The effect of combined rupture of anterior cruciate ligament (ACL), lateral meniscus and anterolateral capsule injury and repair on tibiofemoral contact pressure

前十字韧带(ACL)、前外侧囊和外侧半月板的联合损伤是常见的，对于避免骨关节炎继发进展的理想治疗的适应证仍然具有挑战性。尽管有几种成熟的手术技术，但这些方法对胫股压力和关节运动学的影响仍不充分。本研究的目的是确定外侧半月板撕裂合并前交叉韧带撕裂和前外侧囊损伤对膝关节前移和内旋的影响。此外，根据外侧半月板的完整性，测量改良Lemaire手术后胫股接触压力的变化。这是假设，与完整状态相比，前外侧囊和外侧半月板的联合损伤导致胫骨平台的内旋和前移更高。其次，在改良的Lemaire技术中，关节外肌腱分离伴随着外侧半月板的撕裂导致接触压力与自然测量相比显著增加。连续解剖前交叉韧带、前外侧囊和外侧半月板，模拟复合损伤。在每个解剖步骤后，自动测量和分析胫骨的前移和内旋。使用压力敏感传感器薄膜(Tekscan4011K)测量前交叉韧带重建、前外侧腱固定和外侧半月板修复对胫股接触压力的影响。数据分析采用双向方差分析。这项研究的结果增加了Lemaire膝关节前外侧稳定手术的科学证据水平，并有助于优化这些患者的治疗，以避免骨关节炎的快速发展。

Combined injuries of the anterior cruciate ligament (ACL), the anterolateral capsule and the lateral meniscus are common and remain challenging regarding indication of the ideal treatment to avoid secondary progression of osteoarthritis. Despite several established surgical techniques the effect of these methods on tibiofemoral pressure and joint kinematics are still insufficiently described. The purpose of this study is to determine the impact of lateral meniscus tears in combination with ACL tears and an injury of the anterolateral capsule on anterior translation and internal rotation of the knee joint. Furthermore, changes in tibiofemoral contact pressure are measured after a modified Lemaire procedure depending on the integrity of the lateral meniscus. It was hypothesized that a combined injury of the anterolateral capsule and the lateral meniscus results in a higher internal rotation and anterior translation of the tibia plateau in comparison to the intact state. Secondly, an extra-articular tenodesis in modified Lemaire technique with a concomitant tear of the lateral meniscus leads to a significant increase in contact pressure when compared to native measurements.In a biomechanical study using an industrial robot (Stäubli TX90, Stäubli und Co.) the ACL, the anterolateral capsule and the lateral meniscus are consecutively dissected to simulate a combined injury. The tibial anterior translation and internal rotation are automatically measured and analysed after each dissection step. Pressure sensitive sensor foils (Tekscan 4011 K) are used to measure the impact of ACL reconstruction and anterolateral tenodesis as well as lateral meniscus repair on tibiofemoral contact pressure. Data is analysed using two-way analysis of variance. The results of this study increase the scientific evidence level regarding the Lemaire procedure for anterolateral stabilisation of the knee and help to optimize the treatment of these patients to avoid rapid development of osteoarthritis.