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中华关节外科杂志(电子版) ›› 2021, Vol. 15 ›› Issue (02) : 131 -136. doi: 10.3877/cma.j.issn.1674-134X.2021.02.001

所属专题: 文献 指南共识

专家共识

膝关节前外侧结构加强及重建专家共识(2021年版)
中国研究型医院学会运动医学专业委员会   
  • 收稿日期:2021-04-06 出版日期:2021-04-01
  • 基金资助:
    国家重点研发计划项目(2018YFC1106200,2018YFC1106202)

Expert consensus on augmentation and reconstruction of anterolateral structure of knee (2021)

Chinese Research Hospital Association Sports Medicine Committee   

  • Received:2021-04-06 Published:2021-04-01
引用本文:

中国研究型医院学会运动医学专业委员会. 膝关节前外侧结构加强及重建专家共识(2021年版)[J]. 中华关节外科杂志(电子版), 2021, 15(02): 131-136.

Chinese Research Hospital Association Sports Medicine Committee. Expert consensus on augmentation and reconstruction of anterolateral structure of knee (2021)[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2021, 15(02): 131-136.

膝关节前交叉韧带重建术有一定的失败风险,对于有高危因素的患者,其失败率更高。随着对膝关节前外侧结构在维持膝关节旋转稳定中作用的发现与认知,在前交叉韧带重建的同时可以进行膝关节前外侧结构的加强或重建以降低伴有高危因素的前交叉韧带损伤患者的治疗失败率。因此,专家组在循证医学的基础上,对膝关节前外侧结构的定义、术前评估、手术适应证、手术技术和策略、术后康复及并发症预防与处理原则等方面进行了文献总结和讨论,制定了膝关节前外侧结构加强及重建专家共识规范。本共识将提供一套临床诊疗方法与路径参考,以便医生在为具有较高失效风险患者进行前交叉韧带重建和翻修手术时选择前外侧结构加强或者重建。

Anterior cruciate ligament(ACL) reconstruction of the knee is associated with a certain risk of failure, and the failure rate is higher in high-risk patients. With the discovery and recognition of roles of anterolateral structure(ALS) in maintaining the rotation stability in normal knee, it is possible to augment or reconstruct ALS in combination with ACL reconstruction to reduce the failure rate in the patients with high-risk factors for ACL injuries. Therefore, on the basis of evidence-based medicine, the expert group summarized and discussed literature on the definition, preoperative evaluation, surgical indications, surgical techniques and strategies, principles in postoperative rehabilitation, and prevention and management of complications for the ALS of knee, and developed this consensus. The proposed consensus will provide physicians with a complete set of clinical routines and pathways for the diagnosis and managment in selecting ALS augmentation or reconstruction when performing ACL reconstruction in the patients with high risks of failure and revision surgeries.

表1 联合前交叉韧带重建和前外侧结构加强或者重建的标准
[1]
Kaeding CC. Leger-St-Jean B, Magnussen RA. Epidemiology and diagnosis of anterior cruciate ligament injuries[J]. Clin Sports Med, 2017, 36(1): 1-8.
[2]
Musahl V, Karlsson J. Anterior cruciate ligament tear[J]. N Engl J Med, 2019, 380(24): 2341-2348.
[3]
周天平,徐一宏,徐卫东.前交叉韧带重建相关研究的文献计量学分析[J/CD].中华关节外科杂志(电子版),2020,14(5):612-618.
[4]
Sauer S, English R, Clatworthy M. The ratio of tibial slope and meniscal bone angle for the prediction of ACL reconstruction failure risk[J]. Surg J (N Y), 2018, 4(3): e152-e159.
[5]
Jaecker V, Drouven S, Naendrup JH, et al. Increased medial and lateral tibial posterior slopes are independent risk factors for graft failure following ACL reconstruction[J]. Arch Orthop Trauma Surg, 2018, 138(10): 1423-1431.
[6]
Ho B, Edmonds EW, Chambers HG, et al. Risk factors for early ACL reconstruction failure in pediatric and adolescent patients: a review of 561 cases[J]. J Pediatr Orthop, 2018, 38(7): 388-392.
[7]
Getgood A, Brown C, Lording T, et al. The anterolateral complex of the knee: results from the International ALC Consensus Group Meeting[J]. Knee Surg Sports Traumatol Arthrosc, 2019, 27(1): 166-176.
[8]
Hurley ET, Fried JW, Kingery MT, et al. Antero-lateral ligament reconstruction improves knee stability alongside anterior cruciate ligament reconstruction[J]. Knee Surg Sports Traumatol Arthrosc, 2021, 29(3): 764-771.
[9]
Littlefield CP, Belk JW, Houck D, et al. The anterolateral ligament of the knee: an updated systematic review of anatomy, biomechanics, and clinical outcomes[J/OL]. Arthroscopy, 2020. doi: 10.1016/j.arthro.2020.12.190.
[10]
Madhan AS, Patel NM. The anterolateral ligament of the knee[J/OL]. JBJS Rev, 2020, 8(6): e0136. doi: 10.2106/JBJS.RVW.19.00136.
[11]
Magnussen RA. Editorial commentary: so your knee has a big pivot shift before anterior cruciate ligament surgery-why does that matter?[J]. Arthroscopy, 2020, 36(5): 1407-1408.
[12]
Parisien RL. Editorial commentary: the epic saga of the anterior cruciate ligament and anterolateral complex of the knee-loyal sidekick May provide protection without constraint[J]. Arthroscopy, 2020, 36(5): 1374-1375.
[13]
Reider B. ACL or ACL[J]. Am J Sports Med, 2020, 48(2): 281-284.
[14]
Xu C, Chen J, Cho E, et al. The effect of combined anterolateral and anterior cruciate ligament reconstruction on reducing pivot shift rate and clinical outcomes: a meta-analysis[J]. Arthroscopy, 2021, 37(2): 694-705.
[15]
Claes S, Vereecke E, Maes M, et al. Anatomy of the anterolateral ligament of the knee[J]. J Anat, 2013, 223(4): 321-328.
[16]
Kittl C, El-Daou H, Athwal KK, et al. The role of the anterolateral structures and the ACL in controlling laxity of the intact and ACL-deficient knee[J]. Am J Sports Med, 2016, 44(2): 345-354.
[17]
Lutz C, Sonnery-Cottet B, Niglis L, et al. Behavior of the anterolateral structures of the knee during internal rotation[J]. Orthop Traumatol Surg Res, 2015, 101(5): 523-528.
[18]
Parsons EM, Ao GE, Spiekerman C, et al. The biomechanical function of the anterolateral ligament of the knee[J]. Am J Sports Med, 2015, 43(3): 669-674.
[19]
Inderhaug E, Stephen JM, Williams A, et al. Biomechanical comparison of anterolateral procedures combined with anterior cruciate ligament reconstruction[J]. Am J Sports Med, 2017, 45(2): 347-354.
[20]
Thein R, Boorman-Padgett J, Stone K, et al. Biomechanical assessment of the anterolateral ligament of the knee[J]. J Bone Joint Surg Am, 2016, 98(11): 937-943.
[21]
Song GY, Zhang H, Wu G, et al. Patients with high-grade pivot-shift phenomenon are associated with higher prevalence of anterolateral ligament injury after acute anterior cruciate ligament injuries[J]. Knee Surg Sports Traumatol Arthrosc, 2017, 25(4): 1111-1116.
[22]
Albers M, Shaikh H, Herbst E, et al. The iliotibial band and anterolateral capsule have a combined attachment to the Segond fracture[J]. Knee Surg Sports Traumatol Arthrosc, 2018, 26(5): 1305-1310.
[23]
Melugin HP, Johnson NR, Wu IT, et al. Is treatment of segond fracture necessary with combined anterior cruciate ligament reconstruction?[J]. Am J Sports Med, 2018, 46(4): 832-838.
[24]
Yoon KH, Kim JS, Park SY, et al. The influence of segond fracture on outcomes after anterior cruciate ligament reconstruction[J]. Arthroscopy, 2018, 34(6): 1900-1906.
[25]
Beighton P, De Paepe A, Steinmann B, et al. Ehlers-Danlos syndromes:revised nosology,villefranche,1997[J]. Am J Med Genet, 1998, 77(1): 31-37.
[26]
Taneja AK, Miranda FC, Braga CP, et al. MRI features of the anterolateral ligament of the knee[J]. Skeletal Radiol, 2015, 44(3): 403-410.
[27]
Batty LM, Murgier J, Feller JA, et al. Radiological identification of injury to the kaplan fibers of the iliotibial band in association with anterior cruciate ligament injury[J]. Am J Sports Med, 2020, 48(9): 2213-2220.
[28]
Dodds AL, Halewood C, Gupte CM, et al. The anterolateral ligament: anatomy, length changes and association with the Segond fracture[J]. Bone Joint J, 2014, 96-b(3): 325-331.
[29]
Hosseinzadeh S, Kiapour AM. Sex differences in anatomic features linked to anterior cruciate ligament injuries during skeletal growth and maturation[J]. Am J Sports Med, 2020, 48(9): 2205-2212.
[30]
Lysholm J, Gillquist J. Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale[J]. Am J Sports Med, 1982, 10(3): 150-154.
[31]
Irrgang JJ, Anderson AF, Boland AL, et al. Development and validation of the International Knee Documentation Committee Subjective Knee Form[J]. Am J Sports Med, 2001, 29(5): 600-613.
[32]
Rossi MJ, Lubowitz JH, Guttmann D. Development and validation of the International Knee Documentation Committee Subjective Knee Form[J]. Am J Sports Med, 2002, 30(1): 152.
[33]
Tegner Y, Lysholm J. Rating systems in the evaluation of knee ligament injuries[J]. Clin Orthop Relat Res, 1985, (198): 43-49.
[34]
Marx RG, Stump TJ, Jones EC, et al. Development and evaluation of an activity rating scale for disorders of the knee[J]. Am J Sports Med, 2001, 29(2): 213-218.
[35]
Chen J, Cho E, Xu C, et al. A new rating scale for the rapid evaluation of high-level sports ability[J/OL]. Orthop J Sports Med, 2020, 8(12):2325967120964883.doi:10.1177/2325967120964883.
[36]
Sonnery-Cottet B, Daggett M, Fayard JM, et al. Anterolateral ligament expert group consensus paper on the management of internal rotation and instability of the anterior cruciate ligament -deficient knee[J]. J Orthop Traumatol, 2017, 18(2): 91-106.
[37]
Jesani S, Getgood A. Modified lemaire lateral extra-articular tenodesis augmentation of anterior cruciate ligament reconstruction[J]. JBJS Essent Surg Tech, 2019, 9(4): e41.1-e41.7.
[38]
Tang J, Zhao J. Condyle-pinching double-bundle anterior cruciate ligament reconstruction[J]. Arthrosc Tech, 2020, 9(8): e1109-e1114.
[39]
Zhao J, Qiu J, Chen J, et al. Combined Double-Bundle anterior cruciate ligament reconstruction and anterior cruciate ligament-mimicking anterolateral structure reconstruction[J]. Arthrosc Tech, 2020, 9(8): e1141-e1146.
[40]
Marcacci M, Zaffagnini S, Marcheggiani MG, et al. Arthroscopic intra- and extra-articular anterior cruciate ligament reconstruction with gracilis and semitendinosus tendons: a review[J]. Curr Rev Musculoskelet Med, 2011, 4(2): 73-77.
[41]
Zaffagnini S, Marcheggiani MG, Grassi A, et al. Over-the-top ACL reconstruction plus extra-articular lateral tenodesis with hamstring tendon grafts: prospective evaluation with 20-year minimum follow-up[J]. Am J Sports Med, 2017, 45(14): 3233-3242.
[42]
Marcacci M, Zaffagnini S, Iacono F, et al. Arthroscopic intra- and extra-articular anterior cruciate ligament reconstruction with gracilis and semitendinosus tendons[J]. Knee Surg Sports Traumatol Arthrosc, 1998, 6(2): 68-75.
[43]
Nagai K, Rothrauff BB, Li RT, et al. Over-the-top ACL reconstruction restores anterior and rotatory knee laxity in skeletally immature individuals and revision settings[J]. Knee Surg Sports Traumatol Arthrosc, 2020, 28(2): 538-543.
[44]
Delaloye JR, Hartog C, Blatter S, et al. Anterolateral ligament reconstruction and modified lemaire lateral extra-articular tenodesis similarly improve knee stability after anterior cruciate ligament reconstruction: a biomechanical study[J]. Arthroscopy, 2020, 36(7): 1942-1950.
[45]
Jette C, Gutierrez D, Sastre S, et al. Biomechanical comparison of anterolateral ligament anatomical reconstruction with a semi-anatomical lateral extra-articular tenodesis. A cadaveric study[J]. Knee, 2019, 26(5): 1003-1009.
[46]
Inderhaug E, Stephen JM, Williams A, et al. Anterolateral tenodesis or anterolateral ligament complex reconstruction: effect of flexion angle at graft fixation when combined with ACL reconstruction[J]. Am J Sports Med, 2017, 45(13): 3089-3097.
[47]
Nitri M, Rasmussen MT, Williams BT, et al. An in vitro robotic assessment of the anterolateral ligament, part 2: anterolateral ligament reconstruction combined with anterior cruciate ligament reconstruction[J]. Am J Sports Med, 2016, 44(3): 593-601.
[48]
Geeslin AG, Moatshe G, Chahla J, et al. Anterolateral knee extra-articular stabilizers: a robotic study comparing anterolateral ligament reconstruction and modified lemaire lateral extra-articular tenodesis[J]. Am J Sports Med, 2018, 46(3): 607-616.
[49]
Herbst E, Arilla FV, Guenther D, et al. Lateral extra-articular tenodesis has no effect in knees with isolated anterior cruciate ligament injury[J]. Arthroscopy, 2018, 34(1): 251-260.
[50]
Slette EL, Mikula JD, Schon JM, et al. Biomechanical results of lateral extra-articular tenodesis procedures of the knee: a systematic review[J]. Arthroscopy, 2016, 32(12): 2592-2611.
[51]
Chen J, Wang C, Xu C, et al. Effects of anterolateral structure augmentation on the in vivo kinematics of anterior cruciate ligament-reconstructed knees[J]. Am J Sports Med, 2021, 49(3): 656-666.
[52]
Ra HJ, Kim JH, Lee DH. Comparative clinical outcomes of anterolateral ligament reconstruction versus lateral extra-articular tenodesis in combination with anterior cruciate ligament reconstruction: systematic review and meta-analysis[J]. Arch Orthop Trauma Surg, 2020, 140(7): 923-931.
[53]
Hewison CE, Tran MN, Kaniki N, et al. Lateral extra-articular tenodesis reduces rotational laxity when combined with anterior cruciate ligament reconstruction: a systematic review of the literature[J]. Arthroscopy, 2015, 31(10): 2022-2034.
[54]
Rezende FC, De Moraes VY, Martimbianco AL, et al. Does combined intra- and extraarticular ACL reconstruction improve function and stability? A meta-analysis[J]. Clin Orthop Relat Res, 2015, 473(8): 2609-2618.
[55]
Song GY, Hong L, Zhang H, et al. Clinical outcomes of combined lateral extra-articular tenodesis and intra-articular anterior cruciate ligament reconstruction in addressing high-grade pivot-shift phenomenon[J]. Arthroscopy, 2016, 32(5): 898-905.
[56]
Getgood AJ, Bryant DM, Litchfield R, et al. Lateral extra-articular tenodesis reduces failure of hamstring tendon autograft anterior cruciate ligament reconstruction: 2-year outcomes from the stability study randomized clinical trial[J]. Am J Sports Med, 2020, 48(2): 285-297.
[57]
Helito CP, Camargo DB, Sobrado MF, et al. Combined reconstruction of the anterolateral ligament in chronic ACL injuries leads to better clinical outcomes than isolated ACL reconstruction[J]. Knee Surg Sports Traumatol Arthrosc, 2018, 26(12): 3652-3659.
[58]
Helito CP, Sobrado MF, Giglio PN, et al. Combined reconstruction of the anterolateral ligament in patients with anterior cruciate ligament injury and ligamentous hyperlaxity leads to better clinical stability and a lower failure rate than isolated anterior cruciate ligament reconstruction[J]. Arthroscopy, 2019, 35(9): 2648-2654.
[59]
Lee DW, Kim JG, Cho SI, et al. Clinical outcomes of isolated revision anterior cruciate ligament reconstruction or in combination with anatomic anterolateral ligament reconstruction[J]. Am J Sports Med, 2019, 47(2): 324-333.
[60]
毛云鹤,孙伟豪,付维力,等. 前交叉韧带双束重建联合前外侧韧带重建在前交叉韧带翻修中的应用[J]. 中国修复重建外科杂志,2021, 35(3): 330-336.
[61]
Claes S, Luyckx T, Vereecke E, et al. The segond fracture: a bony injury of the anterolateral ligament of the knee[J]. Arthroscopy, 2014, 30(11): 1475-1482.
[62]
Shaikh H, Herbst E, Rahnemai-Azar AA, et al. The segond fracture is an avulsion of the anterolateral complex[J]. Am J Sports Med, 2017, 45(10): 2247-2252.
[63]
Fu FH, Rothrauff BB. Editorial commentary: the segond fracture has multiple attachments: yet another demonstration of the anatomical complexity of the anterolateral complex of the knee[J]. Arthroscopy, 2020, 36(6): 1687-1689.
[64]
程相允,张升校,路雁惠,等.胫骨平台前外侧撕脱骨折合并前交叉韧带损伤的诊治[J/CD].中华关节外科杂志(电子版), 2018, 12(4):83-86.
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