アブストラクト
| Title | 靱帯 (3) : 後十字靱帯損傷の診断と治療 |
|---|---|
| Subtitle | 特集 : 膝窩部・膝内側部痛の診療 - すぐに役立つQ&A - |
| Authors | 橘優太*1, 田中美成*2, 衣笠和孝*3 |
| Authors (kana) | たちばなゆうた |
| Organization | *1大阪労災病院スポーツ整形外科, 医長, *2部長, *3副部長 |
| Journal | MB Orthopaedics |
| Volume | 35 |
| Number | 1 |
| Page | 69-78 |
| Year/Month | 2022 / 1 |
| Article | 報告 |
| Publisher | 全日本病院出版会 |
| Abstract | 「Abstract」後十字靱帯(PCL)は大腿骨に対する脛骨の後方転位を制動するprimary stabilizerである. PCL損傷により, 特に膝屈曲位で膝蓋大腿関節および内側コンパートメントの軟骨への応力増大が発生する. 一方, 損傷したPCL断端は時間経過で連続性を再獲得し, 安定性が改善する可能性があることから, 単独損傷の場合, Jack PCL Braceなどの装具を使用して脛骨位置を整復しながらリハビリテーションを行う保存治療が第一選択である. 保存治療は良好な臨床成績と早期のスポーツ復帰が期待できる一方で, 長期的には変形性膝関節症や半月板損傷などの危険性に留意する必要がある. 保存治療施行後も膝窩部痛や後方不安定性が残存する場合は手術治療が選択される. 手術治療は自家ハムストリング筋腱を用いる場合, 前外側線維束と後内側線維束の両者を再建する二重束再建法が一重束再建法よりも生体力学的および臨床成績の観点で優れている. 一方, PCL再建術後の脛骨後方転位の再発・残存は改善すべき問題の一つである. 当科の検討において, 自家ハムストリング筋腱を用いた二重束再建術直後にいったん制動された脛骨位置は術後3か月という早期に後方転位が再発し, 前外側線維束側骨孔拡大率は術直後からの脛骨後方転位再発量と正の相関を認めたことから, 適切なリハビリテーションや装具着用といった再建靱帯保護が, 特に術後早期において重要であると考える. |
| Practice | 臨床医学：外科系 |
| Keywords | 後十字靱帯損傷(posterior cruciate ligament injury), 診断(diagnosis), 保存治療(conservative treatment), リハビリテーション(rehabilitation), 手術治療(operative treatment) |
- 全文ダウンロード： 従量制、基本料金制の方共に968円(税込) です。
参考文献
- 1) Race A, et al:The mechanical properties of the two bundles of the human posterior cruciate ligament. J Biomech. 27(1):13-24, 1994.
- 2) Winkler PW, et al:Evolving evidence in the treatment of primary and recurrent posterior cruciate ligament injuries, part 1:anatomy, biomechanics and diagnostics. Knee Surg Sports Traumatol Arthrosc. 29(3):672-681, 2021.
- 3) Race A, et al:Loading of the two bundles of the posterior cruciate ligament:an analysis of bundle function in a-P drawer. J Biomech. 29(7):873-879, 1996.
- 4) Ahmad CS, et al:Codominance of the individ-ual posterior cruciate ligament bundles. An analysis of bundle lengths and orientation. Am J Sports Med. 31(2):221-225, 2003.
- 5) Logan M, et al:The effect of posterior cruciate ligament deficiency on knee kinematics. Am J Sports Med. 32(8):1915-1922, 2004.
残りの46件を表示する
- 6) Li G, et al:Effect of posterior cruciate ligament deficiency on in vivo translation and rotation of the knee during weightbearing flexion. Am J Sports Med. 36(3):474-479, 2008.
- 7) Gill TJ, et al:The effect of posterior cruciate ligament reconstruction on patellofemoral con-tact pressures in the knee joint under simu-lated muscle loads. Am J Sports Med. 32(1):109-115, 2004.
- 8) MacDonald P, et al:A biomechanical analysis of joint contact forces in the posterior cruciate deficient knee. Knee Surg Sports Traumatol Arthrosc. 3(4):252-255, 1996.
- 9) Pearsall AW 4th, et al:The effect of posterior cruciate ligament injury and reconstruction on meniscal strain. Am J Sports Med. 32(7):1675-1680, 2004.
- 10) Van de Velde SK, et al:Analysis of tibiofemo-ral cartilage deformation in the posterior cruci-ate ligament-deficient knee. J Bone Joint Surg Am. 91(1):167-175, 2009.
- 11) Van de Velde SK, et al:Dual fluoroscopic analysis of the posterior cruciate ligament-deficient patellofemoral joint during lunge. Med Sci Sports Exerc. 41(6):1198-1205, 2009.
- 12) Schulz MS, et al:Epidemiology of posterior cruciate ligament injuries. Arch Orthop Trauma Surg. 123(4):186-191, 2003.
- 13) Bedi A, et al:Management of posterior cruci-ate ligament injuries:an evidence-based review. J Am Acad Orthop Surg. 24(5):277-289, 2016.
- 14) Medina O, et al:Vascular and nerve injury after knee dislocation:a systematic review. Clin Orthop Relat Res. 472:2621-2629, 2014.
- 15) Jung TM, et al:Stress radiography to measure posterior cruciate ligament insufficiency:a comparison of five different techniques. Knee Surg Sports Traumatol Arthrosc. 14(11):1116-1121, 2006.
- 16) Holliday CL, et al:Comparing the efficacy of kneeling stress radiographs and weighted gravity stress radiographs to assess posterior cruciate ligament insufficiency. Am J Sports Med. 49(4):1017-1022, 2021.
- 17) Shino K, et al:The gravity sag view:a simple radiographic technique to show posterior lax-ity of the knee. Arthroscopy. 16(6):670-672, 2000.
- 18) Hamada M, et al:Chondral injury associated with acute isolated posterior cruciate ligament injury. Arthroscopy. 16(1):59-63, 2000.
- 19) Ringler MD, et al:Intra-articular pathology associated with isolated posterior cruciate liga-ment injury on MRI. Skeletal Radiol. 45(12):1695-1703, 2016.
- 20) 堀部秀二ほか:スポーツ外傷・障害の理学診断理学療法ガイド. 326-330, 文光堂, 2015.
- 21) Shelbourne KD, et al:Magnetic resonance imaging of posterior cruciate ligament inju-ries:assessment of healing. Am J Knee Surg. 12(4):209-213, 1999.
- 22) Jung YB, et al:Characterization of spontane-ous healing of chronic posterior cruciate liga-ment injury:Analysis of instability and mag-netic resonance imaging. J Magn Reson Imag-ing. 27(6):1336-1340, 2008.
- 23) Yonetani Y, et al:Flexion gap in the isolated posterior cruciate ligament-injured knee affects symptom relief after conservative treatment:a case-control study. Orthop J Sports Med. 5(11):2325967117738239, 2017.
- 24) Akisue T, et al:Evaluation of healing of the injured posterior cruciate ligament:Analysis of instability and magnetic resonance imaging. Arthroscopy. 17(3):264-269, 2001.
- 25) Jacobi M, et al:Acute isolated injury of the posterior cruciate ligament treated by a dynamic anterior drawer brace:a preliminary report. J Bone Joint Surg Br. 92(10):1381-1384, 2010.
- 26) Jung YB, et al:Active non-operative treat-ment of acute isolated posterior cruciate liga-ment injury with cylinder cast immobilization. Knee Surg Sports Traumatol Arthrosc. 16(8):729-733, 2008.
- 27) Pierce CM, et al:Posterior cruciate ligament tears:functional and postoperative rehabilita-tion. Knee Surg Sports Traumatol Arthrosc. 21(5):1071-1084, 2013.
- 28) Wang D, et al:Nonoperative Treatment of PCL Injuries:Goals of Rehabilitation and the Natural History of Conservative Care. Curr Rev Musculoskelet Med. 11(2):290-297, 2018.
- 29) Shino K, et al:Conservative treatment of iso-lated injuries to the posterior cruciate ligament in athletes. J Bone Joint Surg Br. 77(6):895-900, 1995.
- 30) Toritsuka Y, et al:Conservative treatment for rugby football players with an acute isolated posterior cruciate ligament injury. Knee Surg Sports Traumatol Arthrosc. 12(2):110-114, 2004.
- 31) Agolley D, et al:Successful return to sports in athletes following non-operative management of acute isolated posterior cruciate ligament injuries:medium-term follow-up. Bone Joint J. 99-B(6):774-778, 2017.
- 32) Shelbourne KD, et al:Minimum 10-year fol-low-up of patients after an acute, isolated pos-terior cruciate ligament injury treated nonop-eratively. Am J Sports Med. 41(7):1526-1533, 2013.
- 33) Parolie JM, et al:Long-term results of nonop-erative treatment of isolated posterior cruciate ligament injuries in the athlete. Am J Sports Med. 14(1):35-38, 1986.
- 34) Boynton MD, et al:Long-term followup of the untreated isolated posterior cruciate ligament-deficient knee. Am J Sports Med. 24(3):306-310, 1996.
- 35) Strobel MJ, et al:Arthroscopic evaluation of articular cartilage lesions in posterior-cruci-ate-ligament-deficient knees. Arthroscopy. 19(3):262-268, 2003.
- 36) Wang SH, et al:Long-term results of posterior cruciate ligament tear with or without recon-struction:A nationwide, population-based cohort study. PLoS One 3;13(10):e0205118, 2018.
- 37) Strobel MJ, et al:Fixed posterior subluxation in posterior cruciate ligament-deficient knees:diagnosis and treatment of a new clinical sign. Am J Sports Med. 30(1):32-38, 2002.
- 38) Harner CD, et al:Biomechanical analysis of a posterior cruciate ligament reconstruction. Deficiency of the posterolateral structures as a cause of graft failure. Am J Sports Med. 28(1):32-39, 2000.
- 39) Wijdicks CA, et al:Kinematic analysis of the posterior cruciate ligament, part 2:a compari-son of anatomic single-versus double-bundle reconstruction. Am J Sports Med. 41(12):2839-2848, 2013.
- 40) Kennedy NI, et al:Posterior cruciate ligament graft fixation angles, part 2:biomechanical evaluation for anatomic double-bundle recon-struction. Am J Sports Med. 42(10):2346-2355, 2014.
- 41) Markolf KL, et al:Cyclic loading of posterior cruciate ligament replacements fixed with tib-ial tunnel and tibial inlay methods. J Bone Joint Surg Am. 84:518-524, 2002.
- 42) Lee DW, et al:Return to sports and clinical outcomes after arthroscopic anatomic posterior cruciate ligament reconstruction with remnant preservation. Arthroscopy. 35:2658-2668. e2651, 2019.
- 43) Mariani PP, et al:Arthroscopic posterior cruci-ate ligament reconstruction with bone-ten-don-bone patellar graft. Knee Surg Sports Traumatol Arthrosc. 5(4):239-244, 1997.
- 44) Zayni R, et al:Activity level recovery after arthroscopic PCL reconstruction:a series of 21 patients with a mean follow-up of 29 months. Knee. 18(6):392-395, 2011.
- 45) Chahla J, et al:Single-bundle and double-bundle posterior cruciate ligament reconstruc-tions:a systematic review and meta-analysis of 441 patients at a minimum 2 years' follow-up. Arthroscopy. 33(11):2066-2080, 2017.
- 46) Song EK, et al:Transtibial versus tibial inlay techniques for posterior cruciate ligament reconstruction:long-term follow-up study. Am J Sports Med. 42(12):2964-2971, 2014.
- 47) Yoon KH, et al:Minimum 10-year results of single-versus double-bundle posterior cruci-ate ligament reconstruction:clinical, radiologic, and survivorship outcomes. Am J Sports Med. 47(4):822-827, 2019.
- 48) LaPrade RF, et al:Double-bundle posterior cruciate ligament reconstruction in 100 patients at a mean 3 years' follow-up:out-comes were comparable to anterior cruciate ligament reconstructions. Am J Sports Med. 46(8):1809-1818, 2018.
- 49) Gwinner C, et al:Degenerative changes after posterior cruciate ligament reconstruction are irrespective of posterior knee stability:MRI-based long-term results. Arch Orthop Trauma Surg. 138(3):377-385, 2018.
- 50) Tachibana Y, et al:Sequential changes in pos-terior tibial translation after posterior cruciate ligament reconstruction:risk factors for resid-ual posterior sagging. Orthop J Sports Med. 9(6):23259671211009805, 2021.
- 51) Tachibana Y, et al:Tunnel enlargement cor-relates with postoperative posterior laxity after double-bundle posterior cruciate liga-ment reconstruction. Orthop J Sports Med. 9(1):2325967120977834, 2021.
