Clinical evaluation of double-bundle anterior cruciate ligament reconstruction procedure using hamstring tendon grafts: a prospective, randomized and controlled study

Background In clinical studies there is still a lot of controversy about the increased anterior and rotational stability between double-bundle （DB） and single-bundle （SB） anterior cruciate ligament （ACL） reconstruction. The aim of this study was to evaluate the clinical results of four-tunnel DB ACL reconstruction.
Methods Sixty-four consecutive patients with ACL ruptures from May 2005 to May 2006 were randomly assigned into two groups： 32 cases for SB ACL reconstruction and 32 cases for DB ACL reconstruction. Clinical data, including KT 2000, Biodex test, Lysholm score, Tegner score and IKDC score, were prospectively collected until at least 10 months post-operative.
Results The average values of KT 2000 were （1.47±1.17） mm and （1.68±1.14） mm for the SB and DB ACL reconstruction groups at 30° of knee flexion （P 〉0.05）, and were （1.04±0.98） mm and （1.13±0.98） mm at 90° of knee flexion （P 〉0.05）. There were also no significant differences in Lysholm score, Tegner score, IKDC score and Biodex test scores between the two groups （P 〉0.05）. The operation time of DB ACL reconstruction was 20 minutes longer than the SB ACL reconstruction （P 〈0.05）
Conclusion Double bundle ACL reconstructions have no obvious clinical advantages over single bundle ACL reconstructions.     

Medial plica after reconstruction of anterior cruciate ligament

Background The medial plica may be caused by direct trauma or joint degeneration, which also could be iatrogenic. There have been few reports in the literature discussing incidence of the medial plica caused by an operation on the knee joint, specifically after the reconstruction of anterior cruciate ligament （ACL）. In this study, we aimed to evaluate and analyze the relationship between the incidence of the medial plica and reconstruction of the ACL. Methods A retrospective case series study was conducted to review the findings of 1085 patients between 2003 and 2007, who underwent second-look arthroscopy after reconstruction of the ACL （between 2002 and 2006）. The correlation of the incidence of medial plica with the stability of the knee joint, the time from onset of injury to reconstruction surgery, the associated injuries, and the rate of progress during postoperative rehabilitation were analyzed. Results We found that 722 patients had the structure of a medial plica. The incidence after reconstruction of the anterior cruciate ligament （66.5%） was significantly higher than usually reported. All these medial plica had avascular fibrotic and thickened edges. An excision of pathologic medial plica and fat pad synovial fringes were done. The incidences were significantly different between the two groups with their reconstruction operation time, from onset of injury to surgery （less than one month or over 2 years）, and the progress rate of postoperative rehabilitation （knee flexion could not be over 90~ in four weeks）. The incidence was not different between the groups with knee stable conditions.
Conclusions Medial plica is more common in patients after reconstruction of ACL. More associated injuries and more rehabilitation difficulties can increase the medial plica incidence.     

Factors affecting proprioceptive recovery after anterior cruciate ligament reconstruction

Background Proprioception plays an important role in knee movements. Since there are controversies surrounding the overall recovery time of proprioception following surgery, it is necessary to define the factors affecting proprioceptive recovery after anterior cruciate ligament （ACL） reconstruction and to investigate the relationship between proprioception and muscle strength. Methods A total of 36 patients who had their ACL reconstructed with a semitendinosus/gracilis graft （reconstructed group： 6 months post-surgery） and 13 healthy adults without any knee injury （control group） were included in the study. Knee proprioception was evaluated with a passive reproduction test. Isokinetic strength was measured using the Biodex System. Statistical analysis was used to compare proprioception of the reconstructed group versus the control group, and to define causal factors, including sex, hamstring/quadriceps ratio, and the course of injury before reconstruction, We also investigated the correlation between the passive reproduction error and quadriceps index. Results There was a significant difference in proprioception between the reconstructed and control groups （P 〈0.05）. When the course of injury before reconstruction was less than 4 months, there was a linear correlation with proprioception 6 months after the operation （r=0.713, P 〈0.05）. There was a positive correlation between post-surgery proprioception and the quadriceps index at 6 months post-surgery. Conclusions Impaired knee proprioception is observed 6 months after ACL reconstruction. Within 4 months of injury, early undertaking of reconstruction is associated with better proprioception outcome. Patients with enhanced proprioception have a better quadriceps index.     

Combination of medial patellofemoral ligament reconstruction with vastus medialis advancement for chronic patellar dislocation

Background The medial patellofemoral ligament （MPFL） reconstruction is popular in clinical practice for chronic patellar dislocation; however, the combination with vastus medialis advancement is rare. The aim of this study was to evaluate the clinical outcome of the combination of MPFL reconstruction with vastus medialis advancement.Methods We retrospectively analyzed 69 patients with chronic patellar dislocation between July 2004 and October 2008： twenty eight cases with isolated MPFL reconstruction （group Ⅰ）, forty one cases with the combination of MPFL reconstruction with vastus medialis advancement （group C）. All patients had CT scans available for review with knee flexion at 30 degree, on which the congruence angle, patellar tilt angle and patellar lateral shift were measured. Physical apprehension tests were examined and the redislocation was recorded. In addition, knee function was evaluated using the Kujala score and subjective questionnaires.Results Patients were followed up for a mean of 42 months （12-65 months） without a recurrent dislocation reported.Postoperatively, all indexes on CT scan were within the normal range without a statistical difference between the two groups. Results from the apprehension test showed eight patients in group Ⅰ and three in group Chad patellar lateral shift exceeding 1.5 cm with a hard end point （P 〈0.05）. The Kujala score improved significantly from 51.3±4.5 to 79.9±6.2 in group Ⅰ and from 53.7±5.2 to 83.9±6.5 in group C （P 〉0.05）. However, the subjective questionnaire revealed a significant difference （P 〈0.05）, including 12 excellent, seven good and nine fair in group Ⅰ and 30 excellent, six good and five fair in group C.Conclusion The combination of MPFL reconstruction with vastus medialis advancement is better than isolated reconstruction to improve the subjective effects and decrease the patellar instability rate for chronic patellar dislocation.     

Effect of anterior cruciate ligament reconstruction on biomechanical features of knee in level walking: a meta-analysis

Background The anterior cruciate ligament （ACL） is one of the most commonly injured knee ligaments. Even following ACL reconstruction, significant articular cartilage degeneration can be observed and most patients suffer from premature osteoarthritis. Articular cartilage degeneration and osteoarthritis development after ACL injury are regarded as progressive process that are affected by cyclic loading during frequently performed low-intensity daily activities. The purpose of this study was to perform a meta analysis on studies assessing the effects of ACL reconstruction on kinematics, kinetics and proprioception of knee during level walking.Methods This meta analysis was conducted according to the methodological guidelines outlined by the Cochrane Collaboration. An electronic search of the literature was performed and all trials published between January 1966 and July 2010 comparing gait and proprioception of a reconstructed-ACL group with an intact-ACL group were pooled for this review. Thirteen studies were included in the final meta analysis.Results There was no significant difference in step length, walking speed, maximum knee flexion angle during loading response, joint position sense and threshold to detect passive motion between the reconstructed-ACL group and the intact-ACL group （P 〉0.05）. However, there was a significant difference in peak knee flexion angle, maximum angular knee flexion excursion during stance, peak knee flexion moment during walking and maximum external tibial rotation angle throughout the gait cycle between the reconstructed-ACL group and the intact-ACL group （P 〈0.05）.Conclusions Step length, walking speed, maximum knee flexion angle during loading response, joint position sense and threshold to detect passive motion usually observed with ACL deficiency were restored after the ACL reconstruction and rehabilitation, but no significant improvements were observed for peak knee flexion angle, maximum angular knee flexion excursion during stance, peak knee flexion moment during walking and maximum external tibial rotation angle throughout the gait cycle.     

Remnant-preserving posterior cruciate ligament reconstruction with graft tension-relieving: a comparative study with conventional technique

Background Posterior cruciate ligament (PCL) tear is a severe injury to the knee joint and often requires surgical reconstruction.A number of PCL reconstruction techniques have been reported.However,th...     

同种异体骨-后交叉韧带-骨移植重建前交叉韧带

Background AIIografts were widely used in anterior cruciate ligament (ACL) reconstruction for patients with ACL rupture of the knee.This study was to approve the feasibility of bone-posterior cruciate ...     

Bone joint

Diagnosis and arthroscopic treatment of osteo-chondral lesions of the talus;Rotational alignment of femoral prosthesis in total knee arthroplasty;Treatment of ankle arthritis after trauma through arthroscopy： a report of 52 cases;Using patella and iliac bone grafts to repair the bone defects of the knee joint due to giant cell tumor;Treatment of comblined posterior cruciate ligament and posterolateral complex injury using inlay technique     

Clinical characteristics of 4355 patients with anterior cruciate ligament injury

Background Clinical features of anterior cruciate ligament （ACL） injury are important for its prevention,diagnosis and treatment.However,few studies have reported such data,especially in China.The purpose of this study was to describe the clinical characteristics of ACL injury on a large cohort.Methods Between 1993 and 2007,a total of 4355 ACL deficient inpatients （612 athletes and 3743 non-athletes） were registered.Data were collected using a special database system.And the distributions of characteristics in different groups were compared and analyzed statistically.Results All subjects were confirmed with ACL tear during surgery.Statistical analysis revealed that the percentage of females in Athlete Group was significantly higher than that in Non-athlete Group （56.05％ vs.24.95％,P＜0.001）.This study also found that sports trauma was the main cause of ACL tears.Soccer,basketball,judo,wrestling and track and field were the five most responsible activities for athletes.The average injury time for athletes was significantly shorter than that for non-athletes （413.3 days vs.717.5 days,P＜0.001）.Three thousand nine hundred and eight cases were ordered ACL reconstruction （76.04％ single-bundle,18.30％ double-bundle）.Three hundred and forty-five patients （7.92％）were combined with other ligaments injuries,2667 （61.24％） were found with various grades of cartilage lesions,and 3377 （77.54％） were found with meniscal injury.Conclusions Sports trauma was the main cause of ACL tears in China,and reconstruction had become the principal surgical choice.In order to restore knee joint stability and reduce the incidence of cartilage and meniscal injury,patienttailored ACL reconstruction should be suggested at the right moment.     

MIPPO technique and LCP internal fixation for open tibial shaft fractures

<正>Objective To compare the difference in stability of the knee joint after single-tunnel double-bundle and single-bundle anterior cruciate ligament (ACL) reconstruction.Methods Six formalin-soaked specimens of the human knee with retained joint     

LARS人工韧带与自体腘绳肌腱重建前交叉韧带的早期临床疗效比较

目的前瞻性对照研究LARS(ligament advanced reinforcementsystem)人工韧带与四股自体月国绳肌腱重建前交叉韧带(anterior cruciate ligament,ACL)手术的早期临床疗效。方法自2004年8月～2005年6月,共42例前交叉韧带损伤病例,根据LARS韧带使用指征,医生建议和患者意愿,选择自体月国绳肌腱或LARS人工韧带作为移植物。其中LARS韧带重建ACL病例23例,两端以挤压螺钉固定;四股自体月国绳肌腱重建前交叉韧带者19例,股骨端Endobutton悬吊固定,胫骨端Intrafix挤压螺钉和Spiked-washer拴桩双重固定。均在术前及术后3、6、9和15个月给予Lysholm、Tegner、IKDC评分。结果与自体月国绳肌腱重建ACL的病例比较,采用LARS韧带的病例,在术后平均9个月的随访期内,3种膝关节功能评分值高于自体月国绳肌腱A-CL重建的病例。结论应用LARS人工韧带的病例膝关节功能评分均较术前有明显提高。使用LARS人工韧带的病例较使用自体月国绳肌腱的病例术后膝关节功能恢复更早。     

关节镜下先进人工韧带加强系统人工韧带重建膝关节后交叉韧带

目的 探讨关节镜下应用先进人工韧带加强系统(LARS)人工韧带重建膝关节后交叉韧带(PCL)的可行性及近期疗效.方法 选择PCL损伤的患者15例,后抽屉试验为Ⅱ～Ⅲ度,均存在后方不稳定的症状和体征,但无后外角等严重复合损伤.应用法国LARS人工韧带于关节镜下行单束重建膝关节PCL术.比较术前与术后随访3、6及12个月的Lysholm、Tegner评分.结果 术后无1例发生严重的并发症,无滑膜炎产生,无韧带断裂和松动.术后3、6及12个月的Lysholm评分分别为(73.87±3.16)、(90.14±1.99)及(90.86±1.17)分,均显著高于术前的(48.8±5.11)分(P值均<0.01),术后6个月与12个月的Lysholm评分的差异无统计学意义(P0.05).术后3、6及12个月的Tegner评分分别为(5.60±0.51)、(7.53±0.52)及(7.73±0.46)分,均显著高于术前的(1.93±0.96)分(P值均<0.01),术后6个月与术后12个月的Tegner评分的差异无统计学意义(P0.05).根据国际膝关节评分委员会的评分标准分级为A 12例,B 3例.结论 对于单纯性膝关节PCL断裂并有手术指征的患者,采用关节镜下LARS人工韧带重建PCL的创伤小,可取得较好的疗效.     

关节镜下单根LARS人工韧带重建后交叉韧带及内侧副韧带短期临床疗效观察

目的观察后交叉韧带(posterior cruciate ligament,PCL)、内侧副韧带(medial collateral ligament,MCL)同时损伤后,应用LARS人工韧带关节镜下重建PCL,并同时利用残余LARS人工韧带重建MCL的短期临床疗效。方法对8例关节损伤的患者在关节镜下行LARS人工韧带重建PCL,同时利用残余人工韧带重建MCL,术后随访6个月,比较术前、术后膝关节Lysholm评分和稳定性。结果 8例患者术前物理检查均表现为膝关节不稳,术后所有患膝不稳定表现消失。术后无膝关节感染、韧带自发断裂和韧带松动并发症,屈膝活动度110°～120°,术后1、3、6个月膝关节Lysholm评分均较术前增高,差异具有统计学意义(P<0.05)。结论应用LARS人工韧带关节镜下重建PCL,同时利用残余人工韧带修复MCL,术后膝关节可获得即时稳定,利于膝关节早期活动,减少相关并发症的发生,短期临床疗效满意。     

关节镜下异体与自体肌腱联合编织重建前交叉韧带疗效研究

目的观察自体胭绳肌肌腱与同种异体移植物关节镜下重建膝关节前交叉韧带(ACL)的疗效。方法回顾性分析我院2006年2月~2010年6月收治入院的自体胭绳肌肌腱与同种异体移植物关节镜下重建膝关节前交叉韧带(ACL)患者30例临床资料,均采用美国强生公司生产的Rigidfix及Intrafix系统固定,评价项目包括手术时间、发热天数、大腿周径患健侧比值、Lachman试验、中立位前抽屉试验(ADD)和国际膝关节评分委员会(IKDC)评分、Lysholm及Tegner评分。随访时间为12～24个月。结果 30例患者术后膝关节稳定性均得到明显好转;手术前后大腿周径患健侧比值、IKDC评分、lysholm评分及Tegner评分等指标比较差异均有统计学意义(P<0.05);随访(14.5±2.3)个月,膝前区疼痛5例,手术感染性关节炎1例,给予抗生素及激素治疗1个月后痊愈。术后随访发现肌腱没有免疫排斥反应。结论自体胭绳肌肌腱与同种异体移植物联合关节镜下重建膝关节前交叉韧带有较好的疗效。     

关节镜下4种移植物重建膝关节前交叉韧带的临床效果研究

目的应用自体骨-1/3髌腱-骨(B-PT-B)、自体腘绳肌腱(ST/G)、同种异体跟腱和LARS韧带进行关节镜下重建前交叉韧带,比较不同移植物的临床疗效。方法选择4种不同移植物分别对111例交叉韧带损伤患者行关节镜下重建前交叉韧带,术后积极康复训练。结果各组膝关节Lysholm评分在术后3、6、12、18个月均较术前改善,异体跟腱组在术后6个月Lysholm评分均低于其余3组患者(P<0.05),术后12、18个月与自体B-PT-B、ST/G组差异无统计学意义;在术后3、6、12、18个月,LARS组Lysholm评分明显高于其余3组(P<0.05)。结论4种不同移植物均能明显改善膝关节功能,近期LARS韧带改善优于自体B-PT-B、ST/G和异体跟腱。     

关节镜下双束重建膝前交叉韧带的疗效及安全性分析

目的 探讨膝前交叉韧带（ACL）发生损伤后采用关节镜下双束重建与传统单束重建的疗效差异及安全性评价.方法 抽选我院2008年3月～2013年5月收治的131例膝ACL损伤患者,根据术式的不同随机分为对照组（n=65例,采用关节镜下ACL单束重建）和观察组（n=66例,采用关节镜下ACL双束重建）,观察治疗12个月后两组患者IKDC膝关节功能评分、Lysholm稳定性评分、Tegner体育量表评分的差异.结果 两组治疗前IKDC、Lysholm以及Tegner评分比较差异无显著性（P＞0.05）;治疗12个月后,观察组患者的IKDC、Lysholm以及Tegner评分明显高于对照组（P＜0.05）.以KT-1000测定观察组患者术后关节屈膝90.的移动度明显低于对照组（P＜0.05）;屈膝90.关节活动优良率明显高于对照组（P＜0.05）.两组MRI及X线复查安全性比较差异无显著性（P＞0.05）.结论 双束重建比单束重建更能满足膝关节生物力学平衡,恢复膝关节稳定性,值得临床推广.     

关节镜下单束自体肌腱的前交叉韧带重建

目的探讨关节镜下单束自体肌腱重建前交叉韧带（anterior cruciate ligament,ACL）的临床疗效。方法回顾性分析2009年2月至2011年9月23例ACL损伤患者,男15例,女8例;年龄21-53岁,平均32岁;受伤到手术时间为5-40周,平均13周。采用关节镜下保留胫骨残端,取自体半腱肌腱和或股薄肌腱重建ACL。结果23例患者术后获平均18个月（6-32个月）随访,末次随访21例患者（91.3%）Lachmen实验均为阴性。Lysholm评分Tegner评分IKDC主观评分明显改善,轴移实验检查均为阴性,膝关节活动度正常。结论关节镜下单束自体肌腱重建ACL,有效恢复膝关节稳定性,临床效果可靠。     

关节镜内膝后交叉韧带重建术

目的 探讨关节镜内人工韧带重建后交叉韧带的应用和疗效。方法 １１例膝后交叉韧带断裂患者，在关节镜内行Ｇｏｒｅ－Ｔｅｘ人工韧带重建后交叉韧带，手术前后采用Ｌｙｓｈｌｏｎ膝关节评分法比较。结果 平均随访时间１８个月，平均得分由术前４３分提高到术后９１分。结论 膝后交叉韧带断裂并发关节不稳定应该进行重建手术。人工韧带更符合后交叉韧带的功能要求，便于着急镜内操作，创伤小，恢复快，近期疗效肯定。     

创伤性膝关节脱位伴多发韧带损伤的早期手术修复重建

目的探讨创伤性急性腋关节脱位伴多发韧带损伤早期手术修复、重建的疗效。方法2006年10月_2012年12月经早期手术治疗的28例急性膝关节脱位伴多发韧带损伤的患者。所有病例均于早期行关节镜下前、后交叉韧带重建以及侧副韧带修补。重建材料选择异体肌腱,侧副韧带修补采用切开缝合或带线锚钉修复。伴随的其他组织损伤,如半月板、骨软骨损伤等均同期处理。根据Lysholm膝关节评分表对患膝功能进行评估。结果本组28例患者均获随访,平均随访时间为（28．4±2．4）个月。受伤至手术时间7～14（9．3±0.6d。末次随访所有患者伸膝无明显受限,膝关节屈曲（110±20）。,膝关节功能Lysholm评分为（84．0±8．0）分,与术前（40．1±5．2）分比较差异有统计学意义（P〈0．05）。结论创伤性膝关节多发韧带损伤可早期在关节镜下行前、后交叉韧带联合重建,同期行关节内外韧带结构修复增强,治疗效果满意。