前交叉韧带撕裂合并外侧半月板后角根部损伤导致膝关节高度前外旋转不稳定

Anterolateral Rotational Knee Instability Resulting from the Lateral Meniscus Posterior Root Tears Combined with the Anterior Cruciate Ligament Ruptures

目的:探究前交叉韧带(anterior cruciate ligament,ACL)撕裂伴有或不伴外侧半月板后角根部(lateral meniscus posterior root,LMPR)损伤对膝关节前外旋转稳定性的影响。方法:对2015年1月至2017年12月我院连续收治的ACL撕裂并接受韧带重建术的患者进行回顾性研究。根据关节镜探查结果将全部病例分为两组,研究组纳入ACL撕裂合并LMPR损伤病例(ACL+LMPR组),对照组纳入单纯ACL撕裂病例(ACL组)。研究组根据术前核磁中半月板股骨韧带(meniscofemoral ligament,MFL)信号是否消失进一步分为两个亚组,损伤者纳入MFL-亚组,完整者纳入MFL+亚组。比较组间人口学数据、病史资料及膝关节稳定性差异,膝关节稳定性评估包括:Lachman试验、KT-1000侧侧差值、轴移试验以及胫骨前移。结果:LMPR合并损伤率在伤后时间超过6周后显著上升(P=0.048)。与单纯ACL撕裂患者相比,ACL撕裂合并LMPR损伤患者的高度轴移阳性率显著升高(P<0.001),胫骨前移显著增加(P=0.001)。MFL损伤与否对膝关节稳定性无进一步影响。结论:对于ACL撕裂同时合并LMPR损伤的患者,其膝关节动态及静态前外旋转稳定性均进一步下降。

Objective To explore the effect of anterior cruciate ligament(ACL)rupture combined with or without the lateral meniscus posterior root(LMPR)tear on the anterolateral rotational knee instability.Methods Patients diagnosed as ACL injury and undergoing the primary ACL reconstruction between January 2015 and December 2017 were reviewed retrospectively.Patients with ACL ruptures and LMPR tears were selected into the study group,while patients with solely ACL ruptures were allocated into the control group according to the results of their arthroscopic inspection.Moreover,according to the integrity of meniscofemoral ligament(MFL)on the preoperative magnetic resonance imaging(MRI),the patients in the study group were further divided into an MFL-group and an MFL+group.The Lachman test,KT-1000 arthrometer side-to-side difference(KT-SSD),pivot-shift test and anterior tibial translation were conducted or measured to compare the stability of knees between different groups.Demographic data were also recorded and compared.Results The rate of ACL-injured patients combined with the LMPR tear significantly increased 6 weeks after the ACL injury(P=0.048).The positive rate of high-grade pivot-shift test and the distance of anterior tibial translation of the study group were both significantly higher than the control group(P<0.001,P=0.001).Absence or presence of MFL made no further contributions to knee instabilities.Conclusion In patients with ACL ruptures,the LMPR tear can further increase the anterolateral rotational knee instabilities at rest or movement.