外侧半月板后根修复联合外侧关节外肌腱固定显著降低前交叉韧带重建膝关节的内旋和轴移负荷：一项尸体研究
简介
该研究通过10对配对尸体膝关节，在6自由度机器人系统下模拟ACL、外侧半月板后根部（LMPR）及Kaplan纤维的序贯损伤，评估ACL重建（ACLR）后联合LMPR修复和/或改良Lemaire外侧关节外肌腱固定术（LET）的生物力学效果。关键发现：单纯ACLR无法完全恢复旋转稳定性，在轴移试验下15°-90°屈膝时孤立内旋、耦合内旋及前移均显著增加（P<0.…
英文摘要
PURPOSE: To determine the biomechanical effects of lateral meniscus posterior root- (LMPR) and Kaplan fiber tears in anterior cruciate ligament-(ACL) deficient knees and assess the impact of LMPR repair, modified Lemaire lateral extra-articular tenodesis, or both, after ACL reconstruction (ACLR). METHODS: Ten paired cadaveric knees were randomized into four groups and mounted in a six degrees of freedom robotic system. The ACL, LMPR, and Kaplan fibers were sequentially sectioned in random order. After ACLR, LMPR repair and Lemaire were performed in random order. Tibial displacements and rotations were measured under internal rotation (IR) torque and a simulated pivot shift at 0°-90° knee flexion. RESULTS: ACLR alone did not fully restore stability, with significant residual increases in isolated IR between 15° and 90° (all P < .001), coupled IR at all flexion angles (all P < .01), coupled anterior tibial translation (ATT) between 0° and 45° (all P < .05), and coupled valgus rotation between 15° and 90° (all P < .003) during pivot shift. Adding Lemaire to ACLR, without or with LMPR repair, restored stability comparable to the intact knee for isolated IR (without, all P > .086; with, all P > .132), coupled IR (without, all P > .102; with, all P > .172), and coupled ATT (without, all P > .537; with, P > .872) during pivot shift. LMPR repair in ACLR with Kaplan fiber injury restored valgus rotation stability at most flexion angles (all P > .053). CONCLUSIONS: Both the LMPR and Kaplan fibers act as secondary stabilizers to IR and pivot shift loading in the ACL deficient knee, with an additive biomechanical effect of the Kaplan fibers to the ACL with LMPR deficient knee for isolated IR and for coupled IR and ATT during pivot shift. Furthermore, the most important reconstruction state which best restored stability comparable to the ACL intact state was the addition of lateral extra-articular tenodesis to either the ACLR alone or ACLR with LMPR repair state, except for valgus rotation during pivot shift, where LMPR repair contributes most. CLINICAL RELEVANCE: Both LMPR repair and anterolateral corner reconstruction are necessary to restore stability in knees with ACL, Kaplan fiber, and LMPR injuries.