8股及4股自体腘绳肌移植物重建治疗低度轴移的膝关节前交叉韧带损伤的疗效对比研究

目的：比较应用8股腘绳肌移植物及4股腘绳肌移植物重建合并低度轴移（轴移1+）的前交叉韧带（ACL）损伤的临床效果。方法：回顾性分析从2019年10月至2021年3月北京积水潭医院收治的ACL损伤患者，入选患者术前麻醉下检查轴移试验为1度且有术后一年以上随访结果。采用8股腘绳肌移植物重建ACL的患者为A组，4股腘绳肌移植物重建ACL的患者为B组。评估术前及术后最少1年随访时，Lachman试验、KT-1000侧-侧差值、轴移试验、Lysholm评分以及国际膝关节文献委员会（IKDC）评分的组内和组间变化。结果：A组患者50例，平均随访时间14.8±6.2个月；B组患者50例，平均随访13.7±3.3个月。末次随访时，两组患者的主客观评估指标均较术前显著改善（P<0.05）。组间比较显示，末次随访时A、B两组患者的Lachman试验、KT-1000侧-侧差值、Lysholm评分以及IKDC评分差异无统计学意义（P>0.05）;A组轴移试验均为阴性，B组轴移试验44例阴性，6例1+，差异有统计学意义（P<0.05）。结论：合并低度轴移（轴移1+）的ACL损伤患者，应用8股自...     

关节镜下异体骨-髌腱-骨纤维束重建治疗前交叉韧带部分损伤

目的 探讨异体骨-髌腱-骨纤维束（B-PT-B）重建前交叉韧带（ACL）全部纤维束和部分纤维束的早期疗效。方法在187例采用B-PT-B术式重建ACL的患者中，获得随访的ACL部分束损者共25例，其中采用全部纤维束重建的患者6例，部分纤维束重建19例。术后行X线和KT-1000检查，并按照IKDC、Lysholm、Irgang、Larson评分进行疗效评价。结果 所有患者随访时移植物位置良好，KT-1000检查双侧膝关节前向松弛度差值〈3mm。部分束重建组与全部束重建组各评分系统和分项评分系统无显著性差异。结论 异体B-PT-B重建治疗ACL部分损伤可以取得良好的临床疗效，与ACL全部束重建术相比综合评定无明显差异。     

三种移植物关节镜下重建前交叉韧带的临床疗效比较

目的比较分析膝关节镜下自体骨-髌腱-骨（B-PT-B）、同种异体跟腱和LARS（1igament advanced reinforce．mentsystem,LARS）人工韧带重建前交叉韧带（anterior cruciate ligament,ACL）的临床疗效差异。方法从2008年2月-2010年11月,对156例膝关节ACL损伤患者行关节镜下ACL重建术,其中自体骨-髌腱-骨（B-PT-B）组39例,同种异体跟腱组53例,LARS人工韧带组64例。通过一般情况、前抽屉试验、Lachman试验、轴移试验、Lysholm、IKDC膝关节评分进行临床疗效评价。结果所有患者随访12-38个月,平均21个月,术后3、6个月各组膝关节Lysholm、IKDC评分,LARS组明显高于其余2组（P〈O．05）。异体跟腱组与自体B-PT-B组相比,差异无统计学意义（P〉0．05）。术后12月及最后随访时,LARS组略高于其余2组,但3组间差异无统计学意义（P〉0．05）。结论在关节镜下应用3种不同移植物重建前交叉韧带的近期疗效均较为满意,LARS组可在术后早期进行膝关节功能活动近期效果优于自体B-PT-B组和异体跟腱组。对于年轻患者．尤其是运动员ACL损伤。LARS人工韧带是一种理想移植材料。     

自体与深低温冷冻异体髌腱重建前交叉韧带临床疗效比较研究

目的:回顾性观察比较自体与深低温冷冻同种异体骨腱骨(BPTB)组织重建膝关节前交叉韧带(ACL)临床疗效差异。方法:回顾2003年8月~2005年12月共82例ACL损伤患者,其中自体同侧BPTB组织移植59例,同种异体BPTB移植23例。术前、术后行体格检查、膝关节IKDC评定、Lysholm-Tegner评分、VAS疼痛评分及KT-2000检测。采用t检验及χ2检验比较两组间差异。结果:41例自体及17例异体移植物重建患者分别获得平均34.3个月(18~46个月)和平均33.5个月(19~43个月)的最终随访。异体组发生再断裂1例,无感染及排斥反应。自体组4例无明显跪地痛,其余37例患者均极少或未尝试跪地动作,其中髌前取骨处明显压痛5例。5例自体及1例异体移植患者随访时前抽屉试验(ADT)阳性,3例自体及1例异体称植患者Lachman检查阳性。术后两组间关节活动度、膝关节IKDC评定、Lysholm-Tegner评分、KT-2000检测均无显著差异,VAS评分有显著差异(P<0.05)。结论:同种异体与自体髌腱移植物重建ACL临床疗效相近,同种异体移植组织是重建ACL的良好替代物。     

机器人辅助关节镜下重建前交叉韧带的疗效

目的比较机器人辅助关节镜下重建与单纯关节镜下重建前交叉韧带(ACL)的临床疗效。方法采用回顾性队列研究分析2020年1月至2020年9月西安交通大学附属红会医院收治的37例ACL撕裂患者的临床资料,其中男24例,女13例;年龄16~45岁[(30.7±9.8)岁]。17例在机器人辅助关节镜下行ACL重建(机器人组),20例在单纯关节镜下行ACL重建(单纯关节镜组)。比较两组手术时间、导针钻孔次数、骨道位点的准确性(骨道中心点距理想解剖点的距离)、围术期并发症情况。术前、术后4个月及末次随访时采用Lachman试验、KT-2000测量数值评估膝关节稳定情况,采用Lysholm评分、国际膝关节文献委员会(IKDC)评分及关节屈伸活动度评估膝关节功能恢复情况。结果患者均获随访12~18个月[(13.1±4.1)个月]。机器人组手术时间为(83.8±11.3)min,明显长于单纯关节镜组的(50.4±9.1)min(P<0.01)。机器人组导针钻孔次数为(2.2±0.5)次,较关节镜组的(2.5±0.4)次少(P<0.05)。机器人组骨道中心点距理想解剖点的距离为(1.3±0.3)mm,关节镜组为(1.4±0.3)mm,两组差异无统计学意义(P>0.05)。两组均未见围术期并发症。术前、术后4个月及末次随访时两组间Lachman试验、KT-2000测量数值、Lysholm评分、IKDC评分及关节屈伸活动度差异无统计学意义(P均>0.05);两组内术后4个月及末次随访时以上相关指标较术前显著改善(P均<0.01),术后4个月与末次随访时以上相关指标差异无统计学意义(P均>0.05)。结论机器人辅助关节镜下重建ACL较单纯关节镜下重建ACL手术时间稍长,但可一次性制备具有良好位点及方向的骨道,获得与单纯关节镜下重建ACL相似的关节稳定性及功能恢复。     

关节镜下应用LARS人工韧带同时重建前、后交叉韧带

目的 探讨关节镜下应用LARS人工韧带重建前交叉韧带(ACL)、后交叉韧带(PCL)同时损伤的方法及疗效. 方法 关节镜下同时重建13例ACL、PCL损伤的患者,重建材料采用LARS人工韧带.术后随访12～36个月,采用国际膝关节文件编制委员会(IKDC)韧带标准评价表和Lysholm膝关节功能评分表评估患膝功能,通过KT-1000检查膝关节前后松弛度.结果 术后无膝关节感染发生;均无伸膝受限,屈膝活动度105°～125°,平均117°.术后随访时IKDC评分:A类10例(77%),B类3例(23%).屈膝25°位KT-1000检查:双侧膝关节前向松弛度差异＜2 mm 12例,3～5 mm 1例;屈膝70°位检查:＜2 mm 12例,2～4 mm 1例.术前Lysholm膝关节功能评分为(63.8 ±2.9)分(49～69分),终末随访时为(91.1±2.7)分(88～95分),差异有统计学意义(P＜0.01). 结论 关节镜下同时重建膝关节ACL、PCL是目前治疗ACL、PCL同时损伤的一种微创、安全、有效的手术方法,近期疗效佳.     

前交叉韧带重建中不同入路制备股骨骨道的对比研究

目的:比较改良经胫骨隧道(TT)入路和前内侧(AM)入路两种方法解剖位重建前交叉韧带(ACL)术后,股骨隧道的定位情况及临床疗效。方法:回顾性分析2016年1月～2017年12月我科收治的42例单侧前交叉韧带损伤患者的临床资料。其中24例采用改良TT入路技术重建ACL,18例采用AM入路技术重建ACL。术后1周内行膝关节CT平扫+三维重建评估股骨骨道位置,术后3个月时扫描MRI并测量JGS、JGC角;术前及术后12个月评估患者国际膝关节文献委员会(IKDC)评分、Lysholm评分、膝关节前方松弛度及轴移试验结果。结果:术前两组患者性别、年龄、病程、IKDC评分、Lysholm评分、膝关节前方松弛度、轴移试验阴性率,差异均无统计学意义(P>0.05)。末次随访时,两组患者IKDC评分、Lysholm评分,前方松弛度,轴移试验阴性率相较术前均显著改善,差异具有统计学意义(P<0.05);组间比较,差异无统计学意义(P>0.05)。CT三维重建分析显示,两组股骨骨道内口位置无明显差异(P>0.05),MRI测量JGS、JGC角,组间无明显差异(P>0.05)。结论:采用改良经胫骨隧道入路和前内侧入路重建ACL,均可获得良好的股骨解剖中心隧道定位,骨道位置无明显差异,术后早期疗效令人满意。     

关节镜下保留与切除残迹前交叉韧带重建的远期临床比较

目的 评估比较关节镜下保留与切除残迹的前交叉韧带(anterior cruciate ligament,ACL)重建的技术方法 与远期临床效果. 方法 自1999年10月至2005年5月采用经典的经胫骨技术,常规切除ACL残迹,4股胭绳肌腱移植物重建ACL术87例.自2005年6月至2010年5月采用由外向内建立骨隧道,保留ACL残迹,4股胭绳肌腱移植物重建ACL术221例.仅选择两种手术处理中单纯ACL重建,并有完整3年以上随访记录的患者进行对比分析,保留残迹组66例,切除残迹组39例. 结果 两组患者术后随访均为36～ 60个月,两组随访时间比较差异无统计学意义(P＞0.05).术前资料比较,两组在年龄、性别、损伤至手术时间、关节不稳定程度、膝关节功能评分等方面差异均无统计学意义(P＞0.05).随访资料比较,两组双侧股部周径差值、两组Lachman试验稳定程度差异均无统计学意义(P＞0.05).保留残迹组的关节活动度优于切除残迹组(P＜0.05),Lysholm评分显著高于切除残迹组(P＜0.05),前抽屉试验稳定性显著优于切除残迹组(P＜0.05),轴移试验稳定性显著优于切除残迹组(P＜0.05),国际膝关节文件编制委员会( IKDC)评级显著优于切除残迹组(P＜0.05). 结论 关节镜下由外向内建立骨隧道、保留残迹ACL重建术的远期临床效果,包括关节稳定性和关节功能,优于经典的经胫骨技术、切除残迹ACL重建术.     

自体胭绳肌腱与同种异体胫前肌腱重建前交叉韧带的对照研究

目的观察自体胭绳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）的疗效与差异。方法将54例ACL损伤患者分为2组,自体胭绳肌腱移植组33例,同种异体肌腱移植组21例,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（ADT）和国际膝关节评分委员会（IKDC）、Lysholm及Tegner评分。结果两组患者术后膝关节稳定性均较术前得到明显好转,除手术时间外,物理检查及功能评分差异均无统计学意义（P〉0．05）。结论关节镜下自体及同种异体肌腱重建ACL都有较好的疗效,可根据患者的病情及主观要求灵活选择。     

3D打印个性化股骨侧定位导向器辅助前交叉韧带重建疗效观察

目的评价3D打印技术设计个性化股骨侧定位导向器应用于前交叉韧带(ACL)重建手术的临床效果。方法收集2014年1月至2016年1月应用3D打印个性化股骨侧定位导向器辅助行关节镜下ACL重建术患者40例为3D组,术前进行3D建模、ACL股骨侧止点定位。应用常规经膝关节前内侧入路手动进行股骨侧定位的ACL重建术患者40例为常规组。比较两组患者术后Lysholm及国际膝关节文献委员会膝关节评估表(IKDC)评分。结果两组患者手术过程顺利,均未出现并发症。3D组术前均建模顺利,术前定位股骨侧隧道口后,股骨侧隧道长约(42.1±3.3)mm,常规组测量股骨侧隧道长约(39.5±3.9)mm,两组间比较,差异无统计学意义(P>0.05)。两组患者随访时间6~13个月,平均10个月。术后10个月,两组患者Lysholm及IKDC评分均较术前明显提高,差异有统计学意义(P<0.05);两组间Lysholm及IKDC评分比较,差异均无统计学意义(P>0.05)。结论应用3D打印技术设计个性化股骨侧定位导向器进行ACL重建手术有助于精准定位股骨侧解剖点、控制导针方向,利于腱骨愈合,缩短手术时间,加快术后康复。     

Anterior cruciate ligament reconstruction with BPTB autograft, irradiated versus non-irradiated allograft: a prospective randomized clinical study

The effect of using gamma irradiation to sterilize bone-patellar tendon-bone (BPTB) allograft on the clinical outcomes of anterior cruciate ligament (ACL) reconstruction with irradiated allograft remains controversial. Our study was aimed to analyze the clinical outcomes of arthroscopic ACL reconstruction with irradiated BPTB allograft compared with non-irradiated allograft and autograft. All BPTB allografts were obtained from a single tissue bank and the irradiated allografts were sterilized with 2.5 Mrad of irradiation prior to distribution. A total of 102 patients undergoing arthroscopic ACL reconstruction were prospectively randomized consecutively into three groups. The same surgical technique was used in all operations done by the same senior surgeon. Before surgery and at the average of 31 months follow-up (range 24–47 months) patients were evaluated by the same observer according to objective and subjective clinical evaluations. Of these patients, 99 (autograft 33, non-irradiated allograft 34, irradiated allograft 32) were available for full evaluation. When compared the irradiated allograft group to non-irradiated allograft group or autograft group at 31 months follow-up by the Lachman test, ADT, pivot shift test and KT-2000 arthrometer testing, statistically significant differences were found. Most importantly, 87.8% of patients in the Auto group, 85.3% in the Non-Ir-Auto group and just only 31.3% in the Ir-Allo group had a side-to-side difference of less than 3 mm according to KT-2000. The failure rate of the ACL reconstruction with irradiated allograft (34.4%) was higher than that with autograft (6.1%) and non-irradiated allograft (8.8%). The anterior and rotational stability decreased significantly in the irradiated allograft group. According to the overall IKDC, functional, subjective evaluations and activity level testing, no statistically significant differences were found between the three groups. However, there was a trend that the functional and activity level decreased and the patients felt uncomfortable more often in the irradiated allograft group. The statistical analysis showed no significant difference between the non-irradiated allograft group and the autograft group according to the aforementioned evaluations, except that patients in the allograft group had a shorter operation time and a longer duration of postoperative fever. When comparing the postoperative duration of fever of the two allograft groups, there was also a trend that the irradiated allograft group was longer than the non-irradiated allograft group, but no significant difference was found. When the patients had a fever, the laboratory examinations of all patients were almost normal (Blood routine was normal, the values of ESR were 5 ~ 16 mm/h, CRP were 3 ~ 10 mg/l). On the basis of our study, we concluded that patients undergoing ACL reconstruction with BPTB non-irradiated allograft or autograft had similar clinical outcomes. Non-irradiated BPTB allograft is a reasonable alternative to autograft for ACL reconstruction. While the short term clinical outcomes of the ACL reconstruction with irradiated BPTB allograft were adversely affected with an increased failure rate. The less than satisfactory results led the senior authors to discontinue the use of irradiated BPTB allograft in ACL surgery and not to advocate that gamma irradiation be used as a secondary sterilizing method. Further research into alternatives to gamma irradiation is needed. Supported by Provincial Science Foundation of China (2004GG2202034).     

关节镜下前交叉韧带重建术后失败行翻修术的近中期临床疗效

 目的 探讨关节镜下前交叉韧带重建术后失败行翻修术的近中期临床疗效。方法 回顾性分析武警海警总队医院2013-02至2019-02收治的前交叉韧带重建术后失败行翻修术患者30例(30膝)临床资料,术后平均随访时间37个月(6~70个月)。手术前后膝关节功能采用Lysholm评分、Tegner评分、IKDC评分、KT-2000差值进行分析,采用Lachman试验、前抽屉试验对手术前后膝关节前方稳定性进行分析。结果 Lysholm评分术前(48.33±5.43)分,末次随访(82.92±4.13)分;Tegner评分术前(2.18±0.91)分,末次随访(6.52±1.12)分;IKDC评分术前(48.32±5.54)分,末次随访(76.45±3.86)分;KT-2000屈曲90°差值术前(6.95±1.21)mm,末次随访(2.23±0.84)mm,KT-2000屈曲30°差值术前(6.62±1.01)mm,末次随访(2.34±0.42)mm;差异均有统计学意义(P<0.05)。Lachman试验、前抽屉试验术前30例全部阳性,术后全部阴性,膝关节功能术后提高明显。结论 前交叉韧带重建术后失败行翻修术,近中期疗效满意。     

Evaluation of the reproducibility of the KT-1000 arthrometer

The aim of the study was to examine whether the KT-1000 arthrometer was reliable when it came to distinguishing between a group of patients with a chronic anterior cruciate ligament (ACL) rupture and a group of patients without an ACL rupture, and to examine the reproducibility of the examination between two experienced examiners. The aim was also to examine whether the KT-1000 measurements were dependent on whether the patients were awake or under anaesthesia. The study comprised 40 patients: Group A consisted of 20 patients who had a chronic unilateral ACL rupture and Group B consisted of 20 patients who were scheduled for arthroscopy due to knee problems other than an ACL rupture. The KT-1000 examination was performed before surgery by two experienced physiotherapists (PT I and PT II). PT II subsequently performed a retest of the patients under anaesthesia. The mean anterior side-to-side laxity difference between PT I and PT II was 0.2 mm in Group A and 1.8 mm in Group B (n.s., P=0.03). The anterior side-to-side measurements of knee laxity revealed significant differences between Group A and Group B, independent of who the measurements were made by when the patients were awake (PT I P=0.011, PT II P=0.001). However, no significant difference (P=0.063) was found when the patients were under anaesthesia. The interclass correlation coefficient (ICC) between PT I and PT II in Group A was 0.55 (P=0.005) for the anterior side-to-side laxity, while it was 0.60 (P=0.002) in Group B. There were no significant differences within Group A or Group B between the measurements made when people were awake compared with those under anaesthesia. The conclusions of the study were that the KT-1000 arthrometer was able to distinguish a group of patients with an ACL rupture from a group without one. The reproducibility of the KT-1000 measurements of anterior knee laxity between two experienced examiners was considered as fair. Furthermore, the measurements were not dependent on whether the patients were awake or under anaesthesia.     

Does irradiation affect the clinical outcome of patellar tendon allograft ACL reconstruction?

The clinical implications of using irradiation to sterilize allograft bone–patellar tendon–bone (BPTB) remains unknown. The purpose of this study was to compare the clinical outcome of anterior cruciate ligament (ACL) reconstruction with irradiated allograft versus autograft BPTB. We hypothesized that patients undergoing ACL reconstruction with irradiated BPTB allograft would have no significant differences in patient-reported and objective parameters compared to those undergoing autograft BPTB reconstruction. Patients who underwent ACL reconstruction with either irradiated allograft or autograft BPTB from 1996 to 2002 were eligible for this study. One hundred and two patients (39 allograft, 63 autograft) met the study criteria and were available for follow-up. The BPTB allografts were obtained from a single tissue bank and were sterilized with 2.5 Mrad of irradiation prior to distribution. Participants completed the International Knee Documentation Committee (IKDC) subjective knee form and returned for physical and radiographic examinations, instrumented measurement of laxity, and functional testing. Patients were evaluated at an average follow-up of 4.2 years (range 1.8–8.4). Those undergoing allograft reconstruction were older (44±8.4 vs. 25.3±9.3 years, p<0.001) and had a longer median time from injury to surgery (17.1 weeks vs. 9.7 weeks, p=0.04). There was no difference in IKDC Subjective Knee Scores between groups (86.7 allograft vs. 88.0 autograft, p=0.65). The average maximum manual KT-1000 side-to-side difference was 1.3 and 2.2 mm for allograft and autograft, respectively (p=0.04); however, after adjusting for age, this difference was no longer significant. 90.6% of the allograft and 82.8% of the autograft had normal/nearly normal overall IKDC physical examination rating (p=0.37). 66.7% of the allograft and 77.8% of the autograft returned to the same or more strenuous level of sports (p=0.25). Patients undergoing ACL reconstruction with irradiated allograft BPTB had similar clinical outcomes compared to those reconstructed with autograft BPTB. These data suggest that irradiation can be used to sterilize BPTB allograft without adversely affecting clinical outcome.     

Analysis of subjective, objective and functional examination tests after anterior cruciate ligament reconstruction A follow-up of 527 patients

This study included 527 patients (178 female and 349 male) with unilateral anterior cruciate ligament (ACL) rupture who underwent arthroscopic ACL reconstruction using bone-patellar tendon-bone autograft and interference screw fixation. The follow-up examination was performed by independent observers at a median of 38 (21-68) months after the index operation. At the follow-up, the Lysholm score was 86 (14-100) points, the Lysholm instability subscore was 22 (0-25) points and the Lysholm pain subscore was 19 (0-25) points. The Tegner activity level was 6 (1-10). The one-leg-hop test was 91 (0-167)% of the non-injured knee. The difference in the anterior side-to-side laxity as measured with the KT-1000 arthrometer at 89 Newton (N) was 1.5 (-5-13) mm and the total KT-1000 side-to-side difference at 89 N was 2 (-7-11) mm. Using the International Knee Documentation Committee (IKDC) evaluation system, 177 (33.6%) patients were classified as normal (group A), 211 (40%) as nearly normal (group B), 109 (20.7%) as abnormal (group C) and 30 (5.7%) as severely abnormal (group D). The highest correlation coefficients were recorded between the IKDC evaluation system and the Lysholm score (p = 0.66), the patients' subjective evaluation (p = 0.53), the Tegner activity level (p = 0.34), all the laxity tests (p > or = 0.34) and the one-leg-hop test (p = 0.28). The resumption of sporting activities and work as evaluated by the Tegner activity level correlated with the patients' subjective evaluation (p = 0.34) but did not correlate with the laxity tests, i.e., the manual Lachman test (p = -0.06) and the total and anterior KT-1000 tests (p = -0.06). Furthermore, none of the laxity tests correlated with the functional tests or the patients' subjective evaluation. We conclude that the IKDC evaluation system is a reliable and useful tool for evaluating the post-operative outcome after an ACL reconstruction.     

A new technique for arthroscopic management of painful stiff knee after anterior cruciate ligament reconstruction due to femoral malposition

It is well known that a loss of motion occurs after ACL reconstruction, particularly after anterior placement of the femoral insertion of the graft. The problem, however, is related to the nonanatomical placement of the graft and not a consequence of an abnormal healing process. This situation can usually be improved by total graft resection. In our consideration the proximal transplant shift is probably a better treatment for patients with a structurally intact graft. This study was undertaken to illustrate our clinical findings. We examined 4 women and 7 men with a mean age of 28 years; the average follow-up period was 18 months. Preoperatively all patients complained of pain related to activity. The range of motion was 123 degrees -9.5 degrees -0 degrees flexion-extension. Eight patients were unable to participate in sports, and three were unable to work. The IKDC scores were: one B, four C, and six D. The Lachman test was negative or slide positive (1+). Postoperatively all patients improved and reported no or slight pain with a free range of motion (140 degrees -0 degrees -0 degrees ). All patients returned to work, and eight patients were able to practice sports again. The IKDC scores were two A, seven B, and two C. The average Lysholm score was 86 points. The clinical Lachman test was slide positive (1+). The radiological Lachman test and the KT-1000 test had a side-to-side difference of 2 mm. Based on these results, the proximal transplant shift seems to be a good alternative treatment for us at the present time.     

Early active extension after anterior cruciate ligament reconstruction does not result in increased laxity of the knee

If permission of full active and passive extension immediately after an anterior cruciate ligament (ACL) reconstruction will increase the post-operative laxity of the knee has been a subject of discussion. We investigated whether a post-operative rehabilitation protocol including active and passive extension without any restrictions in extension immediately after an ACL reconstruction would increase the post-operative anterior–posterior knee laxity (A–P laxity). Our hypothesis was that full active and passive extension immediately after an ACL reconstruction would have no effect on the A–P laxity and clinical results up to 2 years after the operation. Twenty-two consecutive patients (14 men, 8 women, median age 21 years, range 17–41) were included. All the patients had a unilateral ACL rupture and no other ligament injuries or any other history of previous knee injuries. The surgical procedure was identical in all patients and one experienced surgeon operated on all the patients, using the bone-patellar tendon-bone autograft. The post-operative rehabilitation programme was identical in both groups, except for extension training during the first 4 weeks post-operatively. The patients were randomly allocated to post-operative rehabilitation programmes either allowing (Group A, n=11) or not allowing [Group B (30 to −10°), n=11] full active and passive extension immediately after the operation. They were evaluated pre-operatively and at 6 months and 2 years after the reconstruction. To evaluate the A–P knee laxity, radiostereometric analysis (RSA) and KT-1000 arthrometer (KT-1000) measurements were used, range of motion, Lysholm score, Tegner activity level, the International Knee Documentation Committee (IKDC) evaluation system and one-leg-hop test quotient were used. Pre-operatively, the RSA measurements revealed side-to-side differences in Group A of 8.6 mm (2.3–15.4), median (range) and in Group B of 7.2 mm (2.2–17.4) (n.s.). The corresponding KT-1000 values were for Group A, 2.0 mm (0–8.0) and Group B, 4.0 mm (0–10.0) (n.s.). At 2 years, the differences between the two groups were minimal, regardless of the method that had been used. The RSA measurements in Group A were 2.7 mm (0–10.7) and in Group B 2.8 (−1.8 to 9.5). The KT-1000 values were for Group A, 1.0 mm (−1.5 to 3.5), and for Group B, 0.5 mm (−1.0 to 4.0), without any significant differences between the groups. Nor did the Lysholm score, Tegner activity level, IKDC or one-leg-hop test differ. Early active and passive extension training, without any restrictions in extension, immediately after an ACL reconstruction using bone-patellar tendon-bone graft did not increase post-operative knee laxity up to 2 years after the ACL reconstruction.     

A medium to long-term follow-up of ACL reconstruction using double gracilis and semitendinosus grafts

This paper reports the results of our approach to ACL tears and knee laxity, based on 30 years of experience in ACL reconstruction with hamstrings and founded on the following cornerstones: the use of doubled semitendinosus and gracilis as a free graft; the use of an out-in technique for femoral drilling and of very strong and stiff fixation devices; the careful examination and repair or reconstruction of the lateral compartment in selected patients; and the use of unaggressive rehabilitation. We prospectively evaluated a series of 100 consecutive patients who underwent ACL reconstruction between 2001 and 2002. A clinical and radiological follow-up was performed at a minimum of 6 years. After 6 years, the International Knee Documentation Committee score demonstrated good-to-excellent results (A and B) in 98% of patients. However, arthrometric results using the KT-1000 demonstrated that 6/80 patients (7.5%) had >5 mm manual maximum side-to-side difference. The median Tegner activity score was 5 (range 1–9); the median Lysholm score was 96 (range 81–100); and the median subjective IKDC score was 94 (range 66–100). We reported 6/80 failures as revealed by a 2+ or 3+ pivot-shift test result and/or KT-1000 side-to-side difference of more than 5 mm. The IKDC score revealed excellent results in all women who underwent extra-articular tenodesis. Radiographic evaluation demonstrated early signs of osteoarthritis in 9% of patients.     

关节镜下4股半腱肌腱单束重建前交叉韧带部分损伤

目的 介绍关节镜下单束蕈建增强治疗前交叉韧带(anterior cruciate ligament,ACL)后外侧束部分损伤方法 ,探讨其临床效果. 方法 对26例单纯ACL后外侧柬部分损伤患者,在关节镜下采用自体半腱肌腱进行单束解剖重建.按照国际膝关节评分委员会(internationalknee documentation committee,IKDC)和Lysholm膝关节功能评分表对患膝功能进行评估,通过KT-1000检查比较膝关节的前向松弛度. 结果 术后无活动受限,屈膝活动度130°～150°,平均142°.术后随访12～18个月,最后随访时IKDC评分为A级25例(96%),B级1例(4%);IKDC评分从术前的(71.4±3.7)分提高到随访结束时的(95.8±3.4)分(t=9.836,P<0.01).屈膝25°位KT-1000检查,双侧膝关节胫骨结节前移差异从术前的(5.1±1.2)mm减少到终末随访的(2.1±1.3)mm(t=10.48,P<0.01).患者术前Lysholm膝关节功能评分为(76.7±3.2)分,终末随访时为(95.7±2.4)分(t=7.356,P<0.01). 结论 在关节镜下采用自体半腱肌腱单束解剖重建增强治疗ACL后外侧束部分损伤,能取得良好效果.