非接触性前十字韧带损伤初次重建术后失效的危险因素

目的探讨非接触性前十字韧带(anterior cruciate ligament,ACL)损伤初次重建术后失效的危险因素。方法2015年11月至2017年5月连续收治并随访2年以上的非接触性ACL损伤而行ACL初次重建的患者178例。随访2年内25例患者出现MRI证实的ACL移植物完全断裂或轴移试验阳性或KT-1000侧侧差值超过5 mm或MRI上静态胫骨前移超过5 mm判定为术后失效,纳入术后失效组;按照1∶2的比例匹配术后2年内未失效者50例,纳入术后未失效组。比较两组患者性别、年龄、体质指数(body mass index,BMI)、患侧分布、半月板损伤侧分布、受伤至手术时间、术前麻醉下KT-1000侧侧差值、轴移试验、随访时间、术前下肢负重位全长X线片上胫骨平台后倾角及胫骨前移的差异,采用多因素Logistic回归分析确定ACL损伤初次重建术后失效的危险因素。结果术后失效组的胫骨平台后倾角为17.21°±2.20°,大于术后未失效组的14.36°±2.72°,差异有统计学意义(t=4.395,P<0.001);术后失效组的术前胫骨前移为(8.29±3.42)mm,大于术后未失效组的(4.09±3.06)mm,差异有统计学意义(t=5.504,P<0.001)。两组性别、年龄、BMI、患侧分布、半月板损伤侧分布、受伤至手术时间、麻醉下KT-1000侧侧差值、轴移试验分度、随访时间的差异均无统计学意义(P>0.05)。多因素回归分析结果显示胫骨平台后倾角≥17°是ACL术后失效的独立危险因素(OR=15.62,P=0.002),胫骨前移≥6 mm是ACL术后失效的独立危险因素(OR=9.91,P=0.006);而性别、年龄、BMI、半月板是否损伤、轴移试验分度、KT-1000侧侧差值与术后失效无相关性(P>0.05)。结论术前下肢负重位全长X线片上胫骨平台后倾角≥17°和胫骨前移≥6 mm可增加ACL损伤初次重建术后失效的风险。     

内侧半月板损伤对前交叉韧带重建后失效的诊断意义

目的探讨无明显外伤史情况下,内侧半月板损伤是否可作为前交叉韧带(anterior cruciate ligament,ACL)重建后失效的判断指标。方法回顾比较2011年3月-2015年12月随访并符合选择标准的117例单膝ACL重建患者临床资料,其中56例MRI检查示内侧半月板损伤(试验组),61例MRI检查示内侧半月板无损伤(对照组)。两组性别、手术时年龄、患肢侧别、重建术式以及术后至该次随访时间比较,差异无统计学意义(P0.05),具有可比性。采用KT-2000关节动度仪检测双侧膝关节屈曲30°时胫骨前移距离差值,并根据Rijke等提出的判断标准评定重建ACL是否失效。结果试验组双侧膝关节胫骨前移距离差值3 mm 7例,3~5 mm11例,5 mm 38例;重建ACL失效率为67.9%。对照组3 mm 31例,3~5 mm 18例,5 mm 12例;重建ACL失效率为19.7%。试验组重建ACL失效率明显高于对照组,比较差异有统计学意义(χ~2=27.700,P=0.000)。试验组翻修术中观察结果与术前双膝胫骨前移距离差值评定结果一致。结论 ACL重建术后,若无明显外伤史情况下出现内侧半月板损伤,提示重建ACL可能失效。     

胫骨平台后倾角与非接触性前交叉韧带损伤的相关性

[目的]评估非接触性前交叉韧带损伤与胫骨平台内外侧后倾角之间的相关性。[方法]选取2009年12月~2014年5月,年龄48岁以下于本院行MRI检查的两部分病患资料:(1)74例非接触性前交叉韧带损伤的患者作为损伤组,其中男52例,女22例,年龄18~48岁;(2)66例诊断为半月板损伤或膝关节滑膜炎而无前交叉韧带损伤的患者作为对照组,其中男50例,女16例,年龄18~48岁。利用MRI测量胫骨确定胫骨平台内外侧后倾角,比较两组之间的差异。[结果]损伤组内侧胫骨平台倾斜角度测量结果为(3.70°±4.04°),而未损伤组的测量结果为(2.64°±3.42°)。两组数据差异无统计学意义(P=0.098)。两组研究对象外侧胫骨平台平均后倾角差异有统计学意义(P=0.008),损伤组的外侧胫骨平台后倾角测量结果为(3.83°±4.57°),而未损伤组的后倾角测量结果为(1.77°±4.38°)。两组数据在性别(P=0.53)(表2)和年龄(P=0.198)(表2)上无差别。[结论]胫骨平台外侧后倾角是前交叉韧带非接触性损伤的高危风险因素。     

基于后十字韧带的膝关节多发韧带损伤两种重建技术的对比研究

目的 比较采用关节镜下经胫骨隧道技术和切开胫骨镶嵌骨块技术重建基于后十字韧带的多发韧带损伤患者术后的后向稳定性和临床疗效.方法 自2005年4月至2009年12月,共连续完成基于后十字韧带的多发韧带损伤重建修复手术135例,2年以上随访者88例.后十字韧带采用关节镜下经胫骨隧道技术重建57例(64.8％),切开镶嵌骨块技术重建31例(35.2％),合并损伤予同期重建或修复.随访时间平均(45.9±17.0)个月(24～77个月).采用KT-1000和Telos应力装置测量手术前后膝关节后向稳定性.采用Tegner、Lysholm、AAOS评分评价临床疗效.结果 两组患者的性别、年龄、受伤至手术时间、合并损伤和主观评分比较,差异均无统计学意义.经胫骨隧道组术前KT-1000两侧差值为(13.5±4.8) mm,术后为(2.4±3.4)mm;术前Telos两侧差值为(14.9±7.1) mm,术后为(4.6±4.0) mm.切开胫骨镶嵌骨块组术前KT-1000两侧差值为(13.7±5.2) mm,术后为(2.2±3.6)mm;术前Telos两侧差值为(14.9±5.9) mm,术后为(4.3±3.9) mm.两组患者KT-1000和Telos两侧差值手术前后组内比较差异均有统计学意义,而组间比较差异均无统计学意义.两组患者术后Tegner、Lysholm、AAOS评分的差异均无统计学意义.结论 采用两种技术重建基于后十字韧带的多发韧带损伤,两组患者术后的后向稳定性及功能评分差异均无统计学意义,且均可明显恢复膝关节后向稳定性.     

胫骨后倾截骨对后十字韧带保留型全膝关节置换术疗效的影响

目的 探讨胫骨后倾截骨对后十字韧带保留型全膝关节置换术后临床疗效的影响.方法 2008年1月至2009年3月应用胫骨后倾5°截骨(后倾组)进行后十字韧带保留型全膝关节置换治疗骨关节炎患者27例(27膝),男7例7膝,女20例20膝;平均年龄69.5岁.同期应用胫骨后倾0°截骨(非后倾组)57例57膝,男15例15膝,女42例42膝;平均年龄67.4岁.两组患者术前一般资料、膝关节最大伸直角度、最大屈曲角度和美国膝关节协会评分(knee society score,KSS评分)差异均无统计学意义.比较术后两组胫骨后倾角、关节最大伸直角度、最大屈曲角度和KSS评分的差异.结果 所有患者均获随访12～24个月,平均(15.7±4.3)个月.未发生腓总神经损伤、伤口感染、假体脱位、假体松动等并发症.后倾组术后胫骨后倾角5.7°±2.1°,非后倾组0.9°±0.6°.后倾组术后关节最大伸直角度0.8°±0.3°,非后倾组1.2°±0.4°,差异无统计学意义.后倾组术后关节最大屈曲角度115.7°±4.8°,非后倾组101.1°±5.6°,差异有统计学意义.后倾组术后KSS评分(87.6±5.9)分,非后倾组(83.3±7.2)分,差异无统计学意义.结论 在后十字韧带保留型全膝关节置换术中胫骨后倾截骨可以增加术后关节最大屈曲角度,但对最大伸直角度和KSS评分无明显影响.     

前交叉韧带单束重建中两种股骨隧道制备方法的疗效比较

[目的]比较前交叉韧带单束重建中不同的股骨隧道制备方法对手术效果的影响.[方法]自2005年6月～2010年10月,采用自体半腱肌、股薄肌肌腱单束单隧道重建前交叉韧带140例,其中85例采用经胫骨隧道建立股骨隧道,55例采用经前内侧切口建立股骨隧道.通过Lysholm膝关节功能评分和屈膝30°位KT-1000前向松弛度对手术效果进行比较.[结果]所有患者术后均得到随访,随访时间至少12个月.术后Lysholm膝关节功能评分和KT-1000前向松弛度均较术前有改善.而术后经胫骨隧道组和经前内侧切口组在Lysholm膝关节功能评分和KT-1000前向松弛度方面比较无踢显差异.[结论]前交叉韧带单束重建术中经胫骨隧道建立股骨隧道与经前内侧切口建立股骨隧道两种方法可达到相同的治疗结果.     

后十字韧带合并后外侧韧带结构损伤的关节镜下重建

目的 介绍后十字韧带合并后外侧韧带结构损伤的关节镜下重建及加强方式,总结其初期临床结果.方法 2006年11月至2007年10月,20例陈旧性后十字韧带合并后外侧韧带结构损伤患者采用八股自体胭绳肌肌腱双束重建后十字韧带、自体半腱肌肌腱加强后外侧韧带结构的手术方法.移植物采用微型钢板纽扣进行悬吊式固定.根据IKDC、Lyshohn和Tegner评分标准进行膝关节功能评估.结果 术后随访1～2年,平均(15.5±3.3)个月.末次随访时,患者伸膝活动均正常,1例屈膝受限15°,5例屈膝受限5°.后抽屉试验阴性17例,Ⅰ度阳性2例,Ⅱ度阳性1例.KT-1000检查(屈膝90°,30 kg)双侧松弛度差异平均为(2.35±1.35)mm.18例(90%)屈膝30°位外侧膝关节间隙增宽小于5 mm,2例(10%)分别为5 mm和6 nun.屈膝30°位小腿外旋角度较健侧增加均小于5°,平均为2.10°±2.67°.IKDC、Lysholm和Tegner评分分别为(90.00±3.49)分、(91.90±2.57)分和(6.50±0.69)分,与术前差异均有统计学意义.IKDC膝关节韧带评级15例(75%)正常,4例(20%)接近正常,1例(5%)异常.结论 采用八股自体胴绳肌肌腱双束重建后十字韧带,同时用自体半腱肌肌腱加强后外侧韧带结构能够恢复后十字韧带和后外侧韧带结构损伤后的膝关节稳定性.     

胫骨后倾角解剖与放射学测量评价

目的测量国人胫骨后倾角 ,为全膝关节置换及翻修术提供确切的胫骨后倾角数值。方法25具尸体(50个胫骨标本) ,切除胫骨平台表面软组织及半月板 ,测量胫骨平台内、外侧后倾角度 ;并摄X线片 ,模拟手术方法测量髓内、髓外胫骨后倾角度。结果胫骨平台内侧后倾角为15.02°±4.20°,外侧后倾角为11.74°±3.80°。胫骨X线片髓内定位胫骨后倾角为11.55°±3.60°,髓外定位胫骨后倾角为14.67°±3.68°,退变关节的胫骨后倾角增大。结论无论正常或退变关节的胫骨平台后倾角 ,内侧大于外侧 ;胫骨X线片髓内定位胫骨后倾角小于髓外定位胫骨后倾角 ,后者与实际解剖测量胫骨平台内侧后倾角值的差异无显著性意义 (P>0.05)。建议将胫骨平台内侧后倾角的数值作为全膝关节置换术的参考指数。     

胫骨平台后倾角的测量及临床意义

目的为膝关节置换术(TKA)中胫骨后倾截骨参数提供解剖学依据。方法①70例成人膝关节标本,测量胫骨内外侧髁关节面后倾角、半月板上缘连线后倾角、不同部位半月板和关节软骨厚度;②80例干燥骨性胫骨标本,测量胫骨内外侧髁关节面后倾角;③80例正常成人膝关节MRI矢状位像上测量胫骨内外侧髁关节面后倾角、半月板上缘连线后倾角。结果尸体标本、干燥骨性胫骨标本、膝关节MRI矢状位像上测得的胫骨外内侧髁关节面后倾角分别为:10.2°±2.5°、11.6°±3.3°;12.7°±3.5°、14.4°±3.2°;8.7°±4.5°和11.4°±2.2°。尸体标本测量外内侧半月板上缘连线后倾角分别为2.2°±1.5°、3.0°±2.1°;伸直膝关节MRI矢状位像上测量半月板上缘连线基本水平(0°～5°)。结论TKA术中胫骨后倾截骨应该恢复包括软骨、半月板的后倾角度,而不是骨性后倾角度,建议以0°～5°为宜。     

保留并牵张残留纤维的前十字韧带双束重建术

目的 评估在亚急性期进行保留并牵张残留纤维的前十字韧带双束重建的临床效果.方法 2006年1月至2006年6月,对56例前十字韧带损伤患者在亚急性期进行保留并牵张残留纤维的前十字韧带双束重建.前十字韧带双束重建采用四隧道八股肌腱移植的方法.使用PDS缝线穿缝胫骨侧残留纤维,经深束股骨隧道牵张固定.使用IKDC及Lysholm评分标准评估疗效.结果 53例随访2年以上.末次随访时所有患者Lachman试验均为阴性.屈膝25°KT-1000检测结果显示双侧膝关节松弛度差值为(-0.44±1.53)mm,与术前(8.01±1.83)mm比较差异有统计学意义(t=37.03,P=0.0001).29例(54.7%)双侧膝关节松弛度差值小于0mm,提示患膝相对于健侧更为稳定或紧张.24例(45.3%)双侧膝关节松弛度差值为0～2mm.所有患者轴移试验均阴性.48例膝关节活动度正常,2例有5°屈曲受限,1例有小于5°屈曲受限,2例有5°过伸受限.根据IKDC评估标准,51例(96.2%)正常,2例(3.8%)接近正常.IKDC主观评分为(95.6±3.1)分,Lysholm评分为(94.8±2.9)分.受伤前Tegner评分平均为7.3分,末次随访时为7.1分.结论 根据2年以上随访结果,以IKDC为评估标准,保留并牵张残留纤维的前十字韧带双束重建能够使96.2%的患者恢复正常,3.8%的患者接近正常.     

Association of KT-1000 measurements with clinical tests of knee stability 1 year following anterior cruciate ligament reconstruction.

STUDY DESIGN: Prospective, observational study. OBJECTIVES: To determine the association between KT-1000 measurements with an anterior translation force of 89 N and other measures of outcome (the Tegner activity score, the modified Lysholm score, subjective rating of instability, Lachman test, and pivot-shift test) 1 year following anterior cruciate ligament (ACL) reconstruction. BACKGROUND: Health care professionals often use the side-to-side difference measured with the KT-1000 arthrometer to determine ACL integrity during passive motion. It has been postulated that a 5-mm or greater difference between impaired and nonimpaired knees represents a procedural failure. METHODS AND MEASURES: Ninety patients (46 men, 44 women) with a mean age of 30 +/- 8 years were examined 1 year after surgery. Patients were classified in 1 of 3 groups depending on the amount of laxity between the impaired knee and the nonimpaired knee. Seventy percent of the subjects had a side-to-side difference less than or equal to 3 mm (tight), 13% had a difference of between 3 and 5 mm (moderate), and 17% had a difference greater than or equal to 5 mm (loose) on examination using the KT-1000. RESULTS: Mean Lysholm and Tegner scores did not differ significantly among groups. Side-to-side differences in KT-1000 measurements at 89 N were not associated with the Lysholm score (r = -0.09) or Tegner score (r = 0.02). Lachman tests were related to involved-knee KT-1000 measurements (r = 0.39) but not to side-to-side differences in KT-1000 measurements (r = 0.15). Similarly, pivot-shift tests were related to involved-knee KT-1000 measurements (r = 0.26) but not to side-to-side differences (r = -0.08). CONCLUSIONS: These results suggest that side-to-side KT-1000 measurements obtained with an anterior translation force of 89 N should not be used in isolation to determine ACL reconstruction success or failure 1 year following surgery.     

Four-strand hamstring tendon autograft versus LARS artificial ligament for anterior cruciate ligament reconstruction

This retrospective study compared the results after anterior cruciate ligament (ACL) reconstruction using a four-strand hamstring tendon graft (4SHG) versus Ligament Advanced Reinforcement System (LARS) artificial ligament in 60 patients between January 2003 and July 2004 with a minimum four-year follow-up. The KT-1000 examination, the International Knee Documentation Committee (IKDC) scoring systems and Lysholm knee scoring scale were used to evaluate the clinical results. The mean side-to-side difference was 2.4 ± 0.5 mm and 1.2 ± 0.3 mm in the 4SHG group and LARS group, respectively (P = 0.013). Although other results of ACL reconstruction, measured by IKDC evaluation, Lysholm scores and Tegner scores, showed using a LARS graft clinically tended to be superior to using a 4SHG, there were no significant differences calculated. Our results suggest that four years after ACL reconstruction using a LARS ligament or 4SHG dramatically improves the function outcome, while the patients in the LARS group displayed a higher knee stability than those in the 4SHG group.     

Comparison of sagittal obliquity of the reconstructed anterior cruciate ligament with native anterior cruciate ligament using magnetic resonance imaging

Purpose: This study was conducted to compare the obliquity of asymptomatic anterior cruciate ligament (ACL) grafts with normal controls using sagittal magnetic resonance imaging (MRI). Type of Study: Case control study. Methods: Sagittal MRIs from 30 patients with a reconstructed ACL graft and from 30 individuals with an intact ACL were reviewed. Reconstructed patients were operated on with a 2-incision technique using a patellar tendon autograft. These selected patients had a normal or nearly normal IKDC score with a 3 mm or less anterior posterior translation on KT-1000 arthrometer testing compared with the intact knee. MRI showed a continuous and homogeneous graft without evidence of roof impingement. Obliquity of the grafted ACL was determined on each lateral MRI by measuring the intersection of the graft line with the tibial plateau plane. These figures were compared with data similarly obtained from 30 individuals with a stable knee and an intact ACL determined by history and physical examination. Results: Graft obliquity in reconstructed patients averaged 67° with a range between 55° and 81°. In normal controls, intact ACL obliquity averaged 51° with a range between 45° and 55°. The difference between the two groups was statistically significant (P <.0001). Conclusions: MRIs of patients with an appropriate tibial tunnel placement in order to avoid notch impingement showed a continuous and homogeneous graft similar to the native ACL, but with a more vertical graft that does not recreate the normal sagittal obliquity. However, according to arthrometer testing, these more vertical grafts can control anterior posterior knee displacement.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 19, No 3 (March), 2003: pp 257–261     

前交叉韧带重建术后膝关节功能及三维运动步态分析

目的探讨前交叉韧带(ACL)重建术后膝关节稳定性、功能及三维步态运动学情况。 方法回顾性分析2015年7月到2017年7月在佛山市中医院运动学科采用自体腘绳肌腱行ACL重建并进行了二次关节镜探查的270例病例,其中男164例,女106例。采用Lysholm评分、国际膝关节评分委员会(IKDC)评分、Tenger评分、膝关节损伤和骨关节炎(KOOS)评分、Lachman试验、轴移试验及KT-1000侧-侧差值评价膝关节功能及稳定性;比较膝关节6-自由度运动学参数,以客观评估术后膝关节功能;二次关节镜观察移植物连续性、移植物滑膜覆盖情况,分析移植物形态与膝关节功能、运动步态的相关性;分析患者术后重返运动情况及其影响因素。计数资料比较采用卡方检验,计量资料采用t检验。 结果270例患者平均随访时间为(26 ± 11)个月,1例出现术后感染,经关节镜清理、置管引流后痊愈,其余病例均未发生感染、移植物吸收等并发症。所有患者末次随访平均Lysholm评分、IKDC主观评分、Tegner评分、KOOS的功能、生活质量、疼痛、日常生活及症状评分、IKDC客观评分、轴移试验、Lachman试验、和KT-1000侧-侧差值均较术前明显改善(t＝71.13、15.08、45.94、15.73、21.72、15.25、23.69、36.30、532.19、432.00、444.30、214.65,均为P<0.05);二次关节镜探查191例前交叉韧带完整,79例重建韧带部分撕裂,230例韧带紧张,40例韧带松弛,220例移植物滑膜覆盖为优,50例为差。末次随访时所有患者的膝关节6自由度运动学参数(内外翻、内外旋、屈伸、上下位移、内外位移和前后位移范围)明显优于术前(t＝2.54、-8.67、11.06、-17.44、2.80、2.94,均为P<0.05);滑膜覆盖优组其Lysholm评分、IKDC评分、Tegner评分及KT-1000侧-侧差值及膝关节6自由度运动学参数(内外旋角度和前后位移的范围)均优于滑膜覆盖差组(t＝13.50、7.69、20.05、12.69,均为P<0.01;t＝3.97、8.23,均为P<0.05)。屈伸角度、内外翻角度、内外和上下位移的范围滑膜覆盖优组与覆盖差组相当(P>0.05)。270例患者中有98例患者重返运动,重返运动率为36.3%。 结论采用自体腘绳肌腱重建ACL能够获得较好的膝关节稳定性及功能,然而术后患者重返运动率较低,这是今后需要努力解决的关键问题。     

Anterior cruciate ligament reconstruction in athletes with an ossicle associated with Osgood-Schlatter's disease

We report a series of 20 athletes with an ossicle associated with Osgood-Schlatter's disease (OSD) who underwent anterior cruciate ligament (ACL) reconstruction using autogenous, central-10-mm patellar-tendon graft. All patients had an Osgood-Schlatter's lesion with an ossicle as seen on a plain radiograph. The patients were reviewed at an average follow-up of 44 months (range, 24 to 108 months). The postoperative assessment included clinical examination, KT-1000 testing, isokinetic testing, and subjective score (using the modified Noyes' questionnaire). At the time of latest review, all 20 patients had a stable knee. The average side-to-side difference on manual maximum KT-1000 assessment was 1.9 mm (range, 0 to 5 mm). Average time to return to full sporting activities was 5.2 months (range, 2.6 to 8.9 months). All patients returned to their previous level of activity. The mean modified Noyes' knee score was 96 (range, 89 to 100). To date, no graft failure has occurred. Based on the results of this study, we believe that ACL reconstruction using the autogenous bone-patellar tendon-bone graft can be safely undertaken in athletes with an ossicle associated with OSD without compromising the final knee function.     

Interference screw divergence in endoscopic anterior cruciate ligament reconstruction

Interference screws are commonly used for graft fixation in bone-tendon-bone patellar tendon anterior cruciate ligament (ACL) reconstruction. The clinical significance of graft screw divergence has not been well studied. This report retrospectively reviews our initial experience in 73 consecutive endoscopic (single-incision) ACL reconstructions using interference screw fixation. Femoral divergence occurred more frequently in the lateral plane (29%) than the anteroposterior (AP) plane (15%). No early graft failures were noted clinically or by KT-1000 arthrometer testing. If properly tested at the time of operation, it does not appear that divergence of femoral screws < 30° leads to early clinical failure in endoscopic ACL reconstruction. We propose that stresses on the graft-screw-tunnel construct will concentrate distally when placed in a divergent fashion, resulting in a wedge effect. No changes in early range of motion protocols or rehabilitation are recommended if screw divergence is noted and provided intraoperative stability is noted.     

Failure of clinical methods in assessing graft integrity after anterior cruciate ligament reconstruction: an arthroscopic evaluation.

We reviewed the findings of 24 patients who underwent knee arthroscopy following a bone-patellar tendon-bone autograft anterior cruciate ligament (ACL) reconstruction. Preoperative symptoms included pain, swelling, catching, and/or locking. Only one patient presented with subjective instability. The subjective and objective clinical findings as well as KT-1000 examination were compared with the arthroscopic findings. Thirteen of the 24 patients had an insufficient ACL graft by arthroscopic examination. In only 5 of these patients did the physical examination and/or KT-1000 results reliably detect an insufficient ACL graft. The remaining 8 patients had a stable knee by subjective and objective clinical criteria as well as strict KT-1000 criteria. No significant degenerative changes or lack of motion was present in this group. Also, 7 of the 8 patients had an excellent or good Orthop?dische Arbeitsgruppe Knie (OAK) score and maintained a high level of function. In the two patients who underwent preoperative magnetic resonance imaging the lack of an intact graft was confirmed. A subset of patients appear to have stable knees despite the lack of a functioning ACL graft. Therefore, standard clinical and KT-1000 criteria for ACL deficient knees have limitations in detecting graft integrity after ACL reconstruction. Arthroscopy or magnetic resonance imaging may be needed when graft integrity is in question.     

Revision anterior cruciate ligament reconstruction with doubled semitendinosus and gracilis tendons and lateral extra-articular reconstruction

BACKGROUND: The outcome of revision anterior cruciate ligament reconstruction has only rarely been reported. The purpose of this study was to evaluate the results of revision anterior cruciate ligament surgery with use of an autogenous doubled semitendinosus and gracilis graft in association with an extra-articular procedure. METHODS: Between 1997 and 2003, thirty patients underwent a repeat reconstruction of a previously reconstructed torn anterior cruciate ligament with use of a doubled semitendinosus and gracilis graft combined with an extra-articular reconstruction. Primary reconstruction had been done with an autogenous patellar tendon graft in twenty-six patients and with a prosthetic ligament in four patients; the average time from the primary reconstruction to the revision was five years. Functional outcomes, graft survival, and radiographic outcomes were evaluated at a mean of five years. A graft was considered to have failed when a revision was done or when the side-to-side difference on KT-1000 arthrometer testing was >5 mm and/or the pivot-shift test grade was greater than a trace. RESULTS: One patient underwent another revision reconstruction because of graft failure at three years postoperatively. The mean International Knee Documentation Committee (IKDC) subjective knee score for the remaining twenty-nine patients was 84 +/- 12 points, and the mean Lysholm knee score was 90 +/- 10 points. The side-to-side difference as measured with the KT-1000 arthrometer with maximum manual force was <3 mm in twenty patients (of the twenty-eight who returned for follow-up), between 3 and 5 mm in six patients, and >5 mm in two patients. The result of the pivot shift examination was normal in fifteen patients, slightly positive in eleven patients, and positive in two patients. Twenty-five percent of the patients showed no radiographic signs of degenerative joint disease. CONCLUSIONS: Revision anterior cruciate ligament reconstruction with use of an autogenous doubled semitendinosus and gracilis graft combined with an extra-articular procedure provided satisfactory functional outcomes, with a failure rate of 10%.