膝关节前外侧旋转不稳定的诊断与治疗研究进展

Research advances in the diagnosis and treatment of anterolateral rotatory instability of the knee

前交叉韧带、前外侧复合体和外侧半月板共同维持膝关节的前外侧旋转稳定性,控制胫骨内旋。临床上膝关节前外侧旋转不稳定并不少见,其主要损伤机制是非接触性损伤。轴移试验、胫骨内旋试验可提示前外侧旋转不稳定。X线片、CT、磁共振成像及超声检查可辅助诊断及鉴别诊断。对于急性前外侧旋转不稳定,良好的前交叉韧带重建技术是避免术后残留前外侧旋转不稳定的基础,前外侧韧带重建及关节外腱固定术可酌情选择;而对于慢性前外侧旋转不稳定,采用前外侧韧带重建或关节外腱固定术治疗均有效。本文对膝关节前外侧旋转不稳定的诊断与治疗研究进展进行综述,以期为临床诊治提供参考。

The anterior cruciate ligament(ACL),anterolateral complex(ALC)and lateral meniscus(LM)maintain the anterolateral rotatory stability of the knee and control the internal rotation of the tibia.Anterolateral rotatory instability(ALRI)of the knee is not uncommon in clinic,and its main injury mechanism is non-contact injury.A pivot shift test or a tibial internal rotation test can indicate ALRI while X-ray,CT,MRI and ultrasound can assist in its diagnosis and differential diagnosis.For acute ALRI,good technique of ACL reconstruction is the basis to avoid postoperative residual ALRI,and anterolateral ligament reconstruction and extra-articular tenodesis are optional as appropriate.For chronic cases,however,both anterolateral ligament reconstruction and extra-articular tenodesis are effective.This article reviews the progress in research on the diagnosis and treatment of ALRI of the knee,hoping to provide references for its clinical diagnosis and treatment.