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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >The influence of posterior medial meniscocapsular lesions on tibiofemoral joint laxity with ACL deficiency and reconstruction
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The influence of posterior medial meniscocapsular lesions on tibiofemoral joint laxity with ACL deficiency and reconstruction

机译：后内侧半囊膜病变对伴ACL缺失和重建的胫股关节松弛的影响

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Introduction: Injury to the posterior medial meniscocapsular junction (the ‘ramp’ lesion) occurs at the time of anterior cruciate ligament (ACL) rupture (10-24% of cases); however there is a lack of objective evidence investigating how this affects knee kinematics. It is often missed when viewed arthroscopically from the front of the medial compartment as it can only be seen with the arthroscope in the posteromedial recess. Objectives: To investigate the biomechanical impact of the ‘ramp lesion’ on the ACL deficient and ACL reconstructed knee and the impact of suture repair of the lesion on the same knee states. Methods: Nine fresh frozen cadaveric knees were mounted in a 6 degrees of freedom rig where knee kinematics were recorded at 10° intervals from 0°-100° using an optical tracking system. Measurements were recorded using the following loading conditions: 90 N anterior and posterior tibial forces, 5 Nm internal and external tibial rotation torques, and a combined 90 N anterior tibial force and 5 Nm external tibial rotation torque. Manual Rolimeter readings of anterior translation were taken at 30° and 90°. The knees were tested in the following order: (1) intact, (2) ACL deficient, (3) ACL deficient + posterior meniscocapsule sectioned, (4) ACL deficient + posterior meniscocapsule repaired, (5) ACL patellar tendon reconstruction with posterior meniscocapsule repair and (6) ACL reconstructed + capsular lesion re-created. Statistical analysis was undertaken using repeated-measures ANOVA and post-hoc paired t-tests with Bonferonni correction. Results: Tibial anterior translation and external rotational laxities were both significantly increased compared to the ACL deficient knee following posterior meniscocapsular sectioning ( P < 0.05). These were both restored following ACL reconstruction and meniscocapsular lesion repair ( P > 0.05). Significant changes in anterior tibial translation between the different knee states were identified with the Rolimeter, indicating these changes are clinically detectable ( P < 0.05). Conclusion: Anterior and external rotational laxities were significantly increased after mimicking the ‘ramp lesion’ by sectioning of the posteromedial meniscocapsular junction in an ACL-deficient knee. These were not restored after ACL reconstruction alone but were restored with ACL reconstruction combined with posterior meniscocapsular repair. Tibial anterior translation changes were clinically detectable by use of the Rolimeter. This study suggests that unrepaired posteromedial meniscocapsular lesions will allow abnormal meniscal and tibiofemoral laxity to persist postoperatively, predisposing the knee to meniscal and articular damage but also adding avoidable extra strain on an ACL graft, which may yield.
机译：简介：前十字韧带（ACL）破裂时（10-24％的病例）发生后内侧膜囊囊交界处的损伤（“斜坡”病变）;但是，缺乏客观的证据来研究这如何影响膝关节运动学。从内侧隔室的前部进行关节镜检查时，常常会错过它，因为只有用关节镜在后内侧凹槽中才能看到它。目的：研究“斜坡病变”对ACL缺陷和ACL重建膝关节的生物力学影响，以及该病变的缝合修复对同一膝关节状态的影响。方法：将9个新鲜的冷冻尸体膝盖安装在6个自由度装置中，并使用光学跟踪系统以0°-100°的10°间隔记录膝盖的运动学。使用以下载荷条件记录测量结果：90 N前后胫骨力，5 Nm内外胫骨旋转扭矩，以及90 N前胫骨力和5 Nm胫骨外旋转扭矩的总和。在30°和90°分别获取前平移的Rolimeter手动读数。按以下顺序测试膝盖：（1）完整，（2）ACL缺损，（3）ACL缺损+粘膜后囊切开，（4）ACL缺损+粘膜后囊修复，（5）ACL pa骨肌腱重建后粘膜修复和（6）重新创建ACL +包膜病变。使用重复测量方差分析和事后配对t检验以及Bonferonni校正进行统计分析。结果：与后ACL缺损的膝关节后囊包膜切片相比，胫骨前平移和外部旋转松弛度均显着增加（P <0.05）。这些均在ACL重建和粘膜囊病变修复后得以恢复（P> 0.05）。 Rolimeter可以识别出不同膝关节状态之间胫骨前移的显着变化，表明这些变化在临床上是可检测到的（P <0.05）。结论：通过对ACL缺陷型膝关节的后内侧半囊膜连接处进行切片来模仿“斜坡病变”后，前外侧旋转松弛度显着增加。这些仅在重建ACL后不能恢复，而是通过ACL重建结合后牙包膜修补术得以恢复。胫骨前移的变化在临床上可以通过Rolimeter进行检测。这项研究表明，未经修复的后内侧半囊膜病变将使异常的半月板和胫股松驰症在术后持续存在，使膝关节容易遭受半月板和关节损伤，但还会给ACL移植物增加可避免的额外劳损，这可能会导致屈服。

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