三明治式后十字韧带重建的临床疗效

目的 评估后十字韧带三明治式重建,即保留残存纤维,采用八股腘绳肌腱双束重建后十字韧带的效果.方法 2005年1月至2005年6月,单纯陈旧性后十字韧带损伤患者18例,男14例,女4例;年龄19～42岁,平均34岁.在关节镜下采用自体腘绳肌腱行双束四隧道重建,其中采用四股半腱肌腱重建前外侧束,四股股薄肌腱重建后内侧束.残存纤维保留于重建的双柬移植物之间.通过微型钢板和纽扣悬吊式固定移植物.根据IKDC、Lysholm和Tegner评分标准进行评估.结果 患者均获得2年以上随访,末次随访时发现,17例患者(94.4%)后抽屉试验阴性,1例后抽屉试验1度阳性.KT-1000检查示,双膝后向松弛度差值从术前的(9.3±1.4)mm改善为术后的(0.7±0.9)mm,两者比较差异有统计学意义(P＜0.01).根据IKDC评估标准,16例患者(88.9%)评级正常,2例患者(11.1%)评级接近正常.IKDC主观评分从(64.1±3.3)分增加到(95.6+3.1)分(P＜0.01).Lysholm评分从(58.6+4.4)分增加到(94.9±3.6)分(R＜0.01).Tegner评分,术前为5.6分,末次随访时为6.9分.结论 关节镜下后十字韧带三明治式重建能使88.9%的患者在术后2年得到正常的IKDC评级,11.1%的患者得到接近正常的IKDC评级.     

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.     

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.     

关节镜下采用腘绳肌肌腱和微型钢板纽扣同时重建前、后十字韧带

目的关节镜下采用绳肌肌腱和微型钢板纽扣同时重建前、后十字韧带,并对重建效果进行评估。方法对12例前、后十字韧带损伤患者,在关节镜下采用同侧半腱肌肌腱和微型钢板纽扣重建前十字韧带,采用对侧半腱肌肌腱、股薄肌肌腱和微型钢板纽扣重建后十字韧带。其中2例还同时行后外侧韧带结构重建,1例同时行后内侧韧带结构重建。术后随访12～24个月,采用IKDC和Lysholm膝关节功能评分表对患膝功能进行评估,通过KT-1000检查了解膝关节的前后松弛度。结果术后无伸膝受限,屈膝活动度120°～140°,平均128°。终末随访时IKDC评分为A4例(33.3%),B7例(58.3%),C1例(8.3%)。屈膝25°位KT-1000检查,双侧膝关节前向松弛度差异小于2mm者8例,3～5mm者3例,7mm者1例;屈膝70°位检查,双侧胫骨结节后坠差异为0～2mm者9例,2～4mm者3例。陈旧性损伤患者术前Lysholm膝关节功能评分为(66.5±3.1)分,终末随访时为(93.8±3.5)分,差异具有非常显著性(t=5.376,P<0.01)。10例患者(83.3%)恢复了原来的运动水平,2例患者(16.7%)运动水平较前有所降低。结论在关节镜下采用双侧绳肌肌腱和微型钢板纽扣同时重建前、后十字韧带,能够较满意地恢复膝关节功能。     

关节镜下采用四股和八股腘绳肌肌腱双束重建前十字韧带的比较研究

目的比较关节镜下采用四股和八股腘绳肌肌腱双束重建前十字韧带的临床效果。方法2001年9月至2002年8月,将76例陈旧性前十字韧带损伤患者随机分为两组进行双束重建。一组采用四股腘绳肌肌腱移植物:取同侧半腱肌肌腱,做成两个两股肌腱移植物,分别重建前十字韧带前、后束;一组采用八股腘绳肌肌腱移植物:取同侧半腱肌肌腱做成一个四股肌腱移植物重建前束,取同侧股薄肌肌腱做成另一个四股肌腱移植物重建后束。按照IKDC、Lysholm和Tegner膝关节评分标准评价疗效。结果四股肌腱移植物组有33例、八股肌腱移植物组有35例获得随访,随访时间1～3年,平均16个月。四股肌腱移植物组KT-1000检查示,双侧膝关节前向松弛度差异<3mm者25例(75.8%,25/33),3～5mm者5例(15.2%,5/33),6～10mm者3例(9.1%,3/33);轴移试验阴性28例(84.8%),阳性5例(15.2%)。八股肌腱移植物组KT-1000检查示,双侧膝关节前向松弛度差异<3mm者33例(94.3%,33/35),3～5mm者2例(5.7%,2/35);轴移试验阴性34例(97.1%),阳性1例(2.9%)。根据IKDC检查标准,四股肌腱移植物组有29例(87.9%,29/33)、八股肌腱移植物组有34例(97.1%,34/35)为正常或者接近正常,Lysholm评分分别为(90.2±2.9)分和(97.3±1.7)分,两组比较差异有统计学意义(P<0.05)。结论关节镜下采用八股腘绳肌肌腱较采用四股腘绳肌肌腱双束重建前十字韧带能够明显提高膝关节稳定性。     

胫骨平台后倾角对前十字韧带重建术后膝关节前向稳定性的影响

目的 评估胫骨平台后倾角与前十字韧带重建术后膝关节前向稳定性的关系.方法 选取2010年10月至2011年6月收治的年龄45岁以下单侧前十字韧带完全断裂行前十字韧带重建的40例患者进行回顾性研究.男28例,女12例;年龄14～44岁,中位年龄22岁.随访时间24-37个月,平均27.5个月.依据术前MRI测量的胫骨内侧和外侧平台后倾角分别将患者分为三组:后倾角＜3°组,后倾角3°～5°组,后倾角≥5°组.以末次随访时KT-1000侧侧差值评估膝关节的前向稳定性,＞5 mm为移植物失效,计算失效率,比较三组移植物失效率的差异.采用Pearson相关检验确定胫骨平台后倾角与KT-1000侧侧差值的相关性,利用受试者工作特征曲线和逻辑斯蒂回归计算内侧和外侧平台后倾角致移植物失效的阈值及其敏感度、特异度.结果 术前MRI测量内侧后倾角4.6°±2.8°,外侧后倾角4.2°±3.4°.内、外侧后倾角≥5°组的移植物失效率均高于后倾角＜3°组,差异有统计学意义.内侧、外侧平台后倾角均与KT-1000侧侧差值呈线性相关(r=0.43,P=0.01;r=0.36,P=0.02).内侧或外侧平台后倾角每增加1°,移植物失效的风险分别增加1.76倍和1.68倍.当内侧平台后倾角＞5.6°或外侧平台后倾角＞3.8°时,移植物失效的风险显著增加.结论 胫骨平台后倾角与前十字韧带重建术后膝关节前向稳定性呈正相关.增大的平台后倾角是术后移植物失效的高危因素,内侧和外侧阈值分别为5.6°和3.8°.     

关节镜下后交叉韧带部分损伤重建术

目的 探讨关节镜下选择性后交叉韧带（PCL）部分重建治疗PCL部分损伤的效果及可行性。方法 自2001年1月～2005年6月对21例单纯PCL部分韧带损伤患者行关节镜下PCL部分重建，其中前外侧束损伤13例，后内侧束损伤8例。11例采用自体骨-髌腱-骨重建，10例采用同种异体骨-髌腱-骨重建。对患者手术前后进行后抽屉试验、后向Lachman试验、KT-1000试验及Lysholm评分。结果 21例患者术后获6个月～5年（平均32．4个月）随访。后向Lachman试验：术前13例阳性患者术后12例阴性，1例阳性；后抽屉试验：术前8例阳性患者术后均为阴性；KT-1000（70°）试验：术前平均（7．3±2．5）mm，术后平均（1.8±0．6）mm。Lysholm评分：术前平均（68．2±6、4）分，术后平均（90．6±4．3）分。国际膝关节文献委员会（IKDC）评级：术前D级16例，C级5例；术后A级9例，B级11例，C级1例，总优良率95．2％。结论 PCL部分韧带束损伤后行部分韧带重建临床效果良好。     

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.     

前交叉韧带重建后翻修的临床研究

目的 探讨前交叉韧带(anterior cruciate ligament, ACL)翻修重建的手术适应证、手术方法和临床疗效.方法 2001年11月至2006年7月收治ACL重建后失稳接受翻修患者12例,其中男性9例,女性3例,年龄16～39岁,平均28岁,均在关节镜下行探查与翻修手术.结合上述病例分析翻修的适应证、术中处理方法.术后应用KT-2000、IKDC、Lysholm及Tegner评分系统对临床疗效进行评价.结果 本组患者术前膝关节明显不稳.2例因骨道骨质严重缺损行一期植骨术.其余10例一期行ACL翻修手术,重建移植物采用同侧腘绳肌腱(STG)4例,对侧STG 4例,同侧骨-髌腱-骨(B-PT-B)1例,髂胫束1例.ACL翻修术后KT-2000检查平均差值在膝关节屈曲90°位和30°位分别为1.6 mm和3.1 mm;术后IKDC、Lysholm及Tegner评分平均分别为72.8、78.3、4.9分,较术前有明显改善.结论 ACL翻修重建后患膝的主观功能和客观稳定性可获明显改善.     

自体腘绳肌腱单、双束重建前交叉韧带临床比较研究

目的 比较自体腘绳肌腱单、双束重建前交叉韧带的临床效果.方法 2005年5月至12月采用双束重建前交叉韧带患者33例(双束组),单束重建患者41例(单束组),均采用自体半腱肌腱和股薄肌腱.双束组4例失访,随访时间14～22个月,平均18个月;单束组8例失访,随访时间14-21个月,平均18个月.采用国际膝关节评分委员会评分标准(IKDC),Lysholm和Tegner评分、KT-2000及Biodex肌力测试评价.结果 双束组IKDC,Lysholm和Tegner评分分别由术前的60、66、4分显著上升至术后的85、94、6分.KT-2000在134 N下30°和90°位移情况由术前的5.8和2.4 mm减少为术后1.2和1.1 mm(P＜0.01).双束组伤侧膝关节伸膝及屈膝的峰力矩在60°/s下,相对于正常侧分别为81%和87%,120°/s下为76%和85%.各项值均显著低于对侧(P＜0.01).尽管在30°位KT-2000测量值和伸膝肌力的恢复方面,双束重建较单束重建表现出了更好的趋势,但功能评分,KT测量值和BIODEX测量的结果,单、双束组差异无统计学意义.结论 自体胭绳肌腱单、双束重建前交叉韧带均可以恢复膝关节稳定,改善关节功能,双束重建患者在30°位前后稳定性和伸膝肌力方面表现出了较单束重建更好的趋势.     

关节镜下股骨双束双隧道胫骨Inlay技术同种异体跟腱移植重建后交叉韧带

目的：探讨关节镜下同种异体跟腱重建后交叉韧带（PCL）的方法，验证股骨双柬双隧道、胫骨Inlay技术重建PCL的临床疗效。方法：2005年9月至2007年8月，采用经深低温冷冻及γ射线照射处理后的异体跟腱对10例PCL损伤的患者行关节镜下PCL重建术，手术方式股骨端为双束双隧道重建，可吸收挤压螺钉固定，胫骨端为Inlay固定。通过物理检查、Lysholm及IKDC评分来评价手术疗效。结果：术后8d内患者体温恢复正常，免疫排斥轻，无感染发生。所有患者术后获6～23个月（平均17个月）随访，终末随访时10例患者术膝胫骨下陷征（Sagsign）阴性，后抽屉试验（PDT）及Lachman征均为阴性或I度。疗效评定采用Lysholm评分和IKDC评分。Lysholm评分中交锁、不稳、疼痛、肿胀、爬楼、下蹲和总分术前术后比较差异有统计学意义，术后优7例，良2例，中1例；IKDC评分中疼痛频率、疼痛程度、规律活动量、活动影响程度、功能自评和总分等术前术后比较差异有统计学意义，术后IKDC评分A级7例，B级3例。结论：同种异体跟腱是重建PCL的可靠替代物，双束双隧道和Inlay技术固定可靠，可减少移植物损伤，是PCL重建的理想技术。     

Arthroscopically assisted combined anterior and posterior cruciate ligament reconstruction in the multiple ligament injured knee: 2- to 10-year follow-up

Purpose: This study presents the 2- to 10-year results of 35 arthroscopically assisted combined anterior cruciate ligament and posterior cruciate ligament (ACL/PCL) reconstructions evaluated preoperative and postoperatively using Lysholm, Tegner, and Hospital for Special Surgery knee ligament rating scales, KT-1000 arthrometer testing, stress radiography, and physical examination. Type of Study: Case series. Methods: This study population included 26 men and 9 women with 19 acute and 16 chronic knee injuries. Ligament injuries included 19 ACL/PCL/posterolateral instabilities, 9 ACL/PCL/medial cruciate ligament (MCL) instabilities, 6 ACL/PCL/posterolateral/MCL instabilities, and 1 ACL/PCL instability. All knees had grade III preoperative ACL/PCL laxity and were assessed preoperatively and postoperatively with arthrometer testing, 3 different knee ligament rating scales, stress radiography, and physical examination. Arthroscopically assisted combined ACL/PCL reconstructions were performed using the single-incision endoscopic ACL technique and the single femoral tunnel–single bundle transtibial tunnel PCL technique. PCLs were reconstructed with allograft Achilles tendon (in 26 cases), autograft bone–patellar tendon–bone (BPTB) (in 7 cases), and autograft semitendinosus/gracilis (in 2 cases). ACLs were reconstructed with autograft BPTB (16 cases), allograft BPTB (12 cases), Achilles tendon allograft (6 cases), and autograft semitendinosus/gracilis (1 case). MCL injuries were treated with bracing or open reconstruction. Posterolateral instability was treated with biceps femoris tendon transfer, with or without primary repair, and posterolateral capsular shift procedures as indicated. Results: Postoperative physical examination revealed normal posterior drawer/tibial step-off in 16 of 35 (46%) knees. Normal Lackman and pivot-shift test results were found in 33 of 35 (94%) knees. Posterolateral stability was restored to normal in 6 of 25 (24%) knees, and tighter than normal knee results were found in 19 of 25 (76%) knees evaluated with the external rotation thigh foot angle test. In this group, 30° varus stress testing was normal in 22 of 25 (88%) knees, and grade 1 laxity was found in 3 of 25 (12%) knees. 30° valgus stress testing was normal in 7 of 7 (100%) surgically treated MCL tears, and in 7 of 8 (87.5%) brace-treated knees. Postoperative KT-1000 arthrometer testing mean side-to-side difference measurements were 2.7 mm (PCL screen), 2.6 mm (corrected posterior), and 1.0 mm (corrected anterior) measurements, a statistically significant improvement from preoperative status (P = .001). Postoperative stress radiographic side-to-side difference measurements measured at 90° of knee flexion and 32 lb posteriorly directed proximal force were 0 to 3 mm in 11 of 21 (52.3%) knees, 4 to 5 mm in 5 of 21 (23.8%), and 6 to 10 mm in 4 of 21 (19%) knees. Postoperative Lysholm, Tegner, and HSS knee ligament rating scale mean values were 91.2, 5.3, and 86.8, respectively, showing a statistically significant improvement from preoperative status (P = .001). Conclusions: Combined ACL/PCL instabilities can be successfully treated with arthroscopic reconstruction and the appropriate collateral ligament surgery. Statistically significant improvement is noted from the preoperative condition at 2- to 10-year follow-up using objective parameters of knee ligament rating scales, arthrometer testing, stress radiography, and physical examination. Postoperatively, these knees are not normal, but they are functionally stable. Continuing technical improvements will probably improve future results.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 18, No 7 (September), 2002: pp 703–714     

Posterior cruciate ligament and coupled posterolateral instability of the knee

We wanted to investigate the role of the posterior cruciate ligament (PCL) in the knee's posterolateral stability and the magnitude of the coupled posterolateral instability with the knee examined at 90 degrees of flexion. The coupled posterolateral instability of the knee was studied by selective ligament cutting in cadaver knees set at 90 degrees. The coupled posterolateral displacement after cutting the PCL was 173% of the intact knee. With an intact PCL, the coupled posterolateral displacement after cutting the popliteus tendon and lateral collateral ligament with the knee at 90 degrees of flexion was 299% of the intact knee. When the PCL was cut together with the popliteus tendon and lateral collateral ligament, the coupled posterolateral displacement was 367%. The PCL plays an important role in the posterolateral stability of the knee, and its injury may cause mild (< 5 mm) to moderate (5-10 mm) posterolateral instability. Thus, in a knee with posterolateral instability, injury of the PCL must be considered. With an intact PCL, the posterolateral instability was very recognizable with the knee at 90 degrees of flexion, and injury to the PCL further increased the posterolateral instability and caused posterior translation of the knee. Therefore, examination for posterolateral instability of the knee should also be performed with the knee at 90 degrees of flexion, which is much easier to perform in a clinical setting. A positive posterior translation rather than posterolateral instability at different knee positions differentiates knees with combined PCL and posterolateral instability from knees with isolated posterolateral instability.     

后十字韧带单束重建联合小切口切开腘腓韧带重建治疗严重膝关节不稳定

目的 评估后十字韧带(posterior cmciate ligament,PCL)单束重建联合小切口切开腘腓韧带(popliteofibular ligament,PFL)重建治疗严重的膝关节后向和后外旋转不稳定的临床结果.方法 自2003年7月至2007年4月,共有28例连续的患者接受关节镜下PCL单束重建联合小切口切开PFL重建手术.人选条件:所有患者均为严重的膝关节不稳定,后抽屉试验为3~+或以上,胫骨后移程度与健侧相比≥12mm,胫骨外旋程度大于健侧10°以上,同时不合并外侧副韧带的损伤.入选的患者接受关节镜下单束PCL重建,使用异体跟腱作为移植物.在膝关节外侧通过两个小切口切开,使用异体胫前肌腱重建PFL.股骨侧切口位于股骨外上髁,长度为2cm;腓骨侧切口位于腓骨头,长度为3 cm.结果 术后平均随访时间为39.7个月.使用膝关节应力像评估后向稳定性,胫骨后移程度(患侧与健侧的差值)由术前(17.7±4.5)mm减小为术后(4.5±3.9)mm,胫骨外旋程度(患侧与健侧的差值)由术前16.0°±4.7°减小为术后-2.8°±6.4°,术前与术后的差异有统计学意义.IKDC评分:术前28例均为D级,术后A级为10例,B级9例,C级8例和1例D级.结论 关节镜下PCL单束重建联合使用小切口切开PFL重建能够有效地改善膝关节后向和后外旋转不稳定.     

Arthroscopic reconstruction of the posterior cruciate ligament with quadruple hamstring tendon graft: a double fixation method

BACKGROUND: Surgical reconstruction is indicated for posterior cruciate ligament (PCL) reconstruction for a grade III or IV injury, combined ligament or meniscus injuries, and chronic symptomatic posterior instability. Considerable controversy continues over the choice of graft tissues. Hamstring tendon has been popular in recent years. The purpose of this study is to prospectively assess the outcomes of PCL reconstruction using quadruple hamstring tendon autograft with a double-fixation technique at minimal 2-year follow-up. METHODS: Only patients who received PCL reconstruction without combined associated posterolateral injury reconstruction were included in the series. A hamstring tendon graft is composed of a quadruple-stranded semitendinosus tendon and gracilis tendon 10 cm in length. An arthroscopic technique using a two-incision method and a double-fixation technique were used. Clinical assessments were performed for 30 patients, of which 27 were available for final outcome analysis. Clinical review of patients included the Lysholm knee scores, International Knee Documentation Committee (IKDC) scores, thigh muscle assessment, and radiographic evaluation. RESULTS: On the Lysholm knee rating, 89% of the patients demonstrated good or excellent results in the final assessment. In the IKDC rating analyses, 56% of the patients revealed 3- to 5-mm ligament laxity. Four patients (15%) had grade II laxity. For the IKDC final rating, 26% were normal and 55% were nearly normal. Seventy-eight percent of the patients had less than a 10-mm difference in thigh girth between their reconstructed and opposite limbs. CONCLUSION: Arthroscopic PCL reconstruction with quadruple hamstring tendon autograft appears to produce acceptable results at a minimal 2-year follow-up. The four-stranded hamstring tendon graft is adequate in graft size and associated with minimal harvesting morbidity. The double-fixation method for the graft could provide a rigid fixation. We believe that this technique could afford good ligament function after reconstruction and could be a reasonably acceptable choice for PCL injury.     

Vierjahresergebnisse nach isolierter hinterer Kreuzbandrekonstruktion in Einbündeltechnik

Background

The purpose of this study was to evaluate the clinical and radiological results after isolated reconstruction of the posterior cruciate ligament (PCL) using semitendinosus (ST) and gracilis (GT) tendon grafts with the arthroscopic single-bundle technique.

Materials and methods

Following PCL reconstruction using the single-bundle technique performed between 2002 and 2005, 14?patients (2 women, 12 men) prospectively underwent a standardized follow-up examination after an average postoperative time of 4?years. All patients included in this study had isolated insufficiency of the PCL and symptomatic instability. The exclusion criteria were the presence of a complex knee joint instability and the implementation of additional stabilizing measures or another method of PCL reconstructive surgery. The mean follow-up time was 47.2?±?8.7 months. Preoperative and postoperative stress radiographs were taken using the Telos stress instrument in order to evaluate the posterior translation. Knee joint function and degree of activity were recorded using the Tegner activity score, the subjective IKDC score and the overall IKDC score.

Results

The posterior tibial translation of 10.1±1.7?mm had an overall average improvement to a postoperative value of 4.6?±?2.3?mm (p?Conclusion The above mentioned reconstruction technique can achieve a stable knee function in patients with isolated PCL insufficiency. The isolated single-bundle PCL reconstruction offers a medium-term improvement regarding the activity level and stability of the knee joint.     

局部修复和(或)异体肌腱重建治疗急性膝关节后外侧复合结构损伤

 目的 探讨采用局部修复和（或）异体肌腱重建治疗急性膝关节后外侧复合结构（postero-lateral complex,PLC）损伤的方法及疗效。方法 2006年5月至2008年10月,收治急性P LC损伤患者12例,男9例,女3例;年龄23～47岁,平均31岁;合并后十字韧带损伤9例,合并前、后十字韧带同时损伤3例。首先在关节镜下采用异体肌腱解剖重建前、后十字韧带,然后对于P LC两端附着点撕脱损伤的患者采用铆钉固定、缝线缝合修复治疗;对于P LC实质部断裂的患者采用局部缝合修复和（或）异体肌腱重建的方法治疗。术后根据K T-1000、IKDC及Lysholm功能评定标准评价膝关节功能恢复情况。结果12例患者均获得随访,随访时间12～18个月,平均13.3个月。膝关节活动度由术前118.00°±6.77°提高至术后130.75°±3.05°。KT-1000由术前（14.85±1.83）mm改善至术后（4.18±1.88）mm。根据IKDC综合评定标准,A级7例,B级3例,C级1例,D级1例。Lysholm膝关节功能评分由术前35～44分[平均（38.83±3.16）分]提高至术后79～91分[平均（84.92±3.73）分]。所有患者患膝均无感染及免疫排斥反应。3例患者住院期间B超显示患侧小腿肌间静脉血栓,经低分子肝素钙治疗后好转。2例患者膝关节屈曲较对侧少15°。结论对于急性P LC损伤患者,PLC两端附着点撕脱损伤采用铆钉固定、缝线缝合修复;实质部断裂的患者采用局部缝合修复和（或）异体肌腱重建治疗可取得较好的效果。     

All-Arthroscopic Repair of Arcuate Avulsion Fracture With Suture Anchor

Arcuate avulsion fractures are very rare but present pathologic posterolateral rotation instability. Untreated instability may lead to overload of the reconstructed posterior cruciate ligament (PCL) graft. Surgical treatment and clinical results have not yet been reported to our knowledge. This study presents the case of a 45-year-old man with PCL injury and an arcuate avulsion fracture of the fibular head. The dial test was positive preoperatively, and magnetic resonance imaging showed an “arcuate” sign. The avulsed bone fragment was reduced and fixed with a suture anchor by an all-arthroscopic technique. At the 1-year follow-up, the patient had resumed all his normal activities, including sports. He scored 1+ on the posterior drawer test, and external rotation was 1° less than that in his contralateral normal knee. Compared with the values in the contralateral normal knee, the posterior tibial translation was reduced from 15.5 mm preoperatively to 6.3 mm postoperatively. The postoperative magnetic resonance imaging and computed tomography scans showed that the reconstructed PCL graft and the osseous fragment of the styloid process of the fibular head attached to the popliteofibular ligament were reduced. This technical note describes an all-arthroscopic reduction and fixation technique of arcuate avulsed fracture of the fibular head.     

全关节镜下膝关节后外复合体重建

目的 介绍全关节镜下腘肌腱重建、腘肌腱联合腘腓韧带重建或膝关节后外复合体(posterolateral corner,PLC)解剖重建的手术技术,探讨全关节镜下PLC重建治疗膝关节后外不稳定的效果.方法 2008年8月至2010年4月,共完成全关节镜下后十字韧带(posterior cruciate ligament,PCL)+PLC重建手术34例.患者在接受手术时平均年龄34.1岁(15～52岁);男32例,女2例;从受伤到手术平均10.7个月.所有病例均为陈旧性损伤,且均为复合韧带损伤.所有PCL损伤的病例都存在PLC损伤.合并前十字韧带损伤6例(17.6%),合并前十字韧带、内侧副韧带损伤2例(5.9%),合并内侧副韧带损伤5例(14.7%).对膝关节PLC损伤进行分型,采用不同的重建技术进行治疗.对于A型旋转不稳定,采用全关节镜下腘肌腱重建、腘肌腱联合腘腓韧带重建;对于C型后外不稳定,采用全关节镜下PLC解剖重建.结果 14例患者获得随访并进行二次关节镜检查,平均随访18.5个月(13～25个月).终末随访包括:膝关节查体、KT-1000测量、膝关节应力像和胫骨外旋稳定性.使用膝关节应力像测量胫骨后移程度,胫骨后移由术前平均15.56mm减少为术后5.16mm,手术前后差异有统计学意义.使用屈膝30°位胫骨外旋试验评估膝关节后外旋转不稳定.对比患侧与健侧胫骨外旋的差值,由术前平均14.92°减小为术后-0.22°,手术前后差异有统计学意义.术后患者平均屈曲受限4.23°,无伸膝受限.结论 对于膝关节PLC损伤导致的不稳定,采用全关节镜下PLC重建的手术技术,能够有效恢复膝关节后外旋转不稳定.这种手术技术能够与PCL重建联合应用.

Abstract：

Objectiye To introduce the surgical technique of arthroscopy assisted anatomical posterolateral corner (PLC) reconstruction,including popliteal ligament,popliteofibular ligament and lateral collateral ligament,and evaluate the results of this technique.Methods From August 2008 to April 2010,34arthroscopic posterior cruciate ligament (PCL) and PLC reconstruction surgeries were performed.The average age of the patients was 34.1 (15-52) years.There were 32 males and 2 females.The average time period from injury to surgery was 10.7 months.All patients were chronic injuries and combined ligament injuries,including PCL and PLC injuries.Some cases had other ligament injury,including 6 patients of anterior cruciate ligament (ACL) injury (17.6%),2 of ACL combined medial cruciate ligament (MCL) injuries (5.9%),and 5 of MCL injuries (14.7%).According to Fanellis classification,for type A posterolateral rotation instability,we performed arthroscopic popliteal ligament reconstruction or popliteal ligament combined popliteofibular ligament reconstruction.For type C posterolateral instability,we performed arthroscopic PLC anatomical reconstruction.Results During the follow-up period,14 patients had undergone a second look arthroscopic examination and removal of hardware.The average follow-up time was 18.5 months (13-25 months).At the final follow-up,physical examination,stability evaluation with KT-1000 and Telos stress view,and dial test were performed.The posterior displacement of the knee had decreased from 15.56 mm preoperatively to 5.16mm postoperatively.The external rotation instability had decreased from 14.92° preoperatively to -0.22°postoperatively.The average limitation of knee flexion was 4.23° and no knee extension was limited.Conclusion With the surgical technique of arthroscopy assisted anatomical PLC reconstruction,we can restore the external rotation stability of knee.This technique can be performed combine with PCL reconstruction.