关节镜下经后侧入路重建后交叉韧带

目的 探讨关节镜下经后内侧、后外侧和后纵隔入路保留板股韧带和残留的后交叉韧带(PCL)纤维重建PCL的临床效果. 方法 对9例PCL损伤患者在关节镜下结合常规关节镜入路和后内侧、后外侧入路及后纵隔入路保留板股韧带和残留的PCL纤维,应用自体腘绳肌腱重建PCL.在后外侧入路的关节镜监视下,胫骨隧道定位在PCL胫骨止点外侧关节面下方1～1.5 cm.股骨隧道经前外侧入路定位于股骨内侧髁关节软骨后方1 cm.自体肌腱移植物利用钢丝引导通过骨隧道,移植物两端用可吸收界面螺钉固定.术后6个月了解膝关节功能恢复情况.结果 9例患者均获随访,时间7～14个月,平均8.6个月.术后6个月,患者均无伸膝受限;2例有10°～15°屈膝受限;1例有Ⅰ度后抽屉试验阳性.Lysholm膝关节功能评分术前(47.6±14.9)分,术后6个月(92.9±4.6)分(P＜0.01). 结论 膝关节后内外侧入路和后纵隔入路重建PCL的方法,镜下视野清楚、无盲区,操作安全,韧带的胫骨止点定位准确,短期疗效肯定.     

Full arthroscopic inlay reconstruction of posterior cruciate ligament

We report a full arthroscopic inlay reconstruction technique to avoid the morbidity of traditional open inlay procedure. With the transeptal approach a trough is created arthroscopically at the anatomical tibial insertion of the PCL, which must fit with the patellar bone block of a quadriceps tendon autograft. The bone plug is harvested with two nonabsorbable sutures, each end of which is passed through two holes from the cortical to the cancellous side. The graft is introduced into the knee joint from the posteromedial portal using two traction sutures passed previously through two transtibial tunnels exiting at the middle of the trough. Tibial graft fixation is achieved using the sutures knotted at the anterior aspect of the tibial cortex. Arthroscopic inlay procedure may be a rational surgical alternative because it reduces the crucial steps of an open inlay procedure, such as extensive exposure of the posterior capsule, the need of position change with risk of contamination, longer surgical time, and the risk of bone block fracture if an autograft is harvested. The arthroscopic procedure may also be performed also when hardware presence of previous surgery limits use of the open technique. We initially limited use of this technique to patients: (1) undergoing PCL revision surgery, (2) having hardware from previous tibial surgery, and (3) presenting a PCL lesion following posterior dislocation with previous vascular surgery. The results have been good, and we are now also using this technique for primary PCL reconstruction with favorable results.     

Arthroscopic anterior cruciate ligament reconstruction with periosteum-enveloping hamstring tendon graft

Tendon–bone incorporation of a tendon graft within the bone tunnel is of priority concern when using for anterior cruciate ligament (ACL) reconstruction. Superior healing process and stronger healing strength can be achieved when periosteum is sutured on the tendon inserted into a bone tunnel. We applied this idea to ACL reconstruction for enhancing tendon graft–bone tunnel healing. This is a prospective clinical outcome study with this surgical technique at minimal 2 years follow-up. Periosteum-enveloping hamstring tendon graft has been used in 68 patients. Data from 62 patients who had been followed up completely were analyzed. All patients suffered from a grade 3 or higher grade of Lachman and anterior drawer test with a positive pivot-shift test. Clinical assessments included the Lysholm knee scores, International Knee Documentation Committee (IKDC) scores, KT-1000 instrumented testing, thigh muscle assessment, and radiographic evaluation. The median Lysholm knee score was 59 (40–70) and 94 (60–100) points (P<0.01) before and after surgery. After reconstruction, 81% of patients were able to return to moderate or strenuous activity. Four (6%) patients were found to exhibit grade 2 or more ligament laxity. Complete range of motion could be achieved in 86% of patients. Three patients (5%) had positive pivot shift. Finally, 92% of patients were assessed as normal or nearly normal rating by IKDC guideline. Bone tunnels enlargement of more than 1 mm was identified in 5% of femoral tunnels and 6% of tibial tunnels. The study shows that a satisfactory result can be achieved with the periosteum-enveloping hamstring tendon graft in ACL reconstruction. Periosteum can be easily harvested at the proximal tibia from a routine incision for hamstring tendon harvesting. Besides the potential for improving tendon–bone healing, enveloped periosteum may help to seal the intra-articular tunnel opening in the early postoperative period, and thus avoid synovial fluid reflux into the tunnel. Bone tunnel enlargement could be reduced.     

Arthroscopic posterior cruciate ligament reconstruction with hamstring tendon autograft: results with a minimum 4-year follow-up

This study prospectively evaluates the outcomes at a minimum 4-year follow-up after PCL reconstruction using quadruple hamstring tendon autograft with an arthroscopic double fixation technique. During 1996–1999, hamstring tendon autograft graft has been used in 57 patients. Data from 52 patients who had been followed up completely were analyzed. All patients suffered from a grade 3 or higher grade of posterior drawer test and posterior sag sign with MRI image confirmation. Twelve knees had combined posterior and posterolateral instability, which were simultaneously reconstructed. Clinical assessments included Lysholm knee score, International Knee Documentation Committee (IKDC) scores, KT-1000 instrumented test, thigh muscle assessment, and radiographic evaluation. The mean Lysholm score was 54 (40–65) and 91 (65–100) points (P<0.01) before and after surgery. Thirty (58%) patients could return to moderate or strenuous activity. The evaluation of AP translation has been performed with KT-1000. The average posterior displacement measured with KT-1000 was 11.69±2.01 mm preoperatively and 3.45±2.04 mm postoperatively. Forty-two (81%) patients demonstrated ligament laxity of less than 5 mm. Forty-two (81%) patients were rated as normal or nearly normal based on IKDC scores. Forty-six (88%) patients achieved a minimum of 80% recovery of extensor strength and 44 (85%) patients achieved a minimum of 80% recovery of flexor strength. Statistically significant differences existed in thigh girth, extensor strength, and flexor strength before and after reconstruction. Arthroscopic reconstruction for PCL with four-strand hamstring tendon graft produced satisfactory results. The semitendinosus and gracilis tendon graft is adequate in graft size, technically easier to perform and more reproducible, and had a satisfactory result.     

Arthroscopic-assisted anterior cruciate ligament reconstruction with the central third patellar tendon A 5–8-year follow-up

We reviewed 89 arthroscopically assisted patellar tendon anterior cruciate ligament (ACL) reconstructions for chronic isolated injuries with an average follow-up of 7 years (range 5.4 to 8.6 years). Pain was present in 7 knees (8%). Giving-way symptoms were reported by 7 patients (8%). A KT-2000 side-to-side difference over 5 mm at 30 lbs was recorded in 12 cases (16%). The pivot shift was glide in 17 cases (19%) and clunk in 10 (11%). A 3°– 5° extension loss compared with the normal side was present in 20 knees (22%) and 6°–10° in 4 knees (4%). The intra-articular exit of the femoral tunnel was misplaced in the anterior 50% of the condyles along the roof of the notch in 10% of the knees. This positioning significantly (P = 0.003) increased the frequency of graft failure (62.5%) compared with the cases with a more posterior placement (graft failure 12%). An anterior position of the intra-articular exit of the tibial tunnel (in the anterior 15% of the sagittal width of the tibia) significantly (P = 0.01) increased the frequency of extension loss > 5°. Medial meniscectomy was associated with a 35% incidence of narrowing of the medial joint space, which was significantly higher compared with knees with normal menisci (9%; P = 0.04) or with medial meniscal repair (7%; P = 0.05). In conclusion this study showed satisfactory anterior stability (KT-2000 side-to-side difference up to 5 mm and pivot absent or glide) in 83% of the knees. This percentage increases to 88% in the knees with a correct posterior and proximal femoral tunnel placement. Accuracy in tunnel positioning is essential for the success of ACL surgery. Meniscal repair was effective in decreasing joint space narrowing and should be attempted when possible. Received: 15 November 1996 Accepted: 17 March 1997     

关节镜下股骨双隧道“Y”形LARS人工韧带移植重建膝后交叉韧带

目的 探讨在关节镜下应用人工LARS韧带重建膝关节后交叉韧带(PCL)的手术技巧及临床疗效. 方法 选择2006年6月- 2010年8月关节镜下采用LARS人工韧带重建PCL断裂患者14例,其中男10例,女4例;年龄19 ～58岁,平均38岁.致伤原因:运动扭伤9例,交通伤3例,摔伤2例.左侧5例,右侧9例.病程10 d ～1个月,平均15.7d.MRI示:PCL完全撕裂直接征象14例,前交叉韧带(ACL)完全撕裂直接征象2例,合并内侧半月板损伤5例,合并外侧半月板损伤3例,合并髋臼后壁骨折1例.Lysholn膝关节功能评分20～55分[(40 ±7.9)分].按照国际膝关节文件编制委员会( IKDC)评分:C级3例,D级11例.PCL在股骨及胫骨止点、隧道均用定位器完成. 结果 本组所有患者伤口均为Ⅰ/甲愈合,术后无慢性滑膜炎、韧带断裂、韧带松动、活动明显受限等并发症.所有患者均获随访6 ～ 60个月,平均20.5个月.Lysholm膝关节功能评分84 ～93分[(88±3.6)分],与术前比较差异有统计学意义(P＜0.05).术后12个月根据IKDC评分标准分级:A级10例,B级4例. 结论 在关节镜下运用LARS人工韧带重建膝PCL有效恢复了膝关节稳定性,避免了采用自体肌腱重建取材的并发症,也避免了同种异体肌腱移植材料的排斥及传染疾病的并发症.其手术操作简便,创伤小,康复快.     

关节镜下双束腘绳肌腱股骨双隧道和微型钢板纽扣重建后交叉韧带

目的探讨应用双束腘绳肌腱股骨双隧道和微型钢板纽扣固定法重建后交叉韧带(PCL)的临床效果。方法对13例单纯PCL断裂的患者在关节镜下用腘绳肌双束股骨双隧道和微型钢板纽扣固定法进行重建。其中男9例,女4例;年龄20-53岁,平均36岁;新鲜损伤9例,陈旧性损伤4例。全部取自体半腱肌腱和股薄肌腱作为移植物。根据PCL的解剖特点,将肌腱编织成"Y"形的两束。PCL两束股骨附着点分别钻孔,成双隧道。用微型钢板和纽扣分别固定股骨和胫骨端。结果术后3个月,所有患者均无伸膝受限,膝关节屈膝活动度均>120°。术后1年,屈膝70°时后抽屉试验Ⅰ度阳性1例,其余均为阴性;屈膝30°时后抽屉试验Ⅰ度阳性2例,其余均为阴性;膝关节功能Lysholm评分为(92.51±2.40)分。结论在关节镜下利用腘绳肌腱股骨双隧道和微型钢板纽扣法重建PCL能够更可靠地恢复膝关节功能。     

关节镜下运用4股腘绳肌腱同期重建前后交叉韧带损伤

目的 关节镜下运用Intrafix和可吸收界面螺钉固定自体4股腘绳肌腱，同期重建前交叉韧带（anterior cruciate ligament，ACL）、后交叉韧带（posterior cruciate ligament，PCL），评估其疗效。方法 ACL、PCL同时损伤的患者16例，关节镜下以自体4股胭绳肌腱作为重建移植物，应用可吸收界面螺钉固定移植物股骨端，Intrafix钉鞘和可吸收锥形钉固定胫骨端，同期行ACL和PCL损伤重建术。7例行内侧副韧带修补，4例行外侧副韧带复合结构修复，2例行内外侧同时修复。所有患者按照国际膝关节评分委员会（International Knee Documentation Committee，IKDC）评分标准进行术前评估，均为D级。术前Lysholm评分为（36．5±3．7）分。结果 随访时间为12～18个月，平均14．6个月。终末随访时，IKDC总体评价：A级6例（38％），B级9例（56％），C级1例（6％），无D级患者。Lachman试验0～2mm8例；3～5mm6例；6～10mm2例（P〈0．05）。屈70°前后总位移0～2mm10例；3～5mm5例；6～10mm1例（P〈0．05）。屈70°后位移0～2mm12例；3～5mm4例（P〈0．05）。术后2个月Lysholm功能评分为（90．4±2．9）分，终末随访时为（93．4±3．5）分，与术前相比差异均有统计学意义（P〈0．05）。结论 关节镜下以自体4股胭绳肌腱作为移植物，应用可吸收界面螺钉、Intrafix钉鞘和可吸收锥形钉固定股骨胫骨端同期重建ACL和PCL损伤，有利于早期积极的功能康复，膝关节功能恢复满意。     

Biomechanical comparison of posterior cruciate ligament reconstruction techniques using cyclic loading tests

Posterior tibial translation (PTT) of the posterior cruciate ligament (PCL) reconstructed-knee under cyclic loading of 1,000 cycles with a 100-N load was compared between four different procedures, including two reconstructions with patellar tendon graft (transtunnel and inlay techniques) and two reconstructions with hamstring tendon graft (Endobutton and EndoPearl techniques) in twelve fresh-frozen human knees. The EndoPearl technique is a direct tendon fixation using biodegradable interference screws and an anchoring device, while the Endobutton technique is an indirect tendon fixation using a titanium button and surgical tape. The change of PTT after cyclic loading in the Endobutton technique was significantly greater than in the other reconstruction technique. No graft rupture at the killer turn or complete pullout from the bone tunnel was found. The advantage of the inlay technique compared to the transtunnel technique with respect to the posterior stability could not be shown in the current study. Posterior laxity of PCL reconstructed-knees with hamstring tendon graft using the Endobutton technique increased more easily than that with patellar tendon graft. For PCL reconstruction using the hamstring tendon graft, anatomical fixation may be preferable to prevent excessive posterior laxity in the early phase of the rehabilitation protocol.     

Change in the cross-sectional area of a patellar tendon graft after anterior cruciate ligament reconstruction

The purpose of this study was to clarify the change in the cross-sectional area (CSA) of a patellar tendon graft after anterior cruciate ligament (ACL) reconstruction, and its relationship with postoperative knee laxity. Forty patients (25 men and 15 women) were included in this study. Intraoperative CSA measurements were performed with an instrumented areamicrometer, while a magnetic resonance imaging (MRI) evaluation was utilized for the assessment postoperatively. For intraoperative measurement, the average CSA of a 10-mm wide patellar tendon graft was 32.3 ± 7.0 mm², while the average CSA measured at follow-up (mean: 14.8 months) was 48.8 mm², showing a significant mean increase ratio of 49.4%. This value corresponded to 115% of the native ACL. The average CSA measured in 30 patients at 6 months was 49.7 mm², almost equal to the value at the final follow-up (49.8 mm²) in the same patient group. Among potentially influential factors, postoperative notch width (available space for the ACL graft) had significant correlation with the CSA of the graft at follow-up. Finally, both intra- and postoperative CSA values did not correlate with postoperative knee laxity, indicating that a bigger graft does not guarantee a better laxity.     

Initial fixation strength of interference nail fixation for anterior cruciate ligament reconstruction with patellar tendon graft (experimental study)

The objective of this study was to evaluate initial fixation strength of a new interference nail fixation in anterior cruciate ligament reconstruction using bone-patellar tendon-bone graft. Human cadaver knees were used. Fixation strengths ranged from 500 N to 600 N (mean 550 N). This corresponds to loads in the graft during aggressive rehabilitation. No slippage occurred at fixation site of specimens. Most of the failures appeared from the femoral side with tendon ruptures. With respect to primary fixation strength, interference nail fixation is a reasonable alternative for anterior cruciate ligament reconstruction with bone-patellar tendon-bone graft.     

Arthroscopic posterior cruciate ligament reconstruction using bioabsorbable cross-pin femoral fixation: a technical note

There are many methods for fixation of the posterior cruciate ligament grafts. We introduce a new surgical technique that provides more secure femoral and tibial fixation of a tibialis posterior allograft. The tendon was prepared as a four-stranded graft. The tibial tunnel was made using a standard trans-tibial technique. A femoral tunnel was prepared through a low anterolateral portal. The graft was inserted into the femoral tunnel through the anterolateral portal and TransFix (Arthrex, Naples, FL) was fixed at the femur. Four stands of the graft were passed through the tibial tunnel and IntraFix (DePuy Mitek, Raynham, MA) was fixed at the tibia.     

关节镜下自体半腱及股薄肌腱重建膝前交叉韧带

 目的 探讨关节镜下以自体半腱肌、股薄肌腱重建膝前交叉韧带(ACL)的手术方法及疗效.方法 自2006年3月～2007年12月,关节镜下绳肌腱修复膝前交叉韧带损伤39例.膝前小切口取半腱肌腱、股薄肌腱修整、对折后成四股,分别建立胫骨隧道及股骨隧道,用Endobutton和生物可吸收挤压螺钉固定肌腱,重建ACL的解剖结构和生理功能.术后即行功能锻练.结果 术后患者伤口均Ⅰ期愈合,8～10周膝关节屈伸功能恢复正常.随访时间3～15个月,平均8个月.抽屉试验和Lachman试验阳性者2例,可疑阳性者6例;余患者均为阴性.根据敖英芳临床判断标准,本组优23例,良11例,中3例,差2例.Lysholm评分术后(87.6±4.6),与术前(45.3±4.2)比较,差异显著(P<0.01).结论 绳肌腱具有良好的抗拉强度和刚度,在关节镜下用四股绳肌腱重建膝前交叉韧带是一种疗效可靠的治疗方式.     

Arthroscopic anterior cruciate ligament double-bundle reconstruction using hamstring tendon grafts-fixation with two interference screws: technical note

In this article, an original double-bundle anterior cruciate ligament reconstruction technique is described. The procedure is developed using hamstring tendon grafts while maintaining tibial osseous insertion. Two tibial tunnels are drilled and a simplified and precise outside-in double tunnel femoral drilling technique is utilized. The graft fixation is made using only two interference screws.     

Positioning of the posterior cruciate ligament

The isometric position in ligament reconstruction is the one in which there is little or no change in the length of the graft with range of motion of the joint. It varies according to the positions of the tunnels that will become the attachment sites of whatever graft is being used. Better understanding of this concept that greatly improved the surgical results of intra-articular reconstructions of the anterior cruciate ligament. Unfortunately, the results of posterior cruciate ligament (PCL) reconstructions have lagged behind. A better understanding of the isometry of the PCL and how it relates to the positioning of a graft at the time of reconstruction should help improve the situation. The current scientific studies on the PCL as they relate to isometry are evaluated and summarised in this paper. The tibial isometric point was universally less sensitive to changes in position than was the femoral isometric point. However, all the points that were evaluated for the tibia fell within the normal insertion area of the PCL. This has important ramifications when extrapolating these laboratory studies to the operating room, where it is imperative to get the tibial tunnel or attachment site distal enough on the tibia so that it will be in the usual anatomic location of the PCL. There is less uniformity when it comes to the femoral isometric point, but once again the isometric point from each of the studies fell within the normal anatomic femoral attachment site. The differences between the selected points may be explained by the different study designs.     

Comparison of femoral fixation methods for anterior cruciate ligament reconstruction with patellar tendon graft: a mechanical analysis in porcine knees

The aim of the present study was to evaluate the structural properties of femur–patellar tendon graft complex in anterior cruciate ligament (ACL) reconstruction using different femoral fixation devices. Type of study is biomechanical testing. An ACL reconstruction was performed on 40 cadaver porcine knees, using patellar tendon (PT) graft. Specimens were divided into four groups according to the femoral fixation: interference absorbable screw (Group A), metallic setscrew (Group B), absorbable pins (Group C), and a combination of metallic setscrew and pin (Group D). Other ten knees were used as controls. On each sample, a cyclic loading test, then a load-to-failure test were performed. Elongation after 1,000 loading cycles, ultimate failure load, yield load, stiffness, deformation at the yield point, and mode of failure were recorded. Kruskal–Wallis test and Tukey test were used to compare the differences between groups. The lowest mean elongation after 1,000 load cycles was observed for Group B (1.7 ± 1.4 mm) and D (1.2 ± 0.3 mm). Ultimate failure load of Group D (1,021.8 ± 199.4 N) was comparable with that of normal ACL (1,091.2 ± 193.3 N) and PT graft (1,140.6 ± 285.7 N). All other groups were lower than the controls. For mean stiffness, all the groups, excepting for Group D (172.8 ± 40.4 N/mm), were significantly lower than PT control group (216 ± 78.4 N/mm). Mode of failure was graft pullout for Groups A and B, distal pin breakage for Group C, and midsubstance graft rupture in 80% of the cases for Group D. Only combined compression and suspension fixation did not show significantly different structural properties in comparison with normal ACL and PT graft. Furthermore, it showed no risk of graft pullout or hardware breakdown in comparison with other fixation devices.     

Arthroscopic intra- and extra-articular anterior cruciate ligament reconstruction with gracilis and semitendinosus tendons

Numerous surgical procedures have been developed and used for anterior cruciate ligament (ACL) reconstruction. Patellar tendon is probably the most common graft used, but gracilis and semitendinous tendons present some interesting advantages: small incision, large graft when doubled, characteristics close to ACL, rapid harvest. We describe a combined intra- and extra-articular arthroscopic ACL reconstruction using hamstring tendons which includes some original steps. The tendons are harvested, leaving the distal insertion intact, and sutured together. After drilling of the tibial tunnel, an over-the-top arrangement is formed, creating a groove in the posterolateral aspect of the femur. The tendons are then fixed with double staples in the groove, and their remaining part is fixed distally to Gerdy’s tubercle passing under the fascia, but over the lateral collateral ligament (LCL). This technique ensures sufficient strength in the graft and permits correction of any associated instability, because of the presence of the extra-articular portion of the tendons. Furthermore, the over-the-top arrangement reduces trauma and possible pitfalls related to tunnel construction and permits isometry of the extra-articular portion to be established. Forty patients involved in sports activity were prospectively selected and evaluated at a minimum 2 years’ follow-up. IKDC score and Lysholm score were used for clinical evaluation, and the KT-2000 was used for instrumental laxity measurements. Resumption of sport and time to that point were recorded as well as Tegner activity score. We had 92.5% normal and fairly normal knees according to IKDC score and only 7.5% abnormal knees. Mean Lysholm score was 95. Mean Tegner score was 7.2. KT-2000 showed a mean injured/uninjured difference of 2.1 mm. In all, 90% of patients resumed sports at the same level, 67.5% in 3–4 months and 27.5% in 4–6 months. The highly satisfactory results of this series with no major complications confirm the reliability of this techinque and the possibility of guaranteeing functional behaviour in the knee. Received: 5 April 1997 Accepted: 25 July 1997     

带血管蒂的自体骨髌腱骨重建前交叉韧带的临床研究

 目的观察"带与不带血管蒂的骨髌腱(PT)骨重建前交叉韧带(ACL)对早中期前交叉韧带完全断裂"的临床疗效.方法治疗组(A组)行带血管蒂骨髌腱骨重建前交叉韧带,对照组(B组)行不带血管蒂骨髌腱骨重建前交叉韧带.结果治疗组较对照组总有效率和显效率、前抽屉试验评分均高,两者间有显著性差异.结论带血管蒂骨髌腱骨重建前交叉韧带对治疗前交叉韧带损伤具有较好的治疗作用,可以明显缩短患者恢复时间,改善患者膝关节功能.     

Anterior cruciate ligament patellar tendon reconstruction: it is probably better to leave the tendon defect open!

The purpose of our prospective study was to establish whether or not in anterior cruciate ligament (ACL) patellar tendon reconstruction the tendon defect has to be closed. In 50 consecutive ACL patellar tendon reconstructions, the tendon defect was randomly closed (group I) or left open (group II). The following data were recorded from all patients on the 4th and 14th days post operation: range of motion (ROM), pain at rest, pain and validity at isometric contraction, ability of bent leg raising (at 4th day) and straight leg raising (at 14th day). All the patients underwent ultrasonographic examination after 3 months and X-ray scanning at 6 months post operation. Forty patients underwent a CT-scan examination at 6 months. Thirty patients underwent isokinetic testing between 10 and 12 months post operation. Evaluating the immediate post operation data, no statistically significant differences emerged between the two groups. Ultrasonography showed in 68% of the knees of group I (defect closed) a thickened patellar tendon (PT), while in 60% of group II it was of normal thickness. No patients of either group developed patella infera by X-ray evaluation 6 months post operation. CT scans at 6 months showed that 100% of the knees of group I had a thickened PT in toto (nearly twice as thick as normal). Scar tissue was present not only in its central third but also in more than half of the cases in the medial and lateral third. In group II 75% of the patients had a normal thickness PT and 25% presented with only a minimal thickening. Scar tissue was distinguished only at its central third. Some 32% and 36% of the patients of group I and II, respectively, developed patellar irritability between the 5th and 8th month post operation. Isokinetic tests performed between the 10th and 12th months showed that the quadriceps deficit was slightly less in group II than in group I. Our study did not show very important clinical differences between the two groups but revealed that if the tendon defect is closed, an exuberant scar process arises involving the entire PT. This could mean, as reported in the literature, a high reduction in the biomechanical properties of the PT. For this reason it is probably better to leave the defect open.     

Arthroscopic reconstruction of the anterior cruciate ligament with Leeds-Keio ligament in non-professional athletes

We report our experience using the Leeds-Keio artificial ligament for anterior cruciate ligament (ACL) reconstruction. The study relates the results of the first 40 patients subjected to arthroscopic reconstruction of the ACL with a Leeds-Keio ligament, with a mean follow-up of 73 months. No associated peripheral procedures were carried out on any patient. The average age of the patients at the time of the operation was 31 years (range 26–35 years). The rehabilitation protocol followed by all patients aimed at resumption of sport 4 months after the operation. Clinical assessment included IKDC and the Lysholm scoring scale. The KT-2000 system was used for instrumented evaluation of joint laxity. All patients underwent a radiographic check-up. Clinically there were 55% excellent or good results when using the IKDC scale, while with the Lysholm score, satisfactory results were obtained in 80%. Complete post-traumatic rupture of the ligament was observed in three patients. No patient suffered an episode of either hydrarthrosis or reactive synovitis, which indicates good tolerance to the ligament. The radiographic evaluation of the operated knees showed a close correlation between the appearance of degenerative phenomena and performance of arthroscopic meniscectomy. The results achieved with the Leeds-Keio artificial ligament 5 years after application, although not completely satisfactory and inferior to those obtained with autologous biological ligaments, should be considered an encouragement to promote new efforts in this interesting research field.