow-up, 10 had a 1+ posterior drawer, 3 a 1-2+ drawer and 3 a 2+ drawer; 5 patients still had a reversed shift. KT-1000 measurements revealed 8 mm (4-12 mm) posterior translation. The Lysholm Score averaged 83 points and the Tegner Score 4.0 at follow-up.
慢性膝关节后内侧/后外侧联合不稳定的手术治疗颇具难度。若小腿的骨性结构导致膝关节出现内翻负荷，我们首先会进行高位胫骨外翻截骨术。自1988年起，我们一直使用一种特殊的钻孔导向系统来重建后交叉韧带。通过关节间隙放置器械并在影像增强器控制下钻出隧道。我们更倾向于使用自体或异体骨-肌腱-骨-髌腱移植物来替代后交叉韧带。该手术会按照克兰西所描述的方法联合进行肱二头肌腱固定术。将肱二头肌腱重新绕过外侧副韧带的起点，可对后外侧角施加张力并增强侧副韧带。以这种方式治疗的18例患者中有16例在术后平均18个月时得以复查。术前，所有患者均有2至3 +级的后抽屉试验阳性及反向轴移试验阳性。随访时，10例患者有1 +级后抽屉试验阳性，3例有1 - 2 +级抽屉试验阳性，3例有2 +级抽屉试验阳性；5例患者仍有反向轴移。KT - 1000测量显示后移8毫米（4 - 12毫米）。随访时，Lysholm评分平均为83分，Tegner评分为4.0。
