Cyclops syndrome occurring after partial rupture of the anterior cruciate ligament not treated by surgical reconstruction.

Cyclops syndrome is one of the specific causes of loss of extension of the knee following anterior cruciate ligament (ACL) reconstruction. The syndrome is manifested by progressive loss of extension associated with pain and audible clunk at terminal extension caused by a pedunculated nodule of fibrovascular proliferative tissue usually arising from the graft. The entity has been described recently and has been reported exclusively as a complication of ACL reconstructions. We report the case of a patient with symptoms and arthroscopic and histological findings compatible with cyclops syndrome that developed after a partial ACL rupture that was not treated by surgical reconstruction. A different etiology and classical histological and immunohistological microscopic analysis of the nodule presented in this report may further clarify the pathogenesis of the cyclops syndrome.     

Intraarticular fibrous nodule as a cause of loss of extension following anterior cruciate ligament reconstruction.

Loss of motion is a well-known complication following anterior cruciate ligament (ACL) reconstruction. We have found that loss of extension is more disabling than loss of flexion, and is a more common problem following arthroscopic assisted ACL reconstruction. We are reporting on a group of 21 patients who have developed restricted knee extension following ACL reconstruction utilizing either the central one-third of the patellar ligament or the hamstring tendons as an autogenous graft. The patients presented at an average of 4 months postoperatively with a clinical syndrome of loss of extension associated with pain at terminal extension, crepitus, and grinding with attempted extension beyond their limit. The consistent finding at arthroscopy was a fibrous nodule occupying the intercondylar notch, varying in size from 1 x 1 to 2 x 3 cm, and presenting a mechanical block to full extension. It appears that anterior placement of the graft, particularly on the tibia, results in injury to the graft and subsequent nodule formation. Removal of the nodule resulted in improvement of an average preoperative loss of extension of 11 degrees, to 3 degrees at surgery, and 0 degrees at 1 year follow-up. The average side-to-side difference in terminal extension at final examination, using the uninvolved limb for comparison, was 3 degrees. Histology was available for review on 19 of the 21 patients operated on. The consistent microscopic finding within the nodule was the presence of disorganized dense fibroconnective tissue that, with time, underwent modulation to fibrocartilage. It is postulated that this occurs in response to compressive loading of the nodule.     

Arthroscopic treatment of flexion deformity after ACL reconstruction

After anterior cruciate ligament (ACL) reconstruction, one frequent complication is the restriction of the range of motion and loss of extension. In addition to the presence of adhesions in the suprapatellar pouch, it is possible to detect two different pathological findings in the intercondylar notch: a misplacement of graft causing an intercondylar impingement, or the presence of hypertrophic tissue originating from the graft that blocks the last degrees of extension, causing an "anterior impingement." We reviewed 18 consecutive cases treated by arthroscopic release. All patients had knee range-of-motion restriction after an ACL procedure. The follow-up at 1 and at 6 months shows that good results have been obtained in cases of anterior impingement, whereas in cases of intercondylar impingement a restricted range of motion, especially of flexion, did remain. In all cases, after arthroscopic treatment the postoperative extension was between 5 and 10 degrees, but this deficit regressed after 6 months in 12 patients, whereas a dropout case was necessary in the remaining 6 patients.     

Cyclops lesion – The entity causing loss of knee extension after ACL reconstruction surgery: A case report

Cyclops is a fibrous nodule on the tibial side of the knee and it is one of the common complications that arises after anterior cruciate ligament (ACL) reconstruction surgery that causes loss of knee extension. In this literature, we have discussed about a young gentleman who presented with unresolved swelling and inability to extend knee joint fully 1 year after ACL reconstruction surgery. Cyclops lesion was identified by clinical examination and magnetic resonance imaging (MRI). An arthroscopic excision of the cyclops lesion was successfully done on this patient which resulted in a resolution of swelling and progressive improvement of knee extension.     

Misdiagnosis of an atypical cyclops lesion 4 years after single-bundle anterior cruciate ligament reconstruction

Development of a cyclops lesion is a well described complication after anterior cruciate ligament (ACL) reconstruction. It commonly results in gradual extension loss during the early postoperative course, and magnetic resonance imaging (MRI) of the soft tissue nodule attached to the ACL graft is needed. Cyclops lesions are easy to diagnose based on the symptoms and MRI findings. Previous study showed that 78.6% of cyclops lesions had extension loss within 6 weeks postoperatively, and the diagnosis of 92.8% cases of cyclops lesions was established within 6 months.This article describes a case of misdiagnosis of a cyclops lesion 4 years after ACL reconstruction as a meniscal lesion combined with a meniscal cyst. The patient was asymptomatic for 4 years and then presented with a locked left knee and pain at the inferior pole of the patella during an attempt to gently extend the knee. Magnetic resonance imaging revealed a lateral meniscal cyst. The knee locking was released suddenly 2 days preoperatively. The authors had attributed the missed diagnosis to an atypical history and symptoms and an associated meniscal cyst.The purpose of this article is to help prevent misdiagnosis of atypical cyclops lesions. Cyclops lesions should be considered in the differential diagnosis of patients who present with gradual or sudden loss of extension after ACL reconstruction, regardless of how much time has passed postoperatively.     

Comparison of the ACL and ACL graft forces before and after ACL reconstruction an in-vitro robotic investigation

Background?Long-term follow-up studies have indi-cated that there is an increased incidence of arthrosis following anterior cruciate ligament (ACL) reconstruc-tion, suggesting that the reconstruction may not repro-duce intact ACL biomechanics. We studied not only the magnitude but also the orientation of the ACL and ACL graft forces

Methods?10 knee specimens were tested on a robotic testing system with the ACL intact, deficient, and recon-structed (using a bone-patella tendon-bone graft). The magnitude and orientation of the ACL and ACL graft forces were determined under an anterior tibial load of 130?N at full extension, and 15, 30, 60, and 90° of flexion. Orientation was described using elevation angle (the angle formed with the tibial plateau in the sagit-tal plane) and deviation angle (the angle formed with respect to the anteroposterior direction in the transverse plane)

Results?ACL reconstruction restored anterior tibial translation to within 2.6?mm of that of the intact knee under the 130-N anterior load. Average internal tibial rotation was reduced after ACL reconstruction at all flexion angles. The force vector of the ACL graft was significantly different from the ACL force vector. The average values of the elevation and deviation angles of the ACL graft forces were higher than that of the intact ACL at all flexion angles

Interpretation?Contemporary single bundle ACL reconstruction restores anterior tibial translation under anterior tibial load with different forces (both magni-tude and orientation) in the graft compared to the intact ACL. Such graft function might alter knee kinematics in other degrees of freedom and could overly constrain the tibial rotation. An anatomic ACL reconstruction should reproduce the magnitude and orientation of the intact ACL force vector, so that the 6-degrees-of-freedom knee kinematics and joint reaction forces can be restored.     

The role of arthroscopy in the treatment of postoperative fibroarthrosis of the knee joint

Twenty-one patients with significantly limited range of motion of the knee secondary to open surgical procedures were treated by arthroscopic resection of the adhesions and gentle manipulation. The surgical procedures consisted of realignment procedures for patellar dislocation, arthrotomy for meniscectomy and synovectomy, ligamentous reconstruction, open reduction of intraarticular fractures, and prosthetic replacement. The interval between the arthroscopic treatment and the open procedures was from four months to two years. All patients had the arthroscopic releases performed with general or spinal anesthesia, were kept in the hospital for a minimum of three days, and were placed on a continuous passive motion machine. After discharge, an intensive rehabilitation program was instituted under the supervision of a physical therapist. With a follow-up period ranging from six months to two years, marked improvement of range of motion was obtained in most patients. Preoperative flexion was between 40 degrees and 50 degrees in 13 patients, 30 degrees in two patients, 60 degrees in four patients, 80 degrees in one patient, and 10 degrees in only one patient. The final flexion was between 120 degrees and 140 degrees in 12 patients. The remaining patients had postoperative flexion between 85 degrees and 100 degrees. One patient with 10 degrees of range of motion did not improve. Six of the eight patients with an extension lag preoperatively regained full or almost full extension after arthroscopic debridement. Morbidity was low and no serious complications were encountered. This study suggests that arthroscopic intraarticular release of adhesions is efficacious in the management of arthrofibrosis of the knee subsequent to previous open operative procedures.     

Comparison of the ACL and ACL graft forces before and after ACL reconstruction: an in-vitro robotic investigation

Background Long-term follow-up studies have indi-cated that there is an increased incidence of arthrosis following anterior cruciate ligament (ACL) reconstruc-tion, suggesting that the reconstruction may not repro-duce intact ACL biomechanics. We studied not only the magnitude but also the orientation of the ACL and ACL graft forces

Methods 10 knee specimens were tested on a robotic testing system with the ACL intact, deficient, and recon-structed (using a bone-patella tendon-bone graft). The magnitude and orientation of the ACL and ACL graft forces were determined under an anterior tibial load of 130 N at full extension, and 15, 30, 60, and 90° of flexion. Orientation was described using elevation angle (the angle formed with the tibial plateau in the sagit-tal plane) and deviation angle (the angle formed with respect to the anteroposterior direction in the transverse plane)

Results ACL reconstruction restored anterior tibial translation to within 2.6 mm of that of the intact knee under the 130-N anterior load. Average internal tibial rotation was reduced after ACL reconstruction at all flexion angles. The force vector of the ACL graft was significantly different from the ACL force vector. The average values of the elevation and deviation angles of the ACL graft forces were higher than that of the intact ACL at all flexion angles

Interpretation Contemporary single bundle ACL reconstruction restores anterior tibial translation under anterior tibial load with different forces (both magni-tude and orientation) in the graft compared to the intact ACL. Such graft function might alter knee kinematics in other degrees of freedom and could overly constrain the tibial rotation. An anatomic ACL reconstruction should reproduce the magnitude and orientation of the intact ACL force vector, so that the 6-degrees-of-freedom knee kinematics and joint reaction forces can be restored.     

Anterior cruciate ligament reconstruction stability with continuous passive motion. The role of isometric graft placement.

A comparison was made of the stability of isometric versus nonisometric anterior cruciate ligament (ACL) reconstructions when subjected to immediate postoperative continuous passive motion (CPM). Anterior cruciate ligament reconstructions were performed on 13 anatomic specimen knees using bone/patellar tendon/bone grafts. Nine ACL substitutions were considered isometric with maximum graft length changes of less than 1 mm. Four ACL substitutions were nonisometric with graft length changes of 3 mm or greater resulting from tightening in flexion. The specimens were subjected to CPM through 0 degrees-95 degrees knee flexion. Knee stability was remeasured with a knee arthrometer at three and 14 days after beginning CPM. All four nonisometric specimens had failed within three days, with increased anterior laxity of 2-9 mm in both the Lachman (20 degrees) and anterior drawer (90 degrees) positions. All nine isometric reconstructions successfully retained pre-CPM anterior stability within 1 mm after 14 days of CPM. This investigation illustrates the importance of isometric graft placement for ACL reconstruction success. Continuous passive motion does not appear to adversely affect immediate ACL-substitute integrity or fixation if graft placement is isometric (less than 1 mm of graft excursion through 0 degrees-110 degrees of knee motion). Continuous passive motion may cause graft deformation, fixation failure, or both, with resultant loss of knee stability if the graft is not isometrically positioned (greater than 3 mm of graft excursion resulting from tightening in flexion).     

The early treatment of motion complications after reconstruction of the anterior cruciate ligament.

The use of active and passive knee motion in the immediate postoperative period and a treatment plan for early postoperative limitations in knee motion has proven highly effective in restoring motion after anterior cruciate ligament (ACL) reconstruction. Of 207 knees, 189 (91%) regained a full range of motion of 0 degrees-135 degrees. The remaining 18 knees (9%) did not regain motion as rapidly as the others and were placed in an early postoperative phased treatment program. Six knees had serial extension casts, nine had early gentle manipulation under anesthesia, and three had arthroscopic lysis of intraarticular adhesions and scar tissue. Fourteen of these 18 knees regained a full range of knee motion. Two of the remaining four knees lacked 5 degrees of full extension, whereas the other two, in patients who had failed to follow medical advice and the rehabilitation program, had permanent and significant limitation of motion. The incidence of postoperative motion problems was related to the extent of the surgical procedure. The incidence was 4% in patients who had only ACL reconstruction, 10% in cases in which added lateral extraarticular procedure had been done, 12% where a meniscus repair had been done, and 23% where a medial collateral ligament repair was done.     

Revision anterior cruciate ligament reconstruction using the lateral third of the ipsilateral patellar tendon after failure of a central-third graft: a preliminary report on 10 patients

Long-term outcomes were reported for 10 (77%) of 13 cases of revision anterior cruciate ligament (ACL) reconstruction using the lateral third of the ipsilateral patellar tendon as a graft. All primary ACL reconstructions were ipsilateral central-third bone-patellar tendon-bone graft procedures. Mean age at follow-up was 30.7 years, and mean time from revision ACL surgery to follow-up was 42.9 months. At follow-up, average KT-1000 difference between knees was 2.4 mm. All patients had a negative pivot shift, extension within 5 degrees of the contralateral knee, and flexion within 15 degrees. Mean bilateral comparison ratios for isokinetic strength and hop testing were: extension, 83.5%; flexion, 96%; and single-leg hop 96.9%. No patella fractures or tendon ruptures had occurred. All patients had returned to their previous work level, and 8 of the 10 patients could participate in at least "moderate" sports activities (e.g., skiing and tennis). The results were comparable to published outcome reports for both primary and revision ACL reconstruction. The lateral third of the ipsilateral patellar tendon is a good graft option for revision ACL reconstruction.     

Method for setting total graft force and load sharing in augmented ACL grafts

The objective of this study was to develop a method for obtaining a controllable and reproducible immediate postoperative mechanical state in a knee with an anterior cruciate ligament (ACL) reconstruction. This method, called the force-setting technique, was demonstrated using a composite graft consisting of the middle third of the patellar tendon with bone blocks (PT) and the ligament augmentation device (LAD). The total graft force was set to match the force in the intact ACL at 30 degrees flexion with the knee under the same standardized external load, while at the same time the load sharing between the biologic and augmentation components was controlled. The total graft force was set to match the ACL force three separate times in each knee, with ratios of load sharing set at the following levels: 50% PT-50% LAD, 25% PT-75% LAD, and 75% PT-25% LAD. ACL, PT, LAD, and collateral forces were measured using buckle transducers, and three-dimensional knee motion was measured using an instrumented spatial linkage as 90 N anteriorly directed tibial loads were applied to eight specimens at 0 degree, 30 degrees, 60 degrees, and 90 degrees flexion with an intact ACL, an excised ACL, and the three load-sharing reconstruction states. The total graft force could be consistently set to within an average of 2% of the intact ACL force at 30 degrees flexion, and load sharing between the graft segments could be set to within an average of 5.1% of the desired ratio at 30 degrees.(ABSTRACT TRUNCATED AT 250 WORDS)     

Arthroscopic evaluation after surgical repair of intercondylar eminence fractures

Introduction Patients who undergo surgical repair of intercondylar eminence fracture may have postoperative problems despite good reduction. We used arthroscopy to evaluate the outcomes after surgery to repair intercondylar eminence fractures. Materials and methods Ten patients (8 men and 2 women; average age at the time of surgery 27.9 ± 10.0 years, range from 14 to 50 years) with fracture of the tibial intercondylar eminence underwent an arthroscopic reduction and internal fixation with non-absorbable sutures. Preoperative radiological examination showed that there were one Meyer’s type-II, eight type-IIIA and one type-IIIB fractures. Clinical symptoms and physical findings for all the patients were evaluated 1 year postoperatively. Radiographic assessment and the Lysholm rating scale were also utilized. Second-look arthroscopy was performed after 1 year when removing the implant. Arthroscopy was used to assess the appearance of the surface of the anterior cruciate ligament (ACL), check for the existence of cyclops and look for interposition of tissue in the lateral and medial joint spaces. Results One year after the surgery, all ten patients achieved bony union and had negative Lachman and anterior drawer tests. The average Lysholm knee score was 94.5 ± 7.2 points (range 100–75 points). Arthroscopy showed an irregular surface on the ACL in two of the ten patients, cyclops in two patients, interposition in the lateral joint space in two patients and interposition in the medial joint space in one patient. In the two cases seen with an irregular surface, the ACL was covered with droopy fibrous tissue, but the substance of the ACL was intact. The two patients who had cyclops showed loss of knee extension (5°∼10°), which was regained by subsequent resection of the cyclops. One patient who had an interposition into the lateral joint space complained of catching, which was released by resection of the interposing tissue. Conclusion Arthroscopic refixation of the intercondylar eminence fracture provided bony union and a good clinical outcome. Cyclops syndrome is one of the causes of loss of knee extension, and soft tissue in the medial or lateral compartment is one of the causes of catching of knee after surgical repair of intercondylar eminence fracture. Cyclops syndrome, which may occur following ACL reconstruction, is one of the causes of loss of knee extension after surgical repair of intercondylar eminence fracture. In patients who have knee complaints, such as catching and loss of knee extension, a second-look arthroscopy is useful for identifying and correcting the problem.     

Single-bundle versus double-bundle anterior cruciate ligament reconstruction: an up-to-date meta-analysis

Purpose

The aim of this meta-analysis was to compare the results of arthroscopic single-bundle and double-bundle anterior cruciate ligament (ACL) reconstruction.

Methods

We systematically searched electronic databases to identify randomised controlled trials (RCTs) in which arthroscopic single-bundle was compared with double-bundle for ACL reconstruction. The search strategy followed the requirements of the Cochrane Library Handbook. The outcomes of these studies were analysed in terms of graft failures, Lysholm score, negative pivot-shift test, KT1000 arthrometer measurements, knee extensor and flexor peak torques, knee extension and flexion deficit, and subjective and objective International Knee Documentation Committee (IKDC) final score. Methodological quality was assessed and data were extracted independently. Standard mean difference (SMD) or odds ratio (OR) with 95 % confidence interval (CI) was calculated by a fixed effects or random effects model. Heterogeneity across the studies was assessed with the I-square and chi-square statistic. Forest plots were also generated.

Results

We identified 17 RCTs comprising 1,381 patients who were treated by arthroscopic single-bundle versus double-bundle ACL reconstruction. The results of meta-analysis of these studies showed that arthroscopic double-bundle reconstruction was associated with a lower risk of graft failures (P = 0.002) and a lower rate of positive pivot-shift test (P < 0.0001). Compared with single-bundle reconstruction, double-bundle reconstruction had a lower KT1000 arthrometer measurement (P < 0.00001), a lower knee extension deficit (P = 0.006) and a higher subjective IKDC score (P = 0.03). There was no statistically significant difference between single-bundle and double-bundle reconstruction in Lysholm score (P = 0.91), knee extensor peak torques (P = 0.97), knee flexor peak torques (P = 0.96), knee flexion deficit (P = 0.30) and objective IKDC score (P = 0.18).

Conclusions

Considering the more favourable outcomes of graft failures, knee joint stability and knee joint function in double-bundle reconstruction, we concluded that arthroscopic double-bundle reconstruction should be considered as the primary treatment in ACL reconstruction.     

Arthroskopische Arthrolyse bei Arthrofibrose nach Ersatzplastik des vorderen Kreuzbandes

Objective

Restoration of free knee motion taking into account knee extension, knee flexion, and patella mobility.

Indications

Prolonged knee motion restriction after anterior cruciate ligament (ACL) reconstruction, persistent decreased patella mobility, or extension deficit.

Contraindications

Existing significant joint irritation or active reflex dystrophy with persistent distinctive pain syndrome.

Surgical technique

Arthroscopic arthrolysis possible in most cases. Removal of adhesions in all compartments. Elimination of intraarticular cause of patella infera by removing infrapatellar scar tissue and fibrotic fat pad. In case of severe peripatellar fibrotic tissue, lateral release is useful with partial transection of lateral retinacula. In case of strong capsular contracture, additional medial release indicated to improve patella mobility. Important goal of arthrolysis: full range of knee extension. Arthrolysis for scar tissue removal in the posterior recessus through dorsomedial arthroscopic approach possible. In severe cases posteromedial arthrotomy for posterior capsule release required. Cyclops syndrome makes removal of all tissue adherent to the ACL necessary. An irregular ACL insertion or intercondylar notch stenosis may require notchplasty. Postoperative recurrence of fibrosis may require repeated arthroscopic surgery to improve mobility, such as notchplasty, osteophytes resection, scar removal, and releases.

Postoperative management

Immediate postoperative pain-free physical therapy taking into account full range of extension and patella mobility. Passive exercises under traction. Lymphatic drainage. No exercising in pain throughout the entire postoperative physical therapy. Continuous passive motion treatment for 4 weeks postoperatively useful. No muscle strength or equipment training for at least 3 months postoperatively.

Results

Based on the observations in our working group, approximately pproximately 78?% of patients develop knee osteoarthritis within 5 years.     

Second-look arthroscopy with removal of bioabsorbable tacks

Eleven years after tearing her anterior cruciate ligament (ACL) (not reconstructed), a 36-year-old dancer reinjured her knee and required arthroscopic ACL reconstruction. At arthroscopy, the medial meniscus had a bucket-handle tear that was repaired by using three bioabsorbable tacks. The ACL was then repaired in the usual manner. Because of persistent posterior knee pain throughout her rehabilitation, we performed "second-look" arthroscopy 14 weeks after reconstruction. The meniscus had healed and was stable; however, tack motion was evident and the tacks were easily removed. Inspection of the tacks showed that the barbs had been resorbed. The patient recovered uneventfully, and pain-free flexion 28 days after surgery was 0 degrees-136 degrees. We believe this to be the first reported case demonstrating the early stages of tack degradation in meniscal repair.     

关节镜下应用Rigidfix与Intrafix系统固定异体肌腱重建前交叉韧带

目的 探讨关节镜下应用Rigidfix与Intrafix系统固定同种异体胫前肌肌腱重建前交叉韧带(ACL)的临床效果. 方法自2003年3月至2006年9月对56例在关节镜下确诊ACL断裂的患者采用深低温同种异体胫前肌肌腱进行韧带重建,应用Rigidfix与Intrafix系统对移植物进行固定,术后进行系统康复训练.随访观察患者的主观症状,并检查患膝关节活动度、前抽屉试验、Lachman试验和轴移试验,按照Lysholm膝关节评分标准评价疗效.结果 所有患者随访1.5～5.0年,平均2.3年.有2例患者在剧烈活动时伴有错动感,末次随访时膝关节活动度均可达到伸-5°～0°,屈120°～130°,前抽屉试验、Lachman试验及轴移试验均为阴性,Lysholm膝关节评分由术前(48.2±5.3)分提高至术后(91.1±4.2)分,差异有统计学意义(P<0.05).结论 关节镜下应用Rigidfix与Intrafix系统固定同种异体胫前肌肌腱重建ACL可获得满意的临床疗效.     

Intra-articular mechanical blocks and full extension in patients undergoing anterior cruciate ligament reconstruction.

Patients with acute anterior cruciate ligament (ACL) rupture frequently present with a lack of full extension. Current literature is unclear whether arthroscopic debridement is necessary before reconstruction to achieve full extension postoperatively. This study examined the postoperative extension achieved in 153 knees that underwent ACL reconstruction within 12 weeks of index injury. All patients performed preoperative physical therapy to increase range of motion and control pain/swelling, regardless of presenting range of motion without prior aspiration or arthroscopy. Of the 153 knees, 103 had meniscal pathology, of which 73 were peripheral vertical tears; 96 of the 153 knees lacked >/=3 degrees extension preoperatively. Five of 96 knees had an intra-articular mechanical block to extension and all regained full extension after ACL reconstruction. This study documented that a true intra-articular mechanical block is unusual in primary ACL ruptures. Lack of full extension can be adequately dealt with during surgical reconstruction without a detrimental effect on knee extension postoperatively.     

关节镜下一期自体腘绳肌腱重建前交叉韧带联合LARS韧带重建后交叉韧带

目的探讨关节镜下一期应用自体腘绳肌腱重建前交叉韧带联合LARS人工韧带重建后交叉韧带的临床疗效。方法自2009-02—2010-06对14例膝关节前、后交叉韧带断裂及严重膝关节脱位患者在关节镜下一期采用自体腘绳肌腱重建前交叉韧带联合LARS人工韧带重建后交叉韧带,同时处理合并的侧副韧带及半月板损伤。末次随访时采用膝关节Lysholm评分、IKDC评分评定疗效。结果术后14例均获随访23~36个月,平均29.5个月。均无膝关节肿痛症状、感染、伸膝障碍发生。末次随访时,膝关节屈曲达120°~130°;膝关节IKDC评分：A类11例（78.6%）,B类2例（14.3%）,C类1例（7.1%）;膝关节Lysholm评分（89.2±4.6）分,较术前（54.7±5.3）分明显提高,差异有统计学意义（t=32.156,P=8.91E-14）。结论关节镜下一期应用自体腘绳肌腱重建前交叉韧带联合LARS人工韧带重建后交叉韧带治疗膝关节多韧带损伤临床疗效满意。