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1.
Ashish Devgan Amanpreet Singh Paritosh Gogna Rohit Singla Narender Kumar Magu Reetadyuti Mukhopadhyay 《Indian Journal of Orthopaedics》2015,49(2):136-142
Background:
Single bundle anterior cruciate ligament (ACL) reconstruction has been the current standard of treatment for ACL deficiency. However, a significant subset of patients continue to report residual symptoms of instability with a poor pivot control. Cadaveric biomechanical studies have shown double bundle (DB) ACL reconstructions to restore the knee kinematics better. This study evaluates the outcome of DB ACL reconstruction.Materials and Methods:
30 consecutive patients who underwent anatomic DB ACL reconstruction were included in this prospective longitudinal study. There were all males with a mean age of 25 ± 7.45 years. All patients were prospectively evaluated using GeNouRoB (GNRB) arthrometer, functional knee scores (International Knee Documentation Committee [IKDC] and Lysholm) and postoperative magnetic resonance imaging (MRI) for comparing the graft orientation and footprint of the reconstructed ACL with that of the normal knee.Results:
The average followup was 36.2 months. At the time of final followup the mean Lysholm score was 93.13 ± 3.31. As per the objective IKDC score, 26 patients (86.6%) were in Group A while 4 patients (13.3%) were in Group B. The mean differential anterior tibial translation by GNRB, arthrometer was 1.07 ± 0.8 mm (range 0.1-2.3 mm). All cases had a negative pivot shift test. MRI scans of operated and the contralateral normal knee showed the mean sagittal ACL tibial angle coronal ACL tibial angle and tibial ACL footprint to be in accordance with the values of the contralateral, normal knee.Conclusion:
The study demonstrates that DB ACL reconstruction restores the ACL anatomically in terms of size and angle of orientation. However, long term studies are needed to further substantiate its role in decreasing the incidence of early osteoarthritic changes compared to the conventional single bundle reconstructions. 相似文献2.
Chirag H Chudasama Vyoma C Chudasama Mukund M Prabhakar 《Indian Journal of Orthopaedics》2012,46(5):561-565
Background:
Mucoid degeneration of the anterior cruciate ligament (ACL) is a less understood entity. The purpose of this study was to diagnose mucoid degeneration of anterior cruciate ligament and to assess the effectiveness of arthroscopic treatment in these patients.Materials and Methods:
Between December 2007 and November 2011, 20 patients were diagnosed to be suffering from mucoid degeneration of anterior cruciate ligament (ACL) on the basis of magnetic resonance imaging (MRI), histopathology, and arthroscopy findings. 12 patients were males and 8 patients were females, with mean age of 42.2 years for males (range 28-52 years) and 39.4 years for females (range 30–54 years). They presented with pain on terminal extension (n=10) and on terminal flexion (n=2) without history of significant preceding trauma. MRI showed an increased signal in the substance of the ACL both in the T1- and T2-weighted images, with a mass-like configuration that was reported as a partial or complete tear of the ACL by the radiologist. At arthroscopy, the ACL was homogenous, bulbous, hypertrophied, and taut, occupying the entire intercondylar notch. A debulking of the ACL was performed by a judicious excision of the degenerated mucoid tissue, taking care to leave behind as much of the intact ACL as possible. Releasing it and performing a notchplasty treated impingement of the ACL to the roof and lateral wall. In one patient, we had to replace ACL due to insufficient tissue left behind to support the knee.Results:
Good to excellent pain relief on terminal flexion–extension was obtained in 19 of 20 knees. The extension deficit was normalized in all knees. Lachman and anterior drawer test showed a firm endpoint in all, and 85% (n=17) showed good to excellent subjective satisfaction.Conclusions:
Mucoid hypertrophy of the ACL should be suspected in elderly persons presenting pain on terminal extension or flexion without preceding trauma, especially when there is no associated meniscal lesion or ligamentous insufficiency. They respond well to a judicious arthroscopic release of the ACL with notchplasty. 相似文献3.
陈旧性前十字韧带损伤的诊断 总被引:8,自引:1,他引:7
目的评估前抽屉试验、Lachman试验、轴移试验和MRI在陈旧性前十字韧带损伤诊断中的意义。方法107例手术证实为陈旧性前十字韧带损伤患者,术前均行前抽屉试验、Lachman试验、轴移试验和MR检查。术后计算各项检查的敏感性,并分析产生假阴性的原因。结果前抽屉试验的阳性率为78.5%,Lachman试验为97.2%,轴移试验为91.6%,而MRI敏感性为93.5%。10例患者的关节镜检查显示前十字韧带近侧撕裂端再附着于后十字韧带。在此10例中,前抽屉试验的阳性率为60%,Lachman试验为80%,轴移试验为60%,而MRI敏感性为40%。本组9例轴移试验假阴性的患者中,有4例为撕裂的前十字韧带再附着于后十字韧带而替代了部分前十字韧带的功能,因此关节镜下显示胫骨外侧髁半脱位受限。2例Lachman试验假阴性的患者经关节镜证实为前十字韧带断端再附着伴有半月板桶柄样撕裂。在10例再附着患者中有3例MRI表现为韧带倾斜度变化。结论Lachman试验对诊断陈旧性前十字韧带损伤敏感性最高。MRI和轴移试验较敏感,但结果受MR检查技术和伴发损伤等诸多因素的影响。 相似文献
4.
Piotr Grzelak Micha? Tomasz Podgórski Ludomir Stefańczyk Marcin Dom?alski 《Indian Journal of Orthopaedics》2015,49(2):143-149
Background:
Although ultrasound (US) has a wide range of applications in orthopedic diagnostics, sonographic evaluation of traumatic anterior cruciate ligament (ACL) insufficiency is still inadequate. There is a growing need for diagnostic tests that allow for simple and reliable assessment of ACL instability. This investigation aims to evaluate feasibility of sonographic technique for diagnosing complete ACL insufficiency.Materials and Methods:
Eighty three consecutive patients suspected of ACL injury were examined with sonographic, dynamic test of anterior instability. The translation of the intercondylar eminence against the patellar tendon was measured in the injured and opposite (injured) knee. Subsequent magnetic resonance imaging was performed on all patients. Forty-seven of them underwent a further arthroscopy. Five patients have been examined for the 2nd time to evaluate interclass and intraclass agreement and bias.Results:
Complete ACL insufficiency has been confirmed in 37 patients. In those individuals, the total anterior knee translation and the difference between two joints (side-to-side difference) were significantly increased (8.67 mm standard deviation [SD] 2.65 mm in the affected knee versus 2.88 mm SD 1.26 mm in uninjured joint; P < 0.001). Based on a threshold of 2.0 mm for the side-to-side difference and 5.0 mm for the absolute translation, the sonographic test was found to have a sensitivity and specificity of 91.9% and 95.6%, respectively.Conclusions:
The present technique supports the clinician with additional fast and noninvasive diagnostic procedure that can facilitate the evaluation of anterior knee instability. 相似文献5.
Wei Jiang Shu-guang Gao Kang-hua Li Ling Luo Yu-sheng Li Wei Luo Guang-hua Lei 《Indian Journal of Orthopaedics》2012,46(5):514-519
Background:
The clinical relationship between medial meniscus tear and anterior cruciate ligament (ACL) rupture has been well documented. However, the mechanism of this clinical phenomenon is not exactly explained. Our aim is to investigate the biomechanical impact of partial and complete ACL rupture on different parts of medial meniscus.Materials and Methods:
Twelve fresh human cadaveric knee specimens were divided into four groups: ACL intact (ACL-I), anteromedial bundle transection (AMB-T), posterolateral bundle transection (PLB-T), and ACL complete transection (ACL-T) group. Strain on the anterior horn, body part, and posterior horn of medial meniscus were measured under 200 N axial compressive tibial load at 0°, 30°, 60°, and 90° of knee flexion, respectively.Results:
Compared with the control group (ACL-I), the ACL-T group had a higher strain on whole medial meniscus at 0°, 60°, and 90° of flexion. But at 30°, it had a higher strain on posterior horn of meniscus only. As to PLB-T group, strain on whole meniscus increased at full extension, while strain increased on posterior horn at 30° and on body of meniscus at 60°. However, AMB-T only brought about higher strain at 60° of flexion on body and posterior horn of meniscus.Conclusions:
Similar to complete rupture, partial rupture of ACL can also trigger strain concentration on medial meniscus, especially posterior horn, which may be a more critical reason for meniscus injury associated with chronic ACL deficiency. 相似文献6.
陈旧性前交叉韧带损伤诊治分析 总被引:8,自引:2,他引:8
[目的]探讨临床检查和MRI诊断陈旧性前交叉韧带(anterior cruciate ligament,ACL)损伤的价值。[方法]回顾分析65例陈旧性ACL损伤患者的诊治经过,进行临床检查,其中8例行MRI检查,最后关节镜手术确诊。[结果]53例ACL完全损伤,前抽屉试验、Lachman试验和轴移试验的准确性分别为:79.2%、96.2%和92.5%;12例ACL部分损伤,前抽屉试验、Lachman试验和轴移试验的准确性分别为:16.7%、50.0%和33.3%。MRI诊断ACL损伤的准确性为100%。[结论]临床检查和MRI是诊断陈旧性ACL损伤的有效方法。 相似文献
7.
《Injury》2016,47(8):1744-1749
PurposeTo evaluate the influence of joint aspiration on the sensitivity of physical examination for diagnosing acute anterior cruciate ligament (ACL) lesion in the second outpatient-department (OPD) follow-up referred from emergency department (ED).MethodsThis retrospective study included sixty patients underwent ACL reconstruction with initial visit at ED. They were divided into two groups based on the presence or absence of joint aspiration at ED. All participants were referred to second OPD follow-up within 7–14 days after the injury. Clinical manifestation (including visual analogue scale (VAS) for pain, range of motion (ROM), and severity of knee effusion) and physical examination (Lachman test and pivot shift test) were checked in ED and the second OPD follow-up.ResultsThe group of patients with joint aspiration (G1) showed substantial decreases in mean values of VAS for pain (p = 0.005), ROM (p = 0.001), and effusion level (p < 0.001), even higher VAS and effusion level and lower ROM at the initial visit of ED than the other group (G2). The sensitivity of positive Lachman and pivot shift test was significantly (p < 0.05) increased following knee joint aspiration. Positive Lachman test was recorded at 76.5% in the second follow-up in G1, which was significantly (p = 0.047) higher than that (47.6%) in G2. The percentage of positive pivot shift test was recorded at 76.5% in the second follow-up in G1, which as significantly (p < 0.001) higher than that (31.0%) in G2.ConclusionsKnee joint aspiration in acute ACL injury with suspected hemarthrosis could be considered as a diagnostic procedure. Joint aspiration in early medical attendance might be able to lower pain scores or raise the sensitivity of physical examination for diagnosing acute ACL injury at follow up visit in orthopedic outpatient department.Level of evidenceRetrospective cohort study III. 相似文献
8.
We present a technique for double-bundle anterior cruciate ligament (ACL) reconstruction in a 14-year-old female athlete. The patient presented with anterolateral knee rotatory instability following a traumatic injury suffered while practicing judo. The clinical examination revealed positive Lachman and pivot shift tests with no accompanying meniscal pathology. Roentgenograms revealed open physes, and magnetic resonance imaging scans confirmed an isolated midsubstance ACL tear without cartilaginous injury. The decision was made to anatomically reconstruct the ACL because the athlete wished to continue competitive judo. Autologous hamstring tendons were harvested for double-bundle ACL repair. Following arthroscopic retrograde femoral and antegrade tibial tunnel placement, the ligaments were secured using interference screws within the femoral and tibial epiphysis. Postoperative Lachman and pivot shift tests were negative. 相似文献
9.
Aaron J. Johnson MD Stephen M. Howell MD Christopher R. Costa MD Michael A. Mont MD 《Clinical orthopaedics and related research》2013,471(1):181-188
Background
TKA with retention of the anterior cruciate ligament (ACL) may improve kinematics and function. However, conflicting reports exist concerning the prevalence of intact ACLs at the time of TKA.Questions/purposes
Therefore, we asked: (1) what was the ACL status at TKA; (2) what was the sensitivity and specificity of the Lachman test; (3) did MRI ACL integrity correlate with intraoperative observation; (4) did MRI tibial wear patterns correlate with ACL integrity; and (5) did ACL status depend on age or sex?Methods
We evaluated 200 patients for ACL integrity at the time of TKA. All patients underwent a Lachman test under anesthesia. Intraoperatively, the ACL was characterized as intact, frayed, disrupted, or absent. In 100 patients, MRIs were performed, from which the ACL was graded as intact, indeterminate, or disrupted, and the AP location of tibial wear was categorized.Results
The ACL was intact in 155 patients (78%). The Lachman test alone had poor diagnostic ability. The MRI predicted a tear, but we observed two ACLs with indeterminate status that were disrupted. All knees with anterior wear on the medial tibial condyle had an intact ACL (n = 45), and all knees with posterior wear on the medial tibial condyle had a disrupted ACL (n = 8).Conclusions
Although the Lachman test alone had poor sensitivity, when combined with MRI they together provide a sensitivity of 93.3% and specificity of 99%, which we believe makes these reasonable tests for assessing ACL status in the arthritic knee. 相似文献10.
Background:
The association of meniscal cartilage injury with anterior cruciate ligament (ACL) injury is well documented in literature. The aim of this study was to examine the relative risk factors for meniscal pathology at the time of arthroscopic ACL reconstruction.Materials and Methods:
A review of the case records including both in-patient and out-patient charts of all patients who underwent arthroscopic ACL reconstruction during the preceding 3 years was performed by either of the authors. The relative incidences of associated meniscal pathologies were analyzed in correlation with age, side of injury, time to surgery, mode of injury, and gender as the risk factors. Statistical analysis was performed to obtain individual data correlation.Results:
A total of 192 patients underwent ACL reconstruction during the 3-year time frame. Of these, complete data sets were available for 129 patients. Analysis revealed that the only factor that was statistically significant in raising the risk of meniscal pathology was the time to surgery (P = 0.001). There was a significant increase in medial, lateral, and both meniscal tears noted in cases operated beyond 24 weeks. Further, the incidence of medial meniscal tears as well as lateral meniscal tears increased with delay in presentation for surgery (P = 0.004). Mode of injury, age at presentation, sex, and side were not significantly associated with an increased incidence of meniscal pathology.Conclusion:
The single factor that significantly affects incidence of meniscal co-morbidity in ACL injury is the delay in presentation (i.e. the time to surgery). The incidence of lateral meniscal tears as well as medial meniscal tears increased with delay in surgery. This should guide us toward recommending all patients irrespective of age, gender, or mode of injury to undergo early reconstruction, thereby reducing the likelihood of developing meniscal pathology. 相似文献11.
Vivek Machhindra Morey Hira Lal Nag Buddhadev Chowdhury Chaitanya Dev Pannu Sanjay Meena Kiran Kumar Aravindh Palaniswamy 《Journal of Clinical Orthopaedics and Trauma》2016,7(1):17-22
BackgroundDouble bundle (DB) anterior cruciate ligament (ACL) reconstruction has been proposed to recreate the natural anatomy of ACL. Reconstruction of the anatomy of both the bundles of ACL has been thought to be able to restore the rotational stability of the knee joint. Nevertheless, it remains unclear whether DB reconstruction has better functional outcome than single bundle (SB) ACL reconstruction.PurposeTo evaluate the clinical outcomes, patient satisfaction and manual laxity tests of knee in patients treated with DB ACL reconstruction in Indian population.MethodsWe prospectively followed 25 patients with an isolated ACL injury operated for DB ACL reconstruction after applying the inclusion and exclusion criteria. Patients were evaluated pre-operatively and in the post-operative period at regular intervals with the minimum follow up of 4 years. Clinical stability was assessed by anterior drawer test, Lachman test and pivot shift test. Functional outcome was assessed by IKDC, Lysholm and Modified Cincinnati scores.ResultsAt the end of 4 years, functional outcome in terms of all subjective scores was satisfactory. Graded stability results of the Lachman, Anterior drawer and pivot shift tests were almost near to that in normal knee. No complication occurred post-operatively.ConclusionAnatomical DB ACL reconstruction seems to offer satisfactory results in terms of subjective scores and stability tests to patients with ACL tear. It has been found to be associated with no obvious complications and no failures. However a larger patient pool is desired for conclusive results. 相似文献
12.
Massimiliano Salvi Francesco Caputo Giuseppe Piu Marco Sanna Cristina Sanna Giuseppe Marongiu 《Journal of orthopaedics and traumatology》2013,14(3):185-191
Background
This prospective study was created to evaluate the reliability of a new clinical test, which we termed the “loss of extension test” (LOE test). The LOE test investigates the loss of normal maximum passive extension (MPE) of the knee due to an anterior cruciate ligament tear in comparison to the normal MPE of the healthy knee.Materials and methods
The study was divided into two consecutive parts. Part 1 was designed to assess the side-to-side difference in normal MPE in a healthy population. In part 1, 100 healthy adults were enrolled. Part 2 was designed to evaluate the LOE test reliability in injured knees. In part 2, we included 196 selected patients.Results
In part 1, the average side-to-side difference in MPE in the healthy population was not statistically significant. In part 2, the overall average side-to-side difference in MPE of the injured group was 10.1 mm ± 14.1 (min −20; max 60), which was not statistically significant (p = 0.52). An anterior cruciate ligament (ACL) tear was found in 121 knees among 196 patients. The average side-to-side difference in MPE in the ACL-insufficient group was 16.9 mm ± 13.4 (min −20; max 60), which was statistically significant (p < 0.0001). The accuracy of the loss of extension test was 83.7 %, its specificity was 93.3 %, its sensitivity was 77.7 %, its positive predictive value was 95 %, and its negative predictive value was 72.2 %.Conclusions
The reliability of the LOE test is comparable to those reported in the literature for the Lachman test and dynamic tests, so the LOE test could represent a useful tool for the diagnosis of the anterior cruciate ligament insufficient knee. 相似文献13.
Background:
There is no clear evidence in the literature regarding the incidence of deep vein thrombosis (DVT) in patients undergoing arthroscopic anterior cruciate ligament (ACL) reconstruction. Literature also lacks on the recommendations on thromboprophylaxis in patients undergoing elective arthroscopic ACL reconstruction. We conducted a prospective analysis to assess incidence of DVT in patients undergoing arthroscopic ACL reconstruction.Materials and Methods:
120 consecutive patients with MRI proven ACL injury who were operated for arthroscopic ACL reconstruction were enrolled in this prospective study. None of the patients had risk factors (on history) for DVT, and all were below the age of 45 years. All cases were operated upon by a single surgeon and a standard rehabilitation regime was followed. The patients underwent clinical examination and screening (Doppler ultrasonography/venous scan) for any DVT, on the day prior to surgery, day of discharge (Day 3) and at 4 weeks postsurgery. None of the patients received any form of thromboprophylaxis against DVT.Results:
One hundred and twelve patients (61 males and 51 females) completed the study. The average age was 31.6 years (range 24-42 years). All patients underwent arthroscopic assisted ACL reconstruction surgery within 3 weeks of the injury. Two patients (males) in the series had Doppler venous scan proven DVT. One patient was asymptomatic but the screening Doppler picked up the DVT on the third postoperative day. The other patient was symptomatic at 12 weeks with pain and swelling in the leg and had ultrasound -proven DVT.Conclusion:
In our study the incidence of deep vein thrombosis in patients undergoing arthroscopic ACL reconstruction is 1.78%. We do not recommend routine thromboprophylaxis in patients, who are not high risk candidates for thrombosis and are of less than 45 years, in patients undergoing arthroscopic ACL reconstruction, with early postoperative rehabilitation. 相似文献14.
Kazunori Tanaka Munehiro Ogawa Yusuke Inagaki Yasuhito Tanaka Hitoshi Nishikawa Koji Hattori 《Journal of orthopaedic science》2017,22(3):488-494
Background
The Lachman test is clinically considered to be a reliable physical examination for anterior cruciate ligament (ACL) deficiency. However, the test involves subjective judgement of differences in tibial translation and endpoint quality. An auscultation system has been developed to allow assessment of the Lachman test. The knee joint sound during the Lachman test was analyzed using fast Fourier transformation. The purpose of the present study was to quantitatively evaluate knee joint sounds in healthy and ACL-deficient human knees.Methods
Sixty healthy volunteers and 24 patients with ACL injury were examined. The Lachman test with joint auscultation was evaluated using a microphone. Knee joint sound during the Lachman test (Lachman sound) was analyzed by fast Fourier transformation. As quantitative indices of the Lachman sound, the peak sound (Lachman peak sound) as the maximum relative amplitude (acoustic pressure) and its frequency were used.Results
In healthy volunteers, the mean Lachman peak sound of intact knees was 100.6 Hz in frequency and ?45 dB in acoustic pressure. Moreover, a sex difference was found in the frequency of the Lachman peak sound. In patients with ACL injury, the frequency of the Lachman peak sound of the ACL-deficient knees was widely dispersed. In the ACL-deficient knees, the mean Lachman peak sound was 306.8 Hz in frequency and ?63.1 dB in acoustic pressure. If the reference range was set at the frequency of the healthy volunteer Lachman peak sound, the sensitivity, specificity, positive predictive value, and negative predictive value were 83.3%, 95.6%, 95.2%, and 85.2%, respectively.Conclusion
Knee joint auscultation during the Lachman test was capable of judging ACL deficiency on the basis of objective data. In particular, the frequency of the Lachman peak sound was able to assess ACL condition. 相似文献15.
Arata Yuuki Takeshi Muneta Toshiyuki Ohara Ichiro Sekiya Hideyuki Koga 《Journal of orthopaedic science》2017,22(2):300-305
Background
Associations of lateral/medial knee instability with anterior cruciate ligament (ACL) injury have not been thoroughly investigated. The purposes of this study were to investigate whether lateral/medial knee instability is associated with ACL injury, and to clarify relevant factors for lateral/medial knee instability in ACL-injured knees.Methods
One hundred and nineteen patients with unilateral ACL-injured knees were included. Lateral/medial knee instability was assessed with varus/valgus stress X-ray examination for both injured and uninjured knees by measuring varus/valgus angle, lateral/medial joint opening, and lateral/medial joint opening index. Manual knee instability tests for ACL were evaluated to investigate associations between lateral/medial knee instability and anterior and/or rotational instabilities. Patients' backgrounds were evaluated to identify relevant factors for lateral/medial knee instability. Damage on the lateral collateral ligament (LCL) on MRI was also evaluated.Results
All parameters regarding lateral knee instability in injured knees were significantly greater than in uninjured knees. There were significant correlations between lateral knee instability and the Lachman test as well as the pivot shift test. Patients with LCL damage had significantly greater lateral joint opening than those without LCL damage on MRI. Sensitivity of LCL damage on MRI to lateral joint opening was 100%, while its specificity was 36%. No other relevant factors were identified. In medial knee instability, there were also correlations between medial knee instability and the Lachman test/pivot shift test. However, the correlations were weak and other parameters were not significant.Conclusions
Lateral knee instability was greater in ACL-deficient knees than in uninjured knees. Lateral knee instability was associated with ACL-related instabilities as well as LCL damage on MRI, whereas MRI had low specificity to lateral knee instability. On the other hand, the association of medial knee instability on ACL-related instability was less than that of lateral knee instability.Levels of evidence
Level IV, case series with no comparison group. 相似文献16.
Huijun Kang Kunpeng Fu Conglei Dong Fei Wang 《Acta orthopaedica et traumatologica turcica》2018,52(5):372-375
Objective
The purpose of this study was to evaluate the diagnostic value of the patellar tendon wavy (PTW) sign for an anterior cruciate ligament (ACL) tear on MRI.Methods
One hundred MRI scans were prospectively analyzed, with 50 patients with an ACL tear underwent an ACL reconstruction (group 1) and 50 patients with knee complaints other than ACL tear (group 2). The PTW sign was confirmed on the sagittal MRI. In addition, the patellar tendon length, tibial-femoral angle and tibial anterior translation (TAT) were compared between the groups.Results
The PTW sign was present in 41/50 (82%) MRI scans in group 1 and 10/50 (20%) in group 2, with significant difference between two groups (p = 0.000). Significant differences were also found, in medial TAT (6.29 ± 3.25 mm versus 3.12 ± 2.85 mm) and in lateral TAT (7.62 ± 3.85 mm versus 1.58 ± 3.93 mm) between two groups (both p = 0.000). Comparison of MRI with and without PTW sign, ACL injury was found to be of significant difference with 41/51 (80.4%) versus 9/49 (18.4%) (p = 0.000), and both medial and lateral TAT were with significant differences, 5.39 ± 3.90 mm versus 3.99 ± 2.71 mm (p = 0.039) and 7.67 ± 3.77 mm versus 1.40 ± 3.81 mm (p = 0.000), respectively. The sensitivity and specificity of PTW sign were 82% and 80%. The positive and negative predictive value were 80.4% and 81.6%. The diagnosis accuracy was 81%.Conclusion
The PTW sign is a useful secondary MRI sign to establish the diagnosis of an ACL tear. It may be associated with the TAT secondary to an ACL tear.Level of evidence
Level III, diagnostic study. 相似文献17.
目的 比较关节镜下前交叉韧带(anterior cruciate ligament,ACL)解剖位单束(anatomic single-bundle,ASB)与传统过顶位单束(conventional over-the-top single-bundle,CSB)重建的近期临床疗效.方法 回顾分析2010年10月至2012年10月在我院关节外科接受ACL重建手术的病例及随访资料,按手术方式不同分为ASB组(n=31)和CSB组(n=32),移植韧带来源均为自体腘绳肌腱.比较两组患者在术后3~6个月的膝关节功能,评估方法采用膝关节主动活动度、Lachman试验、轴移试验、Lysholm评分及国际膝关节评分委员会(International Knee Documentation Committee,IKDC)评分.结果 术后膝关节主动活动度:CSB组3例术后膝关节伸直受限,平均5°~10°,ASB组无伸直受限,两组屈曲均正常;Lachman试验:ASB组全部阴性,CSB组6例阳性,差异有统计学意义(P<0.05);轴移试验:ASB组阴性率为67.74%,CSB组阴性率为40.63%,差异有统计学意义(P<0.05);Lysholm评分及IKDC评分差异均无统计学意义(均P>0.05).结论 ACL的ASB重建术后早期能更好地恢复膝关节的前后及旋转稳定性,其临床意义及远期临床效果有待进一步研究. 相似文献
18.
Baljinder S Dhinsa Syed Z Nawaz Kieran R Gallagher John Skinner Tim Briggs George Bentley 《Indian Journal of Orthopaedics》2015,49(2):155-163
Background:
Instability of the knee joint, after anterior cruciate ligament (ACL) injury, is contraindication to osteochondral defect repair. This prospective study is to investigate the role of combined autologous chondrocyte implantation (ACI) with ACL reconstruction.Materials and Methods:
Three independent groups of patients with previous ACL injuries undergoing ACI were identified and prospectively followed up. The first group had ACI in combination with ACL reconstruction (combined group); the 2nd group consisted of individuals who had an ACI procedure having had a previously successful ACL reconstruction (ACL first group); and the third group included patients who had an ACI procedure to a clinically stable knee with documented nonreconstructed ACL disruption (No ACL group). Their outcomes were assessed using the modified cincinnati rating system, the Bentley functional (BF) rating system (BF) and a visual analog scale (VAS).Results:
At a mean followup of 64.24 months for the ACL first group, 63 months for combined group and 78.33 months for the No ACL group; 60% of ACL first patients, 72.73% of combined group and 83.33% of the No ACL group felt their outcome was better following surgery. There was no significant difference demonstrated in BF and VAS between the combined and ACL first groups. Results revealed a significant affect of osteochondral defect size on outcome measures.Conclusion:
The study confirms that ACI in combination with ACL reconstruction is a viable option with similar outcomes as those patients who have had the procedures staged. 相似文献19.
Background:
Partial tears of the anterior cruciate ligament (ACL) are common and usually present with symptomatic instability. The remnant fibers are usually removed and a traditional ACL reconstruction is done. But with increased understanding of ACL double bundle anatomy, the remnant tissue preservation along with a single bundle augmentation of the torn bundle is also suggested. The purpose of this study was to evaluate the results of selective anatomic augmentation of symptomatic partial ACL tears. Our hypothesis is that this selective augmentation of partial ACL tears could restore knee stability and function.Materials and Methods:
Consecutive cases of 314 ACL reconstructions, 40 patients had intact ACL fibers in the location corresponding to the anteromedial (AM) or posterolateral (PL) bundle and were diagnosed as partial ACL tears perioperatively. All patients underwent selective augmentation of the torn bundle, while keeping the remaining fibers intact using autogenous hamstring graft. A total of 38 patients (28 males, 10 females) were available with a minimum of 3 years followup. 26 cases had AM bundle tears and 12 cases had PL bundle tears respectively. Patients were assessed with International Knee Documentation Committee (IKDC) 2000 Knee Evaluation Form, Lysholm score; instrumented knee testing was performed with the arthrometer (KT 2000). Statistical analysis was performed to compare the preoperative and postoperative objective evaluation.Results:
At 3 years followup, 31.6% patients were graded A, 65.8% were graded B and 2.6% was graded C at IKDC objective evaluation. Manual laxity tests, Lysholm''s score, mean side to side instrumental laxity and Tegner activity score improved significantly. 76% patients returned to preinjury level of sports activity after augmentation.Conclusion:
The results of anatomic single bundle augmentation in partial ACL tears are encouraging with excellent improvement in functional scores, side to side laxity and return to sports activity. 相似文献20.
关节镜下保留残端重建前交叉韧带的临床前瞻性对照研究 总被引:1,自引:0,他引:1
目的 前瞻性评估保留残端对于前交叉韧带重建临床疗效的意义.方法 2008年8月至2009年9月共70例有韧带残端存留的前交叉韧带损伤患者入选本研究组,随机分为保留残端组(n=35)和对照组(n=35).分别采取关节镜下保留残端重建前交叉韧带和切除残端的前交叉韧带重建手术技术,移植物均使用同种异体肌腱.术后随访分别进行膝关节功能评分(IKDC分级和Lysholm评分)、客观稳定性评估(Lachman试验、轴移试验和KT-1000测量)、本体感觉功能测量和二次关节镜手术探查.结果 70例患者中共61例(87%)获得随访,平均随访时间13.1个月.两组的功能评分无显著差异:Lysholm评分:保留残端组96.4分,对照组94.9分(P=0.71);IKDC分级中A和B级:保留残端组30例,对照组29例(P=0.586).两组的客观稳定性评估无显著差异:KT-1000测量的侧-侧差值:保留残端组1.69 mm,对照组1.65 mm(P=0.83);Lachman试验阴性例数:保留残端组29例,对照组28例(P=1.00);轴移试验阴性例数:保留残端组31例,对照组27例(P=0.225).本体感觉的角度重复试验结果无显著差异:保留残端组4.56°,对照组4.28°(P=0.522).二次手术探查时发现的移植物滑膜覆盖率无显著差异:保留残端组85%,对照组84.2%.结论 保留残端同时使用异体肌腱移植重建前交叉韧带,对术后膝关节主观功能评分、稳定性和本体感觉和移植物滑膜覆盖程度并无促进作用.Abstract: Objective To evaluate the clinical significance of arthroscopic anterior cruciate ligament (ACL)reconstruction using the remnant-preserved technique.Methods From August 2008 to September 2009,70 cases with the remnant of injured ACL were included in the trials,which were randomized into the remnant preservation(RP)group and the control group,35 cases in each group.All patients in the two groups underwent arthroscopic ACL reconstruction surgeries,with ACL-remnant preserving technique in RP group and ACL-remnant resection in control group,respectively.The injured ACL was reconstructed with allograft in all cases.Postoperative follow-up assessment included the International Knee Documentation Committee(IKDC)grading and Lysholm score,Lachman test,pivot shift test and KT-1000 measurement,proprioception measurements and the arthroscopic second look evaluation.Results Sixty-one(61/70,87%)cases were available for an average of 13.1 months follow-up assessment postoperatively.There were no significant differences between the RP and control group in functional outcome as evaluated with Lysholm score(96.4 vs.94.9,P = 0.71)and IKDC grading(cases with A and B gradings:30 vs.29,P = 0.586).Regarding objective stability,there were no differences between the 2 group in mean side-to-side difference of KT-1000(1.69 mm vs.1.65 mm,P =0.83),Lachman test(negative cases:29 vs.28,P = 1.00)and pivot shift test(negative cases:31 vs.27,P =0.225).There was also no difference between the groups in proprioception evaluation measured with angle repetitive test(4.56°vs.4.28°,P=0.522).During second look arthroscopic examination,the grafts synoveal coverage rates were found to be 85% in the RP group and 84.2% in the control group,without significant difference(P>0.05).Conclusions Arthroscopic ACL reconstruction with the remnant preserving technique using tendon allograft do not improve the postoperative knee-joint function scores,stability,proprioception and synovial coverage of grafts. 相似文献