外侧半月板修复有助于控制胫骨后外侧坡度较陡患者前交叉韧带重建术后轴移现象
简介
本研究探讨了前交叉韧带（ACL）与外侧半月板（LM）在控制膝关节前外侧旋转不稳（ALRI）中的协同作用。通过术中测量26例ACL合并LM损伤患者在半月板修复前后的轴移试验加速度，并计算达到健侧水平所需的最小移植物张力（MRT）。结果发现，LM修复后，轴移加速度显著下降（从4.3 m/s²降至2.9 m/s²），且半数患者所需的ACL移植物张力得以降低。回归分…
英文摘要
PURPOSE: The lateral meniscus (LM) controls anterolateral rotatory instability (ALRI) and is considered a secondary restraint. However, how the anterior cruciate ligament (ACL) and LM contribute to ALRI control remains unclear. This study investigated the degree to which ACL and LM contribute to ALRI control and examined factors contributing to ALRI during anterior cruciate ligament reconstruction (ACLR). METHODS: Twenty-six patients in ACL and LM-injured knees were enroled. Tibial acceleration in pivot shift was measured using a triaxial accelerometer by adjusting ACL graft tension before and after LM repair. ACL graft tension required for below-healthy-side pivot shift acceleration (minimum required tension [MRT]) was measured before and after LM repair. Patient factors for a larger contribution of LM to ALRI were determined by univariate linear regression analysis between changes in pivot shift acceleration before and after LM repair, and explanatory variables included patient and morphological factors. Furthermore, multiple regression analysis was conducted to identify independent factors significantly associated with the change. RESULTS: LM repair reduced the pivot shift acceleration in most cases, even following ACLR fixed at 10 N for each bundle (20 N in total) and pivot shift acceleration decreased significantly from 4.3 ± 1.2 to 2.9 ± 0.9 m/s2 by LM repair (p < 0.001). The MRT was 10 N without LM repair in 13 patients (50%). LM repair reduced MRT to 10 N in 11 of the remaining 13 patients. Only the lateral posterior tibial slope (PTS) significantly correlated with changes in pivot shift acceleration (r = 0.60, p = 0.001). In the multiple regression analysis as well, lateral PTS was the only factor identified as a significant predictor. CONCLUSIONS: LM repair decreased pivot shift acceleration and MRT, indicating the importance of LM repair in force-sharing with the ACL. LM contributes significantly to ALRI in patients with a larger lateral PTS. During ACLR, the LM should be repaired as much as possible. LEVEL OF EVIDENCE: Level III, diagnostic study.