Anterior cruciate ligament reconstruction

The anterior cruciate ligament (ACL) is the most commonly reconstructed knee ligament. It is estimated that more than 100,000 new ACL injuries occur annually. This article discusses preoperative education, perioperative nursing care, surgical technique, and postoperative management of patients undergoing ACL reconstruction procedures.     

Early rehabilitation after arthroscopic reconstruction of the anterior cruciate ligament

Background. The purpose of our research was to evaluate the results of early rehabilitation after arthroscopic reconstruction of the anterior cruciate ligament, based on identical rehabilitation methods applied two weeks later. Material and methods. The research involved 30 persons, randomly divided into two groups. Each group received an identical, 12-week program of rehabilitation, differing only in the time of commencement after surgery. We analyzed the range of movement of the knee joint, the circumferences of the knee and hip, and the strength of the flexor and extensor muscle groups in the knee. Results and Conclusions. The outcome for rehabilitation of the knee is not dependent on the time when the rehabilitation process is commenced. However, in view of the occurrence of a greater number of complications when early rehabilitation is applied, individual adjustment of the timing for commencement of rehabilitation procedures would seem to be the optimal solution.     

Anterior and posterior cruciate ligament injuries

Knee pain is a common complaint in the primary care setting, and ACL and PCL injuries are common causes of knee pain. Therefore, it is important for the primary care physician to be skilled in the diagnosis and initial management of these injuries and to be aware of potential associated knee injuries. By understanding the history, mechanism of injury, physical examination maneuvers, and imaging modalities related to ACL and PCL injuries, primary care physicians can prepare themselves to make an accurate diagnosis. Then they can counsel the patients on the available treatments, initiate conservative treatment if appropriate, and facilitate an effective referral to a primary care sports medicine physician or orthopedic surgeon.     

Anterior cruciate ligament injuries. Operative and rehabilitative options

Injury to the ACL carries significant morbidity and it is an injury that afflicts and disables those enjoying a demanding active lifestyle. A decision on the most appropriate treatment is a difficult one and should be taken seriously because all treatment options require dedication and hard work for a successful outcome.     

Anterior cruciate ligament tears and associated injuries

Anterior cruciate ligament (ACL) tears are a commonly sustained sports injury, often occurring in association with meniscal tears and trauma to other ligamentous structures around the knee. Diagnosis can often be made clinically, but assessment may be difficult in the acute setting when there is a large joint effusion and severe pain. Plain radiographs may detect the presence of a joint effusion and any associated fractures. However, magnetic resonance imaging is vital for assessing acute knee injuries and plays an important role in deciding treatment options and planning surgical intervention. Some of the associated meniscal and ligamentous injuries can be subtle and may easily be overlooked if these structures are not scrutinized closely. This article will discuss the anatomy of the ACL and the mechanisms and initial clinical assessment of ACL injuries, and review the imaging features of ACL tears and some of the associated injuries, including the posterolateral corner structures. These associated injuries have important implications for determining treatment options and subsequent return to athletic activities.     

关节镜下膝关节前交叉韧带重建移植物的选择及康复护理进展

膝关节前交叉韧带（anteriorcruciateliga—ment,ACL）断裂是一种严重的膝关节损伤,可导致膝关节不稳,并可继发关节内主要结构损伤。关节镜下重建ACL是近年兴起的微创手术,目的在于重建膝关节的稳定性和恢复其运动功能,其与开放手术重建方法相比,可明显减少手术创伤、关节粘连、感染等并发症,减轻患者术后疼痛,     

关节镜下腘绳肌腱重建前交叉韧带术后的康复实践

目的探讨术前、术后适宜的康复训练和护理方法,对预防关节镜下腘绳肌腱重建前交叉韧带术后并发症、促进关节功能恢复的作用。方法对22例关节镜下腘绳肌腱重建前交叉韧带术患者手术前后的临床康复、护理方法进行总结。主要内容包括：术前心理准备、功能康复示范及术后五步渐进式康复训练法。结果全部病例均获随访,随访时间4～12月,平均7月。采用Lysholm膝关节功能标准评分,术前平均分61分,终末随访平均分93分,关节功能恢复良好。结论腘绳肌腱重建前交叉韧带术后行5个阶段的规范、系统、适度、个体化的康复训练,可有效的预防术后并发症和恢复关节功能,是一种安全、有效的康复训练方案。     

Anterior cruciate ligament reconstruction of the knee

Anterior cruciate ligament (ACL) injuries affect more than 175,000 patients annually. Located in the center of the knee joint, the ACL is the major stabilizing ligament of the knee. If the ACL is injured, then the knee becomes unstable and can buckle when the person pivots. Surgeons can use autograft or allograft tissue to accomplish ACL reconstruction by using a single-bundle or double-bundle type of repair. The surgeon performs the reconstruction arthroscopically, using two ports and a small incision over the anteromedial surface of the tibia to facilitate passage of the graft and for distal fixation of the graft. Correct placement of the tibial and femoral tunnels is the most important technical aspect of the procedure. After reconstruction, the patient must undergo intense physical therapy starting one or two days after surgery. If diligent with physical therapy, then the patient can return to full activity as soon as four months after surgery.     

关节镜下前交叉韧带重建材料及其重建的理论研究与临床应用

背景:前交叉韧带是膝关节内的核心结构,近年来前交叉韧带损伤的发生率逐渐增高.目的:就前交叉韧带的损伤机制、手术方法、移植物选择、等长重建、重建韧带翻修等问题进行综述,为临床治疗前交叉韧带损伤提供一定的参考.方法:应用计算机检索Medline数据库(1996-01/2009-03),以Anterior cruciate ligament.implant、reconstruction、repair为检索词;应用计算机检索重庆维普数据库(1996-01/2009-03)、清华同方数据库(1996-01/2009-03),以前交叉韧带、移植物、重建、修补为检索词.结果与结论:共收集200篇关于关节镜下前交叉韧带重建的文献,排除发表时间较早、重复及类似研究,纳入18篇符合标准的文献.前交叉韧带是稳定膝关节的重要结构,运动及日常生活中多种因素可导致其损伤,治疗不当将严重影响运动能力或丧失运动能力.为恢复膝关节结构和功能,对损伤的前交叉韧带需要进行重建已成为共识.随着技术的不断进步和手术器械的研制创新,关节镜下重建术已成为当今治疗前交叉韧带损伤的主流方法.尽管治疗前交叉韧带损伤的手术方法很多,但还没有哪一种能完全复制前交叉韧带的解剖关系,手术是否能减少前交叉韧带伤后的继发损害目前还没有定论.对手术方式、移植物的选择、术后康复以及其他辅助治疗等方面仍有大量工作需要完善.     

膝关节镜下前交叉韧带重建的手术配合

目的探讨膝关节镜下前交叉韧带重建的手术配合。方法对19例膝关节前交叉韧带损伤患者,在关节镜下行前交叉韧带重建手术的术前准备和术中护理配合。结果手术进程顺利,无并发症发生,手术效果满意。结论严格的无菌操作,熟练的洗手和巡回护士的配合,提高了手术效率,缩短了手术时间,是手术成功的关键。     

关节镜下双股半腱肌移植前交叉韧带重建术后的康复

目的　探讨关节镜下双股半腱肌移植重建术前交叉韧带 (anteriorcruciateligament ,ACL)手术后配套的康复治疗计划及其在临床康复中的可行性。方法　研究设康复组患者 3 4例 ,对照组 2 1例。术后康复计划实施程序分 3个周期。Ⅰ期 :保护性康复期 ;Ⅱ期 :康复训练准备期 ;Ⅲ期 :抗阻力肌力强化训练期。结果　康复组除 2名 5 0岁以上女性患者关节活动度 (ROM )屈曲受限约 2 0°外 ,其余全部恢复正常。ROM达正常平均 8周 ,全部患者关节稳定性好。同期对比对照组显示 :ROM恢复迟缓 ,肌肉萎缩明显 ,关节达到正常ROM平均为 16周 ,8名患者屈曲受限 2 0° ,χ2 检验二组资料P <0 .0 1。结论　康复计划的实施可有效地防止术后并发症 ,是保证膝关节功能康复的重要措施。该项技术的应用与普及 ,有助于ACL术后康复水平的提高     

康复训练在关节镜下前交叉韧带重建术后患者中的应用

目的：探讨康复训练程序在关节镜下前交叉韧带重建术后患者中的应用效果。方法：参考国内外前交叉韧带损伤重建的康复训练经验,制定了相应的康复程序,对我院运动创伤科46例在关节镜下行前交叉韧带重建术后患者进行康复训练。结果：46例患者均获得随访,术后6个月,Lysholm评分（93.6±2.8）分,与术前（78.2±2.3）分比较,有明显提高。关节活动度：1例患者有5°的伸膝受限,2例患者有5°的屈膝受限。髌上10 cm处双侧大腿周径差值无明显差异。45例患者术后无并发症。结论：应用康复程序对关节镜下膝前交叉韧带重建术后的患者进行康复护理,可较快地恢复关节功能,有利于膝关节的本位感觉良好恢复。     

前交叉韧带重建及其腱-骨愈合特点

近年来，随着自体胭绳肌腱前交叉韧带重建术的广泛开展，腱骨愈合的影响因素和促进方法成为运动医学研究的热点。影响腱-骨愈合的相关因素主要包括移植物的固定方式、骨的性质、应力刺激以及移植肌腱与隧道的匹配关系等，促进腱-骨愈合的方法主要包括生长因子、金属蛋白酶阻断剂、骨保护素等试剂和间充质干细胞、物理方法的运用。目前在促进腱-骨愈合方面已探索出一些较有潜力的方法，但是这些方法大多数尚处于动物实验阶段或者牵涉到复杂的实验室技术，在进入临床应用之前，对这些方法的可行性尚需进。步的研究。     

关节镜下应用LARS人工韧带材料修复重建运动损伤膝关节交叉韧带

目的:探讨在关节镜下应用LARS人工韧带材料修复重建膝关节前、后交叉韧带的应用效果.方法:由第一作者应用计算机检索维普数据库(http://www.cqvip.com/)与LARS人工韧带重建膝关节交叉韧带有关的文献,检索时限为2000-01/2009-12.检索关键词:关节镜,LARS人工韧带,重建,前交叉韧带,后交叉韧带.对资料进行初审,并查看每篇文献后的引文.依据纳入排除标准共保留相关文献27篇.结果:人工韧带的改进和更新经历了较长的历史,真正具有较确定的临床效果也只有短短十几年的时间.通过对LARS人工韧带疗效分析,大部分表现为短、中期的临床效果较好,并发症较少见,特别是没有急性滑膜炎的报告,长期效果不能确定.结论:关节镜下运用LARS人工韧带重建膝前、后交叉韧带可达到解剖重建,有效恢复膝关节稳定性;对于要求能立即回到运动场的年轻患者,特别是运动员前交叉韧带损伤,LARS人工韧带是理想和安全的移植材料.     

关节镜下异体韧带重建膝前交叉韧带术患者的护理

在关节镜下行异体韧带重建膝前交叉韧带是治疗陈旧性膝前交叉韧带断裂的新方法.报道了2000年2～6月行此手术的6例病例,近期疗效满意.术前须向患者说明手术特点和预期效果,指导功能锻炼;术后注意肢体位置的正确摆放,观察患肢运动、血运、伤口引流等,并早期指导功能锻炼.     

关节镜下重建前交叉韧带的康复护理

目的:探讨膝关节镜下行前交叉韧带重建的康复护理.方法:对26例膝关节前交叉韧带损伤患者在膝关节镜下行前交叉韧带重建术后进行系统的护理和康复训练,如术前重视心理护理,术后进行患肢膝关节持续冰敷48 h,并指导患者在佩戴膝关节角度锁定支具下早期进行有计划、有规律性的康复训练.结果:患者均顺利康复出院.随访3个月～2年,所有病例术前症状消失,完全恢复正常行走,步态、关节的稳定性及活动度均正常,抽屉试验阴性,无1例发生关节僵硬、皮肤坏死、股四头肌功能下降.结论:膝关节镜下行前交叉韧带重建手术,术前进行有效的心理护理是手术成功的基本前提,术后进行系统的护理和早期进行有计划、有目的、循序渐进的功能锻炼是保证其成功康复的关键.     

关节镜下LARS人工韧带在重建前交叉韧带中的临床应用

目的探讨在关节镜下运用韧带增强重建系统（LARS）人工韧带重建前交叉韧带的手术方法和临床疗效。方法 2007年6月起运用法国LARS人工韧带治疗前交叉韧带断裂14例。等距点建立胫骨和股骨骨道,置入韧带后游离纤维位于关节腔内,挤压螺钉固定。结果经平均18个月随访,术后Lysholm评分平均92分,优9例,良5例,优良率为100%。术后无感染、无韧带断裂,无膝关节疼痛。结论运用＂LARS人工韧带＂重建前交叉韧带可达到解剖重建,可有效恢复膝关节稳定性;关节镜下手术拥有创伤小、康复快、疗效好等微创特点。     

Anterior cruciate ligament reconstruction in skeletally immature patients

The management of pediatric patients with an anterior cruciate ligament (ACL) tear can be a challenging endeavor for physicians, athletic trainers, coaches, and parents alike. In particular, the significant longitudinal growth that arises from the physes about the knee creates a unique set of circumstances that must be considered in this patient population. The purpose of this review is to provide a summary of the most recent current literature for the management of skeletally immature patients with an ACL tear.     

匀速下蹲式训练在关节镜下前交叉韧带重建后康复中的应用研究

目的探讨匀速下蹲式训练在关节镜下前交叉韧带重建后患肢功能康复中的效果。方法将80例行前交叉韧带重建手术患者分为观察组和对照组,各40例。对照组给予常规术后功能锻炼指导,观察组在此基础上增加匀速下蹲式训练。比较两组患者康复效果、肌力及活动舒适度。结果观察组康复效果、膝关节功能、肌力恢复达标率及总体舒适度均明显优于对照组,组间比较差异有统计学意义(P0.05)。结论采用匀速下蹲康复训练并制订不同阶段的活动方案,可促进患者韧带重建术后的功能恢复及适应,使训练过程达到最佳效应。