Two-stage reconstruction with autografts for knee dislocations

Traumatic knee dislocations are severe injuries that involve damage to the anterior cruciate ligament, the posterior cruciate ligament, and the lateral or medial ligamentous structures. There are no established methods of treatment. The objective of the current study was to report the clinical outcome of a two-stage autologous reconstruction on nine knees (eight patients). The mean followup was 40.1 months. The first stage of the reconstruction was done at a mean of 2 weeks after the injury, and the posterior cruciate ligament was reconstructed by an arthroscopically assisted technique using contralateral autogenous hamstring tendon as the graft material. Three months later, the second stage of the reconstruction was done for the ligaments that had not healed with conservative treatment. Arthroscopically assisted anterior cruciate ligament reconstruction was done on all of the knees using the ipsilateral autogenous hamstring tendon or bone-patellar tendon-bone as the graft material. At the same time, a medial collateral ligament reconstruction using an autogenous semitendinosus tendon was done on one knee, and reconstruction of the posterolateral ligamentous structures using a biceps tendon was done on three knees. Each of the knees that was reconstructed was capable of full extension, and the mean degree of passive flexion was 139.5 degrees +/- 5.2 degrees. The mean side-to-side difference in anteroposterior total laxity (KT-1000 arthrometer, manual maximum) was 2.3 +/- 1.9 mm. None of the knees had lateral or medial instability. All of the injured ligaments were able to be reconstructed with autografts, and severe contracture was able to be prevented. A good clinical outcome can be achieved when two-stage reconstruction is used for traumatic knee dislocations.     

Revision ACL reconstruction using doubled semitendinosus and gracilis tendons: a follow-up study

Abstract Few papers report the results of revision ACL reconstruction with hamstrings tendons. We report our results with revision anterior cruciate ligament (ACL) surgery using a doubled gracilis and semitendinosus tendons (DGST) graft, in association with an exta-articular procedure. Twelve patients underwent ACL revision surgery using autogenous homolateral DGST graft in association with an extra-articular procedure and were evaluated at a mean follow-up of 35 months. At follow-up evaluation, all patients scored negatively on the Lachman test and normally or near normally on the jerk test. The KT 1000 evaluation showed a average side-to-side difference at 30 lb and MM of 1.4±1.7 mm and 1.6±1.6 mm, respectively. The Lysholm score was 98±2 (range, 94–100); excellent results (score 95–100) were obtained in 83% of cases, good results (score 84–94) in 17%, and no fair or poor results. At the IKDC evaluation, the result was excellent (normal) in one-thirds of cases and good (nearly normal) in twothirds. Therefore, the use of hamstring tendons in association with lateral tenodesis seems to be a good alternative to the use of allografts or contralateral bone-patellar tendon-bone graft in revision ACL reconstructions.     

Rehabilitation after hamstring anterior cruciate ligament reconstruction

A prospective comparative study was conducted involving 62 patients to determine the effects and limits of accelerated rehabilitation on clinical outcome. The study focused on whether aggressive rehabilitation after anterior cruciate ligament reconstruction with the doubled semitendinosus and gracilis tendon autograft results in stretching the graft. Thirty patients had postoperative rehabilitation according to the current conservative protocol, and 32 patients had rehabilitation using an accelerated regime. Each patient was evaluated subjectively and objectively 36 months or more after surgery. Concerning the side-to-side difference in the anterior laxity, 87% of the patients in the conservative rehabilitation group had 3 mm or less and 80% of the patients in the accelerated rehabilitation group had the same acceptable laxity. There was no significant difference between the two groups. Muscle torque was restored significantly earlier in the patients in the accelerated rehabilitation group than in the patients in the conservative rehabilitation group. Nine months after surgery, however, there were no significant differences in the torque between the two groups. Accelerated rehabilitation significantly increased the incidence of knee effusion during rehabilitation. This study showed that acceleration of postoperative rehabilitation could rapidly restore muscle strength without significantly compromising graft stability in anterior cruciate ligament reconstruction with the doubled hamstring tendon autograft. However, this study also showed that acceleration significantly increases the incidence of synovitis. Acceleration of postoperative rehabilitation has advantages and disadvantages for clinical outcome after anterior cruciate ligament reconstruction.     

Comparison of surgical treatments for knee dislocation

This retrospective study compared three surgical procedures for acute knee dislocation. Eleven patients (group 1) underwent direct repair of the cruciate ligaments, 6 patients (group 2) underwent anterior cruciate ligament (ACL) reconstruction with hamstring tendons and posterior cruciate ligament (PCL) reattachment, and 6 patients (group 3) underwent PCL reconstruction with ipsilateral bone-patellar tendon-bone and ACL reconstruction with doubled semitendinosus and gracilis tendons. Average follow-up was 6.9 years (range: 24 months to 19 years). Surgical results were evaluated using the IKDC evaluation form, KT-2000 arthrometer, and Lysholm and Tegner scores. Statistical analysis was performed using Fisher's exact test and the Cochran-Mantel-Haenszel test to compare different surgical procedures. In terms of stability and range of motion, results were less favorable after direct repair and cruciate ligament reattachment. Better results were reported after combined ACL and PCL reconstruction. Average side-to-side total anteroposterior translation as measured by the KT-2000 arthrometer at 20 degrees +/- 5 degrees of knee flexion was 6.67 mm, 3.6 mm, and 3.2 mm in groups 1, 2, and 3, respectively. At final International Knee Documentation Committee (IKDC) evaluation, only 2 group 3 patients achieved a group qualification A, while a group qualification B was achieved by 5 patients (2 patients in group 1, 2 patients in group 2, and 1 patient in group 3). Nine patients in group 1, 4 patients in group 2, and 3 patients in group 3 achieved group qualifications C and D (fair or poor results). Based on these results, we do not recommend reattachment of the cruciate ligaments after knee dislocation for obtaining a stable knee with full range of motion.     

Prospective clinical comparisons of semitendinosus versus semitendinosus and gracilis tendon autografts for anatomic double-bundle anterior cruciate ligament reconstruction

Background

The data available from the previously reported clinical studies remains insufficient concerning the hamstring graft preparation in double-bundle anterior cruciate ligament (ACL) reconstruction.

Objective

To test the hypothesis that there are no significant differences between the semitendinosus tendon alone and the semitendinosus and gracilis tendon graft fashioning techniques concerning knee stability and clinical outcome after anatomic double-bundle ACL reconstruction.

Methods

A prospective study was performed on 120 patients who underwent anatomic double-bundle ACL reconstruction according to the graft fashioning technique. The authors developed the protocol to use hamstring tendon autografts. When the harvested doubled semitendinosus tendon is thicker than 6 mm, each half of the semitendinosus tendon is doubled and used for the anteromedial (AM) and posterolateral (PL) bundle grafts (Group I). On the other hand, when the harvested semitendinosus tendon is under 6 mm in thickness, the gracilis tendon is harvested additionally. The distal half of the semitendinosus and gracilis tendons are doubled and used for the AM bundle graft, and the remaining proximal half of the semitendinosus tendon is doubled and used for the PL bundle grafts (Group II). Sixty-one patients were included in Group I, and 59 patients in Group II. The two groups were compared concerning knee stability and clinical outcome 2 years after surgery.

Results

The postoperative side-to-side anterior laxity averaged 1.3 mm in both groups, showing no statistical difference. There were also no significant differences between the two groups concerning the peak isokinetic torque of the quadriceps and the hamstrings, the Lysholm knee score, and the International Knee Documentation Committee evaluation.

Conclusion

There were no significant differences between the two graft fashioning techniques after anatomic double-bundle ACL reconstruction concerning knee stability and postoperative outcome. The present study provided orthopedic surgeons with important information on double-bundle ACL reconstruction with hamstring tendons.

Level of evidence

Level II; prospective comparative study.     

Semitendinosus Kennedy ligament augmentation device anterior cruciate ligament reconstruction.

This is a prospective study of 78 chronic unilateral isolated anterior cruciate ligament (ACL) patients who were treated with an arthroscopically-assisted reconstruction technique using the semitendinosus tendon, occasionally associated with the gracilis, augmented with the Kennedy-ligament augmentation device (LAD). There was a minimum two-year follow-up period (mean, 34.3 months; range, 24-50 months). Ligamentous surgery was always restricted to the ACL intraarticular reconstruction. Preoperative, intraoperative, and postoperative examinations at three, six, 12, 18, and 24 months, and every year thereafter, including subjective and objective evaluation with KT 1000 arthrometer laxity measurements, were completed. Two-year examination data were available on 77 (98.7%) of the 78 patients compared with preoperative data. The pivot shift (side-to-side difference) improved from 49.3% with Grade 0-1 to 92.2% with Grade 0-1. KT 1000 20-pound anterior drawer (greater than 5 mm side-to-side difference) improved from 49.3% (mean, 6 mm) to 91.1% (mean, 0.55 mm). KT 1000 maximum manual anterior drawer (greater than 5 mm side-to-side difference) improved from 21.9% (mean, 7.8 mm) to 97.4% (mean, 0.55 mm). After ACL reconstruction, 89.6% of patients had a full range of motion and only 10.3% had flexion contractures of less than 5 degrees; 5.2% of patients had mild effusion. Functional Lysholm knee scoring of 100 points improved from 7.7% scoring over 85 points preoperatively (mean, 66.5) to 92.1% postoperatively (mean, 95.6). Instability was controlled in 89.4% of the patients, and 71.4% have been involved in sports after injury. Anterior cruciate ligament reconstruction reduces pathologic laxity, improves lower-leg function, and minimizes flexion contracture and effusion.     

Revision anterior cruciate ligament reconstruction using the regenerated semitendinosus tendon: Analysis of ultrastructure of the regenerated tendon

In this report, we present a case of a college skier who sustained a rerupture of the reconstructed anterior cruciate ligament (ACL) 8 months after surgery in which an autogenous semitendinosus tendon graft was used. At the revision surgery, the harvested semitendinosus tendon appeared to be regrown. Thus the regenerated tendon was reharvested, and in combination with the gracilis tendon, was used as a graft. The electron microscopic examination revealed a difference in fibril diameter between the regenerated tissue and the normal tendon. Although the regenerated semitendinosus tendon could be reharvested, the feasibility of its use for revision surgery is still to be determined.     

Physeal sparing reconstruction of the anterior cruciate ligament in skeletally immature prepubescent children and adolescents

BACKGROUND: The management of anterior cruciate ligament injuries in skeletally immature patients is controversial. Conventional adult reconstruction techniques risk potential iatrogenic growth disturbance due to physeal damage. The purpose of this study was to evaluate the results of a physeal sparing, combined intra-articular and extra-articular reconstruction technique in prepubescent skeletally immature children. METHODS: Between 1980 and 2002, forty-four skeletally immature prepubescent children and adolescents who were in Tanner stage 1 or 2 (with a mean chronological age of 10.3 years) underwent physeal sparing, combined intraarticular and extra-articular reconstruction of the anterior cruciate ligament with use of an autogenous iliotibial band graft. Twenty-seven patients had additional meniscal surgery. Functional outcome, graft survival, radiographic outcome, and growth disturbance were evaluated at a mean of 5.3 years after surgery. RESULTS: Two patients underwent a revision reconstruction for graft failure at 4.7 and 8.3 years postoperatively. In the remaining forty-two patients, the mean International Knee Documentation subjective knee score (and standard deviation) was 96.7 +/- 6.0 points, and the mean Lysholm knee score was 95.7 +/- 6.7 points. The results of the Lachman examination for anterior cruciate ligament integrity was normal for twenty-three patients, nearly normal for eighteen patients, and abnormal for one patient. The results of the pivot-shift examination were normal for thirty-one patients and nearly normal for eleven patients. Four of the twenty-three patients who underwent concurrent meniscal repair had a repeat arthroscopic meniscal repair or partial meniscectomy. The mean growth in total height from the time of surgery to the final follow-up evaluation was 21.5 cm. No patient had an angular deformity measured radiographically or a discrepancy in the length of the lower extremities measured clinically. CONCLUSIONS: Physeal sparing, combined intra-articular and extra-articular reconstruction of the anterior cruciate ligament with use of an autogenous iliotibial band graft in skeletally immature prepubescent children and adolescents provides excellent functional outcome with a low revision rate and a minimal risk of growth disturbance.     

术前MRI测量腘绳肌腱横截面积与前交叉韧带重建中移植物的相关性研究

目的:探讨测量MRI腘绳肌腱横截面积在行前交叉韧带重建术前与前交叉韧带重建中移植物的相关性。方法:收集2021年11月至2022年3月在骨关节科拟行前交叉韧带重建术的50例患者的MRI资料,男32例,女18例,年龄19～48(31.1±8.7)岁。术前对半腱肌和股薄肌腱进行MRI测量并记录,然后在关节镜下行前交叉韧带重建术,术中取股薄肌腱与半腱肌腱来制备最终所需移植的肌腱,并且在术中测量已制备好的最终移植物的直径。最后使用统计学软件分析得到数据。结果:MRI测量半腱肌肌腱横截面积、股薄肌肌腱横截面积、半腱肌肌腱与股薄肌肌腱横截面积之和与前交叉韧带术中所需移植物的直径大小呈显著正相关,r值分别为0.858、0.728、0.842(P<0.001),半腱肌肌腱与股薄肌肌腱横截面积之和的曲线下面积(area uder curve,AUC)、灵敏度、和特异性分别为0.925、90.48%、85.71%。结论:在进行前交叉韧带重建术的患者中,术前MRI测量与术中腘绳肌移植直径大小有具有较强的统计学相关性,半腱肌肌腱与股薄肌肌腱横截面积之和对于前交叉韧带重建术中移植物的直径大小有较高的预测价...     

Anterior cruciate ligament reconstruction in athletes with an ossicle associated with Osgood-Schlatter's disease

We report a series of 20 athletes with an ossicle associated with Osgood-Schlatter's disease (OSD) who underwent anterior cruciate ligament (ACL) reconstruction using autogenous, central-10-mm patellar-tendon graft. All patients had an Osgood-Schlatter's lesion with an ossicle as seen on a plain radiograph. The patients were reviewed at an average follow-up of 44 months (range, 24 to 108 months). The postoperative assessment included clinical examination, KT-1000 testing, isokinetic testing, and subjective score (using the modified Noyes' questionnaire). At the time of latest review, all 20 patients had a stable knee. The average side-to-side difference on manual maximum KT-1000 assessment was 1.9 mm (range, 0 to 5 mm). Average time to return to full sporting activities was 5.2 months (range, 2.6 to 8.9 months). All patients returned to their previous level of activity. The mean modified Noyes' knee score was 96 (range, 89 to 100). To date, no graft failure has occurred. Based on the results of this study, we believe that ACL reconstruction using the autogenous bone-patellar tendon-bone graft can be safely undertaken in athletes with an ossicle associated with OSD without compromising the final knee function.     

The effect of initial graft tension on postoperative clinical outcome in anterior cruciate ligament reconstruction with semitendinosus tendon.

Introduction: The goal of this study is to establish the influence of tensioning the graft during anterior cruciate ligament (ACL) reconstruction, with a semitendinosus tendon graft, on postoperative stability. Type of study: Prospective controlled clinical trial. Material and methods: Forty-eight patients were randomly allocated to three groups in which three different tensions, 8, 12, or 15 kg force, was applied on the reconstructed ACL during the operation. The patients were observed for 1 year or more after surgery (min. 1 year, max. 2 years 8 months). Clinical outcome was evaluated using the visual analogue scale, anterior knee laxity (using the KT2000 arthrometer) and the torque of the knee extensor. Results: Postoperatively, the average side-to-side differences in anterior laxity were 1.3 mm in the 8 kg group, 2.1 mm in the 12 kg, and 2.4 mm in the 15 kg group. The visual analogue scale averaged 84, 83, and 79 mm, respectively. There were no significant differences among the three groups. There were also no significant differences between the groups for muscle strength recovery during isokinetic and isometric contraction at 1 year postoperatively. Conclusion: There were no significant differences among the groups in subjective clinical results, anterior laxity, and knee extensor strength in the ACL reconstructions that used the autogenous semitendinosus tendon graft.     

RETRACTED ARTICLE: The effect of graft choice on functional outcome in anterior cruciate ligament reconstruction

A prospective, randomised, 5-year follow-up study was designed to compare the functional results between patellar tendon and hamstring tendon autografts after anterior cruciate ligament reconstruction. Primary reconstruction was performed in 32 patients using the central third of the patellar ligament and in 32 patients using double-looped semitendinosus and gracilis tendons. All reconstructions were performed by a single surgeon, with identical surgical technique and rehabilitation protocol. Of the total 64 patients in the study, 54 (85%) were available for the 5-year follow-up. No statistically significant differences were seen with respect to Lysholm score, International Knee Documentation Committee (IKDC) classification, clinical and KT-2000 arthrometer laxity testing, single-legged hop test and anterior knee pain. Graft rupture occurred in two patients (8%) in the patellar tendon group and in two patients (7%) in the hamstring tendon group; 23 patients (88%) in the patellar tendon group and 23 patients (82%) in the hamstring tendon group returned to their pre-injury activity level. Good subjective outcome and stability can be obtained by using either graft; no statistically significant differences were found in functional outcome between the grafts.     

Anterior cruciate ligament augmentation under arthroscopy

We present a new surgical technique of anterior cruciate ligament (ACL) augmentation using autogenous hamstring tendons or allogenic fascia lata under arthroscopy for patients in whom considerable ACL remnants with mechanoreceptors are preserved. We review the clinical results of 40 patients who underwent this ACL augmentation, as assessed by manual instability tests, KT-2000 knee arthrometer, Lysholm and Gillquist score, joint position sense and magnetic resonance imaging (MRI), and compare them with those of ACL reconstruction. The side-to-side differences of anterior displacement measured by the KT-2000 knee arthrometer at 30 lbs, an average of 5.3 +/- 2.6 mm preoperatively, was significantly improved to an average of 0.7 +/- 1.8 mm in the augmentation group, while an average of 6.0 +/- 2.4 mm was improved to 1.8 +/- 2.1 mm in the reconstruction group. There was no statistically significant difference between the preoperative values in the two groups, but the postoperative values of the augmentation group were significantly less than those of the reconstruction group. The ratio of anterior terminal stiffness of the augmentation group was 1.2 +/- 1.8, and that of the ACL reconstruction group was 0.7 +/- 0.4. This was a statistically significant difference (P < 0.05). Thus, as for the KT-2000 knee arthrometer, the ACL augmentation group showed significantly better anteroposterior stability and terminal stiffness than the ACL reconstruction group. The final inaccuracy of joint position sense of the augmentation group was 0.7 degrees +/- 0.7 degrees, while that of the reconstruction group was 1.7 degrees +/- 1.2 degrees indicating a significant difference (P < 0.05). This study demonstrates that ACL augmentation, which can preserve ACL remnants with mechanoreceptors, is superior to ACL reconstruction from the viewpoint of position sense and joint stability.     

Muscle and tendon morphology after reconstruction of the anterior cruciate ligament with autologous semitendinosus-gracilis graft

BACKGROUND: The autologous semitendinosus-gracilis graft is the first choice of many orthopaedic surgeons when reconstructing the anterior cruciate ligament. The effect that graft harvest has on muscle and tendon morphology remains unclear. The purpose of this study was to describe these effects more completely. METHODS: Magnetic resonance images were acquired from eight patients before the anterior cruciate ligament reconstruction with semitendinosus-gracilis autograft and then again postoperatively after they had returned to sports. Muscle and tendon morphology was described by determining the volume and peak cross-sectional area of each structure on digitally reconstructed images. The effects that the procedure had on muscle and tendon length were evaluated separately and then together as a muscle-tendon complex. RESULTS: Anterior cruciate ligament reconstruction with semitendinosus-gracilis autograft resulted in a marked decrease in volume, cross-sectional area, and length of the semitendinosus and gracilis muscles. Tendon regeneration occurred in varying degrees in nearly all subjects. The morphology of the biceps femoris and semimembranosus muscles suggested that they had been compensating for the reduced semitendinosus and gracilis muscle function. Although semitendinosus and gracilis muscle retraction occurred following tendon stripping, nearly all of the subjects displayed evidence of at least partial tendon regeneration. CONCLUSIONS: Anterior cruciate ligament reconstruction with semitendinosus-gracilis autograft had a marked impact on semitendinosus and gracilis muscle morphology. However, this altered muscle morphology did not appear to have a clinically important impact on short-term outcomes. The biceps femoris and semimembranosus muscles appear to compensate for reduced semitendinosus and gracilis function. Tendon regeneration is observed in most people, but it is often incomplete at six months.     

自体与同种异体组织重建膝关节前交叉韧带的临床对比研究

目的　观察自体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 5 3例ACLⅢ度损伤患者随机分为自体组织移植组 (A组 ,n =2 5 )和同种异体组织移植组 (B组 ,n =2 8)。A组包括骨 髌腱 骨 15例 ,4股半腱肌腱或半腱加股薄肌腱重建 10例 ;B组包括骨 髌腱 骨 18例 ,6股半腱加股薄肌腱 4例 ,2股胫后肌腱 4例 ,跟腱骨重建 2例。两组患者术前、术后均行理学检查、Lysholm Tegner和IKDC膝关节综合功能评定及关节活动度测量仪 (KT 2 0 0 0 )检测。随访 12～ 31个月 ,平均 19个月。结果　手术前后两组各项指标有显著差异 (P <0 0 5 ) ;但两组间术后除B组手术耗时短和术后发热时间较长外 ,其它各项指标均无明显统计学差异 (P >0 0 5 )。两组术后健、患侧对比 ,胫骨前移小于 3mm分别达 88%和 86 % ;而 >5mm分别占 4 %和 7 1% ;感染率为 0 %和 3 5 %。结论同种异体与自体移植物重建ACL疗效相近 ,对多发韧带损伤、韧带重建翻修及中老年或运动量较少的患者 ,同种异体移植组织仍是重建ACL良好的替代物     

In vivo determination of knee kinematics in patients with a hamstring or patellar tendon ACL graft

Video fluoroscopy was used to assess the in vivo kinematics for patients with a patellar-tendon-bone or double-looped semitendinosus gracilis anterior cruciate ligament (ACL) graft. Patients with a double-looped semitendinosus gracilis ACL graft experienced kinematic patterns more similar to the normal knee than patients with a patellar-tendon-bone reconstruction. Patients with a double-looped semitendinosus gracilis reconstruction also experienced more anterior contact at full extension and throughout the flexion cycle than patients with a patellar-tendon-bone reconstruction, which resulted in patients with double-looped semitendinosus gracilis grafts experiencing more posterior femoral rollback. Therefore, removal of the central third of the patella ligament leads to a decrease in quadriceps mechanism efficiency, which resulted in the more posterior contact positions demonstrated by the patients with patellar-tendon-bone grafts in this study.     

Initial biomechanical properties of anterior cruciate ligament reconstruction autografts

To provide more information to consider when selecting a reconstruction technique, we did a side-by-side comparison of some of the initial biomechanical properties of currently accepted reconstruction methods. Our research hypotheses were that a quadrupled, woven semitendinosus and gracilis graft is as strong as any of the other commonly used graft materials and that quadrupling and weaving the hamstring graft may increase the stiffness of the overall construct Using lower extremity cadaveric specimens harvested from young donors, we fashioned seven each of seven types of graft: 9-mm, 10-mm, and 11-mm-wide patellar tendon graft (PTG); 10-mm-wide central quadriceps tendon graft; doubled semitendinosus graft; tripled semitendinosus graft; and quadrupled, woven semitendinosus and gracilis graft. Specimens were stripped of remaining soft tissue, and anterior cruciate ligament (ACL) constructs were created for biomechanical testing. The tibia was translated anteriorly on the femur, mimicking a pivot shift maneuver, andfailure strength, failure mechanism, and construct stiffness were recorded. No differences in mean strength were detected. The quadrupled, woven graft was significantly stiffer than the doubled semitendinosus graft and no less stiff than any of the PTG constructs. All grafts showed similar and adequate initial absolute strength to reconstruct the ACL. Quadrupling and weaving the semitendinosus and gracilis graft increases the stiffness of the reconstructed specimen to a level statistically similar to that of specimens reconstructed with a PTG.     

ACL reconstruction using an abnormally thick autogenous patellar tendon graft.

This prospective study measured the patellar tendon thickness of 543 patients who underwent anterior cruciate ligament (ACL) reconstruction with an autogenous bone-patellar tendon-bone graft to document the normal range of patellar tendon thickness and to determine if using thicker than normal patellar tendons as an ACL graft source affected postoperative outcome. The postoperative results of 55 patients who underwent ACL reconstruction with a patellar tendon > or =7 mm thick (thick tendon group) were compared with those of 488 patients who underwent ACL reconstruction with a patellar tendon < or =6 mm thick (normal tendon group). 5 mm (4.5 mm in women and 5.3 mm in men) with a range of 3-11 mm (3-7 mm in women and 3-11 mm in men). There was no statistically significant difference in the postoperative KT-1000 arthrometer mean manual maximum difference (2.0 mm for grafts < or =6 mm thick and 1.9 mm for grafts > or =7 mm thick), postoperative quadriceps muscle strength scores, modified Noyes questionnaire subjective scores (mean of 91 points for grafts < or =6 mm thick and 92 points for grafts > or =7 mm thick), or postoperative stability and pain scores. These results indicate that an abnormally thick patellar tendon should not preclude the use of this involved tendon as a graft source for ACL reconstruction.     

Assessment of the endoscopic semitendinosus/gracilis autograft procedure with interference screw fixation for reconstruction of the anterior cruciate ligament

The semitendinosus/gracilis autograft procedure with interference screw fixation was evaluated for clinical effectiveness of anterior cruciate ligament (ACL) reconstruction. Thirty patients underwent the procedure and were evaluated an average of 15 months postoperatively. Results revealed 22 (73%) patients had a standard knee evaluation form score of normal or nearly normal, and 24 (80%) patients returned to strenuous or moderate activity levels. Average Lysholm outcome score was 89, and bilateral KT-2000 differences were <3 mm at follow-up. Functional knee test symmetry index percentage outcome for the one-legged hop test was 92.6% for distance and 98% for time. Length of time (i.e., < or =90 days or > or =91 days) between injury and surgery was independent of outcome. These findings indicate the semitendinosus/gracilis autograft is a viable procedure for reconstruction of the ACL-deficient knee.     

关节镜下保留残端五重折股薄肌腱重建前交叉韧带的疗效分析

目的 介绍一种单独应用股薄肌腱重建前交叉韧带(ACL)的方法,并评估其疗效.方法 2003年4月至2008年5月,前瞻性研究采用保留ACL胫骨侧残留部分单独应用股薄肌腱重建ACL的方法治疗40例ACL损伤患者,其中男22例,女18例;年龄17～43岁,平均30.7岁.急性损伤33例,陈旧性损伤7例.受伤至手术时间平均3.4周(1～12周).术中评价所取股簿肌腱的长度,移植腱的长度及直径.术后评价包括KT-2000的前方不稳定性患健差,膝关节活动度,屈膝肌力的患健差,手术前后的IKDC评分及VAS评分.结果 所取股薄肌腱的长度平均为239 mm;移植腱直径为7.6 mm,长度为41.4 mm.KT-2000的前方不稳定性患健差术前平均为5 mm,术后平均为1 mm,差异有统计学意义(P＜0.05).膝关节活动度与健侧最大相差不到5°,差异无统计学意义(P＞0.05).术后6个月患膝在60°/s伸膝时扭矩恢复到健侧的89%,术后1年恢复到92%,术后2年恢复剑95%;术后6个月患膝在90°/s屈膝时扭矩恢复到健侧的85%,术后1年恢复到86%,术后2年恢复到89%.术前IKDC评分平均为49.3分,术后2年平均为95.0分;VAS评分术前平均为30.3分,术后2年平均为85.4分,差异均有统计学意义(P＜0.05).结论 单独廊用股薄肌腱重建ACL,屈膝肌力恢复满意.保留残留韧带可促进重建韧带的血运和本体感觉的恢复,加速患者的康复.