LaPrade R F
Department of Orthopaedic Surgery, University of Minnesota, Minneapolis 55455, USA.
Am J Sports Med. 1997 Sep-Oct;25(5):596-602. doi: 10.1177/036354659702500502.
The purpose of this study was to evaluate prospectively the arthroscopic findings in the lateral compartment of knees with posterolateral knee complex injuries, to help identify individual injured anatomic structures, and to assist in the clinical identification of these injuries. Thirty of 33 consecutive knees noted to have grade 3 posterolateral knee complex injuries on preoperative evaluations and examinations under anesthesia underwent arthroscopic evaluation concurrently with open reconstruction. The arthroscopic evaluation revealed a significant number of pathologic changes in the lateral compartment that may have gone undetected if only an open reconstruction had been performed. Tears were identified arthroscopically in 25 (83%) of the anteroinferior, 22 (73%) of the posterosuperior, and 14 (47%) of the posteroinferior popliteomeniscal fascicles. Injuries to the coronary ligament (80%) and meniscotibial portion of the midthird lateral capsular ligament (73%) were also frequently seen. Other structures injured included the meniscofemoral portion of the posterior capsule (37%), the ligament of Wrisberg (33%), and the meniscofemoral portion of the midthird lateral capsular ligament (10%). Ten avulsions (33%) of the popliteal tendon origin off the femur were also identified. Identification of these injured components greatly facilitated open reconstruction of injuries to the posterolateral complex of the knee. All 30 knees were noted to have greater than 1 cm of lateral joint laxity with application of a varus stress. When an unexpected amount of lateral joint laxity is seen arthroscopically (a "drive-through" sign) in a patient with suspected ligamentous instability, one should consider a diagnosis of posterolateral knee complex injury.
本研究的目的是前瞻性评估存在膝关节后外侧复合体损伤的膝关节外侧间室的关节镜检查结果，以帮助识别个体损伤的解剖结构，并协助对这些损伤进行临床诊断。在术前评估和麻醉下检查中被发现有3级膝关节后外侧复合体损伤的33例连续膝关节中，有30例在进行开放重建的同时接受了关节镜评估。关节镜评估显示外侧间室存在大量病理改变，若仅进行开放重建，这些改变可能未被发现。关节镜下发现25例（83%）前下、22例（73%）后上和14例（47%）后下腘半月板束有撕裂。冠状韧带损伤（80%）和外侧关节囊韧带中份半月板胫骨部分损伤（73%）也很常见。其他损伤的结构包括后关节囊的半月板股骨部分（37%）、Wrisberg韧带（33%）和外侧关节囊韧带中份的半月板股骨部分（10%）。还发现10例（33%）腘肌腱股骨起点撕脱。识别这些损伤的组成部分极大地促进了膝关节后外侧复合体损伤的开放重建。所有30例膝关节在施加内翻应力时均有大于1 cm的外侧关节松弛。当在疑似韧带不稳定的患者关节镜检查中发现意外程度的外侧关节松弛（“贯通”征）时，应考虑诊断为膝关节后外侧复合体损伤。
