关节镜下与切开骨-髌腱-骨重建前交叉韧带的疗效比较

自 2 0世纪 90年代初Ｎｏｙｅｓ首次采用关节镜辅助膝关节前交叉韧带 (ＡＣＬ)重建以来 ,镜下重建已在国内外普遍开展 ,并逐渐成为重建ＡＣＬ的标准手术。为了解镜下重建与切开重建手术的疗效差别 ,笔者从 1998年 1月至 2 0 0 1年 3月对ＡＣＬ断裂患者进行关节镜下与切开自体骨 -髌腱 -骨 (Ｂ -ＰＴ -Ｂ)ＡＣＬ重建的前瞻性比较研究。临　床　资　料1.一般资料 :本组共 5 6例 ,随机分成两组。Ａ组 :关节镜下重建组 ,男 2 3例 ,女 6例 ;年龄 2 0～ 6 1岁 ,平均 31.7岁。急性断裂 19例 ,陈旧性断裂 10例 ;孤立性ＡＣＬ损伤 11例 ,合并损伤 18…     

关节镜下髌韧带与腘绳肌腱重建前交叉韧带的疗效比较

目的比较分析膝关节镜下自体髌韧带与腘绳肌腱移植重建前交叉韧带(ACL)的疗效。方法回顾分析49例膝关节镜下自体髌韧带移植重建ACL及54例自体腘绳肌腱移植重建ACL的情况，随访24～48个月，平均31．6个月。采用Lysholm膝关节评分、国际膝关节文献编制委员会分级评估标准和KT-1000关节测量仪测定稳定性评价疗效。结果两组间患者满意度、关节稳定性及功能差异均无统计学意义。髌韧带重建组膝痛发生率较腘绳肌腱组高(37％比11％)。结论关节镜下髌韧带与腘绳肌腱移植重建ACL的疗效相同。ACL重建中等长重建、牢固固定及早期康复锻炼对疗效更有决定作用。     

关节镜下重建前交叉韧带术式与疗效分析

 目的 观察关节镜下不同术式重建前交叉韧带的疗效,根据不同情况选择合适的手术方式.方法 采用Lysholm膝关节评分法,对行自体髌腱骨-腱-骨重建前交叉韧带和异体髌腱骨-腱-骨重建前交叉韧带两种术式及随访资料进行分析.结果 Lysholm膝关节评分:自体髌腱组平均(94.86±1.35),异体髌腱组为(90.00±2.24),两组比较差异显著(P<0.05).膝关节屈曲90°前抽屉应力下侧位片示股骨髁后缘和胫骨平台后缘的切线距离,自体髌腱组为(4.97±0.51)mm,异体髌腱组为(5.4±0.18)mm,两组差异显著(P<0.05).结论 自体髌腱组在Lysholm评分和稳定性方面均优于异体髌腱组,自体髌腱重建前交叉韧带疗效确切,节省经费,是一种比较好的重建方法.     

军队人员关节镜下重建前交叉韧带

目的 探讨军人前交叉韧带损伤患者采用自体四股半腱肌腱 股薄肌腱重建前交叉韧带的手术方法及远期疗效.方法 关节镜下以自体四股半腱肌腱 股薄肌腱为前交叉韧带重建替代物,保留少许前交叉韧带残端作为定位标志物,对35例前交叉韧带损伤军人行重建术.结果 术后35例膝关节活动度均恢复至正常范围,无韧带撞击现象,前抽屉试验全部阴性,Lachman试验全部小于Ⅰ度.Lysholm评分由术前的平均52.3分提高到术后的平均88.5分,差异有显著性意义(P＜0.01).大多数患者获得满意治疗效果,可继续从事日常工作.结论 关节镜下自体四股半腱肌腱 股薄肌腱重建前交叉韧带是恢复膝关节稳定性较好的方法.关节镜下重建前交叉韧带是前交叉韧带损伤军人较为理想的手术方式,其创伤较小、卧床时间短、远期疗效较好.     

手术时机对关节镜下前交叉韧带重建手术临床效果影响研究

目的 探讨手术时机对关节镜下前交叉韧带重建手术临床效果的影响。方法 回顾性分析北部战区空军医院自2017年9月至2020年1月收治的接受关节镜下前交叉韧带重建手术的88例（88膝）患者的临床资料。根据受伤至手术时间,将患者分为两组,A组（n=41）在受伤后3周内接受重建手术,B组（n=47）在受伤后超过6周接受重建手术。比较两组患者术前和末次随访时的Lysholm评分、国际膝关节评分委员会（IKDC）评分、膝关节最大屈曲角度,以及前抽屉试验阳性、Lachman试验阳性比例;同时,在术中观察两组患者的合并症情况。结果 所有患者手术顺利,无麻醉意外及死亡患者,术后未出现血管神经损伤及膝关节感染等并发症。术后随访时间9～12个月,平均10个月,所有患者随访期间膝关节无二次手术。A组和B组末次随访时的Lysholm评分、IKDC评分、膝关节最大屈曲角度均大于术前,且A组末次随访时的Lysholm评分、IKDC评分大于B组,差异有统计学意义（P <0.05）。A组合并半月板损伤内侧7例（17.1%）、外侧11例（26.8%）、双侧9例（22.0%）,B组合并半月板损伤内侧8例（17.0%）...     

关节镜下双股半腱肌重建膝关节前交叉韧带80例

目的　介绍关节镜下双股半腱肌闭合拉出钢板法重建前交叉韧带(ACL)手术操作及其技巧。　方法　设计应用关节镜下双股半腱肌闭合拉出钢板法重建ACL,对80例患者手术操作经验进行总结。　结果　本组80例完成关节镜下重建ACL手术,平均手术时间为80min。术中出现穿导针弯曲、断裂,微型器械断裂,微型钢板骨隧道内受阻等情况。本组病例平均随访16个月,除2例术膝轻度胀痛外,其余患者无主诉症状。所有病例感觉膝部稳定,恢复原工作。Lysholm膝部评分,术前(48±12)分,术后(92±4)分（P<0．01）。　结论　关节镜下双股半腱肌闭合微型钢板固定法重建ACL,手术效果良好。临床实践中应掌握手术原则,严格按手术程序操作。     

关节镜下同时修复重建前交叉韧带合并半月板损伤

目的　探讨关节镜下同时修复重建前交叉韧带 (ACL)合并半月板损伤的临床效果。方法　 4 8例患者全部在关节镜下完成ACL、半月板损伤的修复重建术。术前临床症状、体征包括 :膝关节行走痛 4 1例 ,膝关节不稳定感 36例 ,关节交锁史 8例 ,Lachman试验阳性 4 5例 ,前抽屉试验阳性 38例 ,外侧轴移试验阳性 2 4例。半月板损伤采用系列导管下特制长缝合针由内向外缝合法修复 ;ACL损伤修复采用半腱肌、股薄肌 ,闭合拉出微型钢板法重建 ,术后采用康复治疗。　结果　本组随访 13～ 6 5个月 ,平均 2 7个月。 1例剧烈活动后膝关节胀痛 ,2例活动受限 2 0° ,其余关节功能正常。Lyshlom膝关节评分 ,术前 5 8± 9,术后 95± 5 (P <0 .0 1)。　结论　关节镜下同时修复重建ACL、半月板损伤的疗效显著 ,值得推广。     

关节镜下重建前交叉韧带术后留置引流与否的对比临床研究

目的:对比关节镜下自体腘绳肌腱重建前交叉韧带(ACL)术后留置引流与否的临床结果。方法:将2008年2月~2013年2月54例陈旧性ACL断裂在关节镜下行自体腘绳肌腱重建术的患者分为2组,一组不留置引流(27例),一组留置引流(27例),采用相同的手术技术和术后处理,比较两组患者的疼痛评分、肢体周径增加、关节活动度、下肢深静脉血栓发生率、血肿形成、感染、伤口愈合不良等临床结果。结果:无引流组在术后2周患膝周径与术前相比差值显著大于有引流组(P<0.05),术后4、6周患膝周径与术前相比差值差异均无统计学意义。无引流组术后2周患膝关节活动角度显著小于有引流组(P<0.05),两组术后4、6周患膝关节活动角度差异均无统计学意义。两组在术后1、2、3天,2周VAS评分差异均无统计学意义。两组均未出现术后下肢深静脉血栓、血肿、伤口感染不愈合等并发症。结论:关节镜下前交叉韧带重建术后常规不留置引流可能是更好的选择。     

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.     

关节镜下重建膝关节新鲜与陈旧前交叉韧带训练伤疗效对比分析

目的比较部队官兵体能训练所致膝关节前交叉韧带(ACL)损伤手术时机对疗效的影响。方法关节镜下对平均病程(5±0.8)周27例新鲜组和平均病程(76±10.5)周19例陈旧组ACL损伤,均以半腱肌和股薄肌为替代物进行手术重建。结果按Lysholm评分,新鲜组和陈旧组ACL损伤的优良率分别为92.5%和78.9%,两组比较差异有显著统计学意义(P<0.01)。结论体能训练所致膝关节交叉韧带损伤早期关节镜手术重建的疗效优于晚期重建。     

A prospective comparison of bone-patellar tendon-bone and hamstring grafts for anterior cruciate ligament reconstruction in female patients

The aim of the study is to compare the results after arthroscopic anterior cruciate ligament (ACL) reconstruction using central-third, bone-patellar tendon-bone (BTB group) (n=28) and four-strand semitendinosus/gracilis (ST/G group) (n=31) autografts in female patients. The type of study was non-randomised prospective consecutive series. A consecutive series of 61 female patients, all with unilateral ACL ruptures, was included in the study. In both groups, interference screw fixation of the graft was used at both ends, and 59/61 (97%) of the patients returned for the follow-up examination after a period of 26 (23–31) months. The pre-operative assessments in both groups were similar in terms of the Lysholm score, KT–1000 measurements, one-leg-hop test, and knee-walking test. At the 2-year follow-up, the knee-walking test was significantly worse in the BTB group than in the ST/G group (P=0.003). Furthermore, the knee-walking test was significantly worse at follow-up than pre-operatively in the BTB group (P<0.005). The corresponding finding was not made in the ST/G group. A reduction in knee laxity compared with the pre-operative assessments was found in both groups. No significant difference in the post-operative knee laxity measurement was found between the groups. A significant increase in activity level and subjective scores was found in both groups compared with pre-operative values, without any significant differences between the groups. Two years after ACL reconstruction, the groups displayed no significant differences in terms of functional outcome and knee laxity. However, the use of ST/G autografts rendered significantly less discomfort during the knee-walking test than the use of BTB autografts.     

A prospective comparison of bone-patellar tendon-bone and hamstring tendon grafts for anterior cruciate ligament reconstruction in male patients

The aim of the study was to compare the results after arthroscopic anterior cruciate ligament (ACL) reconstruction using central-third, bone-patellar tendon-bone (BPTB Group) (n = 45) and four-strand semitendinosus/gracilis (ST/G Group) (n = 78) autografts in male patients. The type of study is non-randomised, prospective consecutive series. A consecutive series of 126 male patients, all with unilateral ACL ruptures, was included in the study. In both groups, interference screw fixation of the graft was used at both ends and 123/126 (97%) of the patients returned for the follow-up examination after a period of 25 (23–33) months. The pre-operative assessments in both groups were similar in terms of the Tegner activity level, the Lysholm knee scoring scale, KT-1000 measurements, one-leg-hop test and knee-walking test. A significant reduction in knee laxity as measured with the KT-1000 arthrometer, compared with the pre-operative assessments, was found in both groups (P < 0.001). No significant differences in the post-operative knee-laxity measurements were found between the groups. Both groups had a significantly improved functional outcome at follow-up in terms of the Lysholm knee scoring scale, Tegner activity level and one-leg-hop test. The BPTB Group had a significantly higher Tegner activity level at follow-up, compared with the ST/G Group (P = 0.02). Moreover, the patients in the BPTB Group were significantly more likely to have a Tegner activity level of 6 or above (P = 0.03). Otherwise, no significant differences were found between the two study groups at the 2-year follow-up. Two years after an ACL reconstruction, the two groups displayed no significant differences in terms of functional outcome and knee laxity. However, more patients in the BPTB Group returned to a higher Tegner activity level than that in the ST/G Group.     

Reconstruction of anterior cruciate ligament using the doubled tendon graft technique: an experimental study in rabbits

In an attempt to assess reconstruction of the anterior cruciate ligament (ACL) by a new method, 18 New Zealand white rabbits underwent ACL replacement using the medial one-third of the patellar tendon and the semitendinosus tendon, thus partly reproducing the anatomical configuration of the ACL, with the semitendinosus tendon replacing the posterolateral bundle of the ACL and the patellar tendon replacing the anteromedial bundle. The Noulis-Trillat-Lachman test was performed before and after transection of the ACL, after reconstruction and before sacrifice. The animals were divided into four groups and were killed at 3, 6, 12 and 22 weeks after surgery. Femur-ligament-tibia complexes were evaluated postoperatively for gross morphology and histological appearance. The tendons of the first group showed compact parallel fibres with no definitive separation of their bundles and areas of disorganized collagen matrix. Tendons were surrounded by trabecular lamellar bone haphazardly arranged. The tendons of the second, third and fourth groups looked more like normal tendon. The trabecular bone surrounding the tendons formed a tunnel. The Noulis-Trillat-Lachman test result was negative before the procedure, 6.5±0.5 mm on average after transection of the ACL, 1.5±0.6 mm after the procedure, and negative again before sacrifice. The joints of the animals killed at 12 and 22 weeks showed signs of osteoarthritic lesions. Received: 29 May 1997 Accepted: 1 March 1998     

No benefit of bracing on the early outcome after anterior cruciate ligament reconstruction

Forty patients were prospectively investigated to evaluate the effects of bandaging after reconstructive surgery of the anterior cruciate ligament (ACL). For the 6 weeks of the postoperative course, the operated knee was bandaged in 20 patients (group A) and braced in the other 20 patients (group B). The isokinetic torque for extension and flexion (Cybex) and the range of motion (ROM) were investigated after 6, 12, 24 and 52 weeks postoperatively. At 24 weeks and 1 year postoperatively the stability of the knee joint (KT-1000) as well as the clinical outcome (‘Orthopädische Arbeitsgemeinschaft Knie’) were evaluated. No statistically significant differences between the two groups were found for the extension and flexion strengths. Free ROM was achieved significantly earlier in group A than in group B. No statistically significant differences regarding the stability of the operated knee joint nor the early outcome were found between the two groups. This study demonstrated that the renunciation of using a brace had no adverse effect on the early outcome with respect to stability and function. On the contrary, bracing seems not to be mandatory after ACL reconstruction when the central third of the patellar tendon is used.     

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.     

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.     

Double semitendinosus anterior cruciate ligament reconstruction: 10-year results

In a series of 30 consecutive patients who suffered from chronic instability of the knee joint, reconstruction of the torn anterior cruciate ligament was performed with a looped semitendinosus tendon, reinforced by an extra-articular anterolateral procedure. Of these 30, 27 could be followed up 9–11 years after the operation. The evaluation included the International Knee Documentation Committee (IKDC) questionnaire and was completed by testing with a Kneelax arthrometer at 132 N and by anteroposterior standing X-ray, in order to evaluate the degenerative changes. At the time of the check-up: 96% of the study group considered that they had normal or nearly normal knees, and 81% had recovered to the same sports activity level as before their injury. The degenerative changes noted at the index operation did not progress notably, except in two cases. Laxities of 7 knees were normal, with a side-to-side difference of less than 2 mm; 15 were nearly normal, with a mean difference of 3.45 mm; and 5 were abnormal, with a mean difference of 6.2 mm. The study shows that the procedure is efficient in restoring a satisfactory stability for most patients and stabilises the evolution of the degenerative lesions as shown by standing X-ray. Received: 30 December 1996 Accepted: 25 July 1997     

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-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     

Patellar tendon length after anterior cruciate ligament reconstruction: a comparative magnetic resonance imaging study between patellar and hamstring tendon autografts

Patellar tendon shortening after anterior cruciate ligament reconstruction may be associated with anterior knee pain or patellofemoral arthritis. The present study was designed to compare postoperative changes in patellar tendon length after anterior cruciate ligament reconstruction between patellar tendon and hamstring tendon autograft. Magnetic resonance images of both knees (operated and healthy) and functional outcome were documented at least 1 year postoperatively in 16 patellar tendon harvested patients and in 32 hamstrings harvested patients. Patellar tendon length, patella length and Insall–Salvati ratio were measured. The operated knee values were compared to the respective values of the non-operated control knees. A significant 4.2 mm or 9.7% patellar tendon shortening in patellar tendon group and a non-significant 1.14 mm or 2.6% shortening in hamstrings group was detected. No significant difference was detected in terms of major shortening—patella baja—(6% for the patellar tendon group vs. 0% for the hamsting group). There was no significant difference in anterior knee problems between the two groups as evidenced by the Shelbourne score (94 for the patellar tendon group vs. 98 for the hamsting group). Harvesting of the patellar tendon for anterior cruciate ligament reconstruction resulted in a significant shortening of the remaining tendon. In contrast harvesting of the hamstring tendons did not affect significantly the patellar tendon length. However, the incidence of patella baja and overall functional outcome was not significantly different between the two groups. Paper presented at the 12th ESSKA 2000 Congress, Innsbruck, Austria, 2006 and also presented at the 5th Biennial ISAKOS Congress, Hollywood, FL, USA, 2005.