Functional results after anterior cruciate ligament reconstruction using the patellar ligament bone-tendon-bone technique

This study evaluates the outcome after surgical repair of the cruciate ligament in 129 patients (physical examination plus questionnaire) and another 49 patients (questionnaire only) after a mean interval of 3.2 years. A modified Lysholm score and the OAK score together with KT 1000 arthrometry were used. Ninety-five percent of patients evaluated the overall result as ‘excellent’ or ‘good’. The overall OAK objective score was good or excellent in 81%. Elongation as measured by KT 1000 arthrometry was 1.0 mm (67 N) and 1.2 mm (90 N) on average compared with the contralateral knee. Received: 6 May 2000     

自体中1／3髌韧带重建前十字韧带术后膝关节内并发症的探讨

目的探讨应用自体中1/3髌韧带移植重建前十字韧带术后膝关节内有关的并发症及其发病机制。方法1994年1月～1997年11月 ,对18例前十字韧带断裂的患者采用关节镜或小切口关节切开术 ,完成自体中1/3髌韧带移植重建前十字韧带。术后平均随访2年 ,对所有病例进行临床检查 ,确定膝关节疼痛部位 ,检查膝关节活动度及稳定性 ,并利用膝关节屈曲90°的侧位X线片测量髌韧带长度。结果随访18例患者 ,17例术后膝关节存在触发性或功能性疼痛 ,膝关节疼痛常位于髌股关节、髌骨下极、髌韧带供区及胫骨结节部位。8例患者术后患膝活动度有不同程度受限。6例患者髌韧带发生不同程度的短缩 ,平均短缩2.8mm。4例患者髌股关节间隙变窄。两种术式以上并发症的发生率及严重程度差异无显著性意义。结论应用自体中1/3髌韧带重建前十字韧带不仅应注意疼痛等并发症的发生 ,还应关注髌韧带供区及髌股关节并发症的发生 ,重视其发病的病理基础。髌韧带中1/3缺损可引起髌韧带短缩及髌股关节退变。     

关节镜下髌韧带和六股异体腘绳肌腱单束重建前交叉韧带的临床研究

目的 比较关节镜下采用髌韧带和六股异体腘绳肌腱单束重建前交叉韧带的临床效果.方法 回顾性分析2006年10月至2009年12月我科采用关节镜下异体移植物单束重建前交叉韧带(ACL)的108例患者的临床资料,其中六股异体腘绳肌腱58例(腘绳肌腱组),异体髌韧带50例(髌韧带组).术后应用Lachman和pivot-shift试验以及KT-1000评估膝关节稳定性,按照国际膝关节评分委员会(IKDC)、Lysholm膝关节评分评价膝关节功能.结果 术后患者随访时间12～38个月,平均为28.6个月.腘绳肌腱组KT-1000检查示双侧膝关节前向松弛度差异为(1.2±1.2)mm,显著小于髌韧带组(1.8±1.5)mm,差异具有统计学意义(P＜0.05).腘绳肌腱组轴移试验阴性55例(94.8%),阳性3例(5.2%),髌韧带组阴性41例(82.0%),阳性9例(18.0%),差异具有统计学意义(P＜0.05).术后腘绳肌腱组和髌韧带组IKDC评分为(90±5)分和(89±5)分,Lysholm评分为(94±5)分和(93±6)分,两组比较差异无统计学意义(P＞0.05).结论 关节镜下单束重建前交叉韧带采用六股异体腘绳肌腱较髌韧带能够明显提高膝关节稳定性.

Abstract：

Objective To compare the outcome of arthroscopic single-bundle anterior cruciate ligament(ACL)reconstruction with six-strand hamstring tendon and patellar tendon allograft.Methods From October 2006 to December 2009,108 patients with arthroscopic single-bundle ACL reconstruction were retrospectively reviewed,with 58 patients with six-strand hamstring tendon(Group H),and 50 patients with patellar tendon allograft(Group P).Patients were available for clinical evaluation with KT-1000 arthrometer measurements,Lachman and pivot-shift test,and knee function with the Internationa]Knee Documentation Committee(IKDC),Lysholm scores.Results All the patients were followed up at an average of 28.6 months(range 12-38 months).The average side-to-side difference was lesser for group H(1.2 ± 1.2)mm than group P(1.8 ±1.5)mm(P＜0.05).On the pivot-shift test,55(94.8%)patients were negative and 3(5.2%)were positive in group H,whereas 41(82.0%)were negative and 9(18.0%)were positive in group P,with significant difference between two groups(P＜0.05).All knee function scores were improved postoperatively,without statistically significant difference between the two groups(P＞0.05).Conclusion Arthroscopic single-bundle ACL reconstruction with six-strand hamstring tendon will achieve better knee stability than patellar tendon allograft.     

Simultaneous reconstruction of anterior cruciate ligament and posterior cruciate ligament by using allogeneic patellar tendon under arthroscopy

With fast development of arthroscopic surgery inChina, simple reconstruction of ACL (anteriorcrucial ligament) or PCL has been reported in number. However , the methods concerningsimultaneous reconstruction of ACL and PCL are rarelyreported. Simultaneous …     

The phenomenon of "ligamentization": anterior cruciate ligament reconstruction with autogenous patellar tendon

Reconstruction of the anterior cruciate ligament (ACL) with patellar tendon (PT) is a common procedure for the symptomatic ACL-deficient knee. Questions regarding graft incorporation, viability, and nutrition of the transplanted tissue are of concern. This relates to the graft's response to its new intrasynovial milieu and new physical forces. These factors were studied in a rabbit model of ACL reconstruction using PT and were evaluated with histological and biochemical parameters with respect to time. A histological and biochemical metamorphosis of the grafted PT occurred in this study. Autografts demonstrated a gradual assumption of the microscopic properties of normal ACL; by 30 weeks postoperatively, cell morphology was ligamentous in appearance. Normally, type III collagen is not observed in PT, however, a gradual increase in its concentration was seen in the grafts; by 30 weeks its concentration (10%) was the same as in normal ACL. Similarly, glycosaminoglycans content increased from its normally low level in PT to that found in native ACL. Collagen-reducible crosslink analysis demonstrated that grafted tissue changed from the normal PT pattern of low dihydroxylysinonorleucine (DHLNL) and high histidinohydroxymerodesmosine (HHMD) to the pattern seen in normal ACL (high DHLNL and low HHMD) by 30 weeks. These data suggest that when PT is placed in the anatomic and environmental milieu of the ACL, a "ligamentization" of the grafted tissue results; also the autograft initially depends on synovial fluid nutrition, as revascularization occurs after 6 weeks.     

″Silent” transverse patellar fracture following anterior cruciate ligament reconstruction

Patellar fracture is a rare but specific complication of anterior cruciate ligament reconstruction using bone–patellar tendon–bone autograft. When this complication occurs, early internal fixation is recommended and need not compromise the outcome. We report 2 cases of displaced transverse patellar fracture occurring after reconstruction but which were not diagnosed and presented with late sequelae.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 17, No 9 (November-December), 2001: pp 997–999     

关节镜下中1/3髌腱移植重建膝后十字韧带

目的关节镜下应用中1/3髌腱移植重建后十字韧带,评估其近期临床治疗效果。方法采用骨-中1/3髌腱-骨组织移植重建膝关节后十字韧带,用于治疗后十字韧带损伤后关节不稳定。手术在关节镜下经前方入路完成。结果12例患者平均随访17.3个月。Larson评分由术前60.7分提高到93.4分,Lysholm评分由术前55.0分提高到91.6分。所有患膝术前后抽屉试验及Lachman试验均阳性,术后仅2例后抽屉试验弱阳性、1例Lachman试验弱阳性。结论在关节镜直视下,能准确定位后十字韧带解剖止点,钻制骨隧道,植入移植组织。该技术具有不切开关节囊,损伤小、关节粘连率低的优点。     

关节镜下应用自体胭绳肌腱重建前交叉韧带的临床分析

目的探讨自体股薄肌及半腱肌重建前交叉韧带（ACL）的临床疗效。方法研究应用自体股薄肌、半腱肌移植重建前交叉韧带损伤病例共30例。术后追踪随访进行为期2年的康复训练,术前和术后随访时行患肢X线检查、功能评分。结果本组病例均获得随访,时间平均32个月（24～40个月）,术后Lachman征及旋转移位试验阴性。Lysholm评分由术前平均（54．80±2．10）分增加至术后2年为（91．00±2．30）分,两者之间的差异有统计学意义（t=61．930,P〈0．01）。而Tegner评分则由术前平均（5．00±1．20）分增加至术后2年（6．23±1．40）分,两者之间的差异有统计学意义（t=3．650,P〈0．01）。手术前后x线复查无退行性改变。结论自体胭绳肌腱重建ACL术后2年随访发现患者膝关节前向不稳消失,膝关节功能评分比术前明显增加。用该方法重建ACL能有效恢复膝关节的功能。     

膝关节镜下采用挤压螺钉固定骨-髌腱-骨自体移植重建前交叉韧带

目的　探讨采用关节镜下微创手术的方法重建膝关节前交叉韧带。　方法　在膝关节镜下采用挤压螺钉固定骨 髌腱 (中 1/ 3) 骨复合体自体移植重建前交叉韧带 ,术后 1年以上者 2 0例 ,平均随访时间 1年 5个月。　结果　按关节功能评定标准 ,本组 2 0例中 ,优 13例 ,良 5例 ,可 2例 ,优良率 90 % ;9例术后关节镜观察重建前交叉韧带的形态结构 ,7例塑形改建良好。　结论　关节镜下重建前交叉韧带手术创伤小 ,骨道定位准确、固定牢固 ,可做到等长重建 ,有利于早期康复 ;由于利用了自体骨 髌腱 骨组织 ,重建的韧带经塑形改建后可获得牢固的生物学固定     

重建前交叉韧带血供的实验研究和临床应用

目的：探讨加速前交叉韧带替代物血供重建的方法。方法：用狗作动物模型，将两侧髌韧带内侧1／3游离，左侧直接包埋于髌下脂肪垫，右侧髌下脂肪垫切除后将韧带游离置于关节腔。术后2、4、6、8周灌注，取材，观察髌下脂肪垫对游离髌韧带血供重建的影响。临床应用于前交叉韧带断裂重建术20例（Jones 髌下脂肪垫覆盖术），结果：髌下脂肪垫包裹的游离髌韧带血供重建速度较未被包裹的一侧大大加快，其韧带内的细胞坏死，胶原崩解亦较对照组明显减少，临床应用19例疗效满意。结论：在作交叉韧带重建手术，应尽量保留并利用髌下脂肪垫等软组织，包裹替代物，以促进其血循环重建，减少坏死，保持韧带活力，使替代物发挥稳定膝关节的功能。     

The comparison of functional results of anterior cruciate ligament injuries treated with semitendinosus tendon and central one-third of patellar tendon autografts

The results of ACL reconstructions with autologus grafts taken from semitendinosus tendon and patellar ligament are presented. There were 78 patients in four groups. Patient age ranged from 15 to 47 years. The period of observation varied from 1 to 10 years, average 3.5. The first group consisted of 28 people treated with single semitendinosus tendon graft. In the second group there were 12 patients with acute ACL injuries treated by reinsertion of torn ligament attachment augmented by semitendinosus tendon. The third group of 18 persons had an ACL reconstruction with central one-third of patellar ligament fastened with thread loops on bone screws or staples. The last group of 20 patients had ACL reconstruction with central one-third of patellar ligament autograft. All patients were prospectively evaluated according to the Hospital for Special Surgery and the Lysholm and Gillquist scales. The statistical analysis clearly reveals the best results in the fourth group of patients, who had graft fixation with interference screws. Received: 4 April 2001/Accepted: 23 April 2001     

Posttraumatic incarceration of medial collateral ligament into knee joint with anterior cruciate ligament injury

Medial collateral ligament of the knee is an important coronal stabiliser and often injured in isolation or as combination of injuries. The article reports a case of incarcerated medial collateral ligament (MCL) injury in combination with anterior cruciate ligament (ACL) injury in 20 year old male who presented to us 4 weeks after injury. Clinical examination and MRI was correlated to complete ACL tear with torn distal MCL and incarceration into the joint. Patient was taken up for ACL hamstring graft reconstruction with mini-arthrotomy and repair of the torn MCL. Patient was followed up with dedicated rehabilitation protocol with good functional results. At one year follow-up, patient exhibited full range of motion with negative Lachman, Pivot shift and valgus stress tests. This article highlights the rare pattern of MCL tear and also reviews the literature on this pattern of injury.     

不同方法移植重建膝前交叉韧带的实验研究

目的探讨自体髌韧带移植重建前交叉韧带(ACL)的固定方法及即刻固定强度。方法将15具标本分为3组,分别为1/3骨-髌韧带-骨(1/3B-PT-B)挤压螺钉固定组,1/3骨-髌韧带Krackow双锁边缝合组和原始标本ACL组。对标本施行单轴拉伸,运用生物力学方法检测分析。所有实验均在液压万能材料试验机(WE-5A)上进行,用数字试应变仪(YJ-14)读取应变,用KG-101高精度数显光栅位移测微仪测量位移。加载速率为1.4mm/min,由于实验均为单轴拉伸试验,故载荷轴向、加载速率和加载等级三者均保持一致。从零加载至韧带撕裂、断裂时为止。达到极限强度过程须全面记录。结果1/3B-PT-B置换挤压螺钉固定组强度、刚度均高于原始标本ACL组及1/3骨-髌韧带Krackow双锁边缝合组,差异有显著性意义(P<0.05)。结论选用1/3B-PT-B置换挤压螺钉固定重建ACL,术后替代物强度高,关节稳定性较好。     

Protection of the bone-tendon-bone graft during anterior cruciate ligament reconstruction

Damage of graft fibers is a complication that can happen during arthroscopic reconstruction of the anterior cruciate ligament. It usually occurs while pulling the neoligament through the tibial tunnel, inserting the femoral screw, or doing additional notchplasty. Protection of the graft with a polyethylene tube can reduce the risk of graft laceration.     

关节镜下前十字韧带重建术术中失误原因的分析与对策

目的 回顾性分析前十字韧带(anterior cnltiale ligament，AcL）重建术中的各种失误并提出解决办法．为临床治疗提供参考．方法 自1995年1月～2002年6月对194例陈旧性ACL损伤患者行关节镜下ACL重建术。固定方法包括88例Kurosaka挤压螺钉固定和106例Aesculap内扣式缝线钢板固定．其中86例使用自体中1/3骨-髌韧带-骨移植．19例应用异体髌韧带移植．89例为自体半腱肌腱与股薄肌腱移植。结果 36例发生术中失误．其中2例不可挽救。术中失误的原因可分为隧道问题，移植物问题、固定问题等。术中最常见的失误是导针位置和方向不佳．与移植物和固定方式选择无关。Aesculap内扣式缝线钢板法固定自体半腱肌腱与股薄肌腱修复ACL时最常遇到的问题是取下的移植物过短或分叉。结论 只有掌握各种ACL重建方法的操作要点并加以灵活运用才能减少和正确处理各种术中失误。     

四股半腱肌腱和髌韧带修复陈旧性前十字韧带损伤的前瞻性研究

目的比较60例陈旧性前十字韧带(ACL)损伤患者关节镜下应用4股半腱肌腱或髌韧带重建ACL的疗效。方法对60例具有可比性的陈旧性ACL损伤患者行关节镜下重建术,重建材料选用自体4股半腱肌腱或髌韧带。所有手术均由同一名医生完成。术前和术中检查表明两组患者之间差异无显著性意义,具有可比性。术后随访时检查患者的膝关节活动度、膝关节稳定性、日常活动和运动恢复情况。结果两组患者术后的关节稳定性相同。半腱肌腱组恢复体育活动的百分比略大于髌韧带组,分别为80%和73%,两组间差异无显著性意义,但伸膝角度丧失(≤3°)的百分比小于髌韧带组,分别为6%和40%,差异有非常显著性意义。KT-2000关节动度仪检查,30磅(133.4N)拉力试验中,半腱肌腱组13%的患者双膝移位差值>3mm,髌韧带组中20%的患者>3mm。术后半腱肌腱组与髌韧带组中度髌股关节病变的发生率分别为6%和17%。结论关节镜下半腱肌腱或髌韧带移植重建ACL的疗效相当,差异无显著性意义。     

Anterior cruciate ligament reconstruction: outcome using a patellar tendon bone (PTB) autograft (one bone block technique)

Objective  The aim of this study was to determine the outcome of anterior cruciate ligament (ACL) reconstruction using a patellar tendon bone autograft (one bone block technique). Method  We retrospectively evaluated a case series of patients who had received arthroscopic ACL reconstructions using patellar tendon bone autograft. Fifty-four (54) ACL reconstructions were evaluated at a mean of 38 months (range 25–62 months). Clinical assessment was made using a modified Lysholm score, documentation of International Κnee Documentation Committee (lΚDC), the anterior knee pain questionnaire of Shelbourne and Trumper, and by ΚΤ-Rolimeter arthrometric analysis. Radiographic assessments were also performed. Results  Arthrometric analysis showed that 51 knees (94%) were graded Α or Β with a median laxity of 2 mm, postoperatively. The Lysholm score improved postoperatively from 70 to 89. The patellar position in terms of congruence angle did not show any significant change, and the final shortening of the patellar tendon using the Insall–Salvati ratio was 6.07%. Only three patients complained of moderate pain on kneeling, one patient was unable to participate in strenuous works and one patient complained of harvest-site tenderness. Conclusion  It is concluded that the use of patellar tendon autograft with a single tibial-tubercule bone block and a strip of patellar periosteum have the advantages of being available and comparable in terms of graft size and strength and shows satisfactory results with reduced anterior knee pain.     

An anterior cruciate ligament and medial collateral ligament tear in a skeletally immature patient: a new technique to augment primary repair of the medial collateral ligament and an allograft reconstruction of the anterior cruciate ligament

The goal of this case report is to fill a dual purpose. We describe a case involving a tear of the anterior cruciate ligament (ACL) and medial collateral ligament (MCL) in a skeletally immature athlete. At the same time, we describe a new technique with which we repaired the ACL with an allograft posterior tibialis tendon through intra-articular tunnels. A trial of conservative therapy for the MCL was performed. During surgery, its instability was assessed. No improvement was seen in stability, so a primary repair of the MCL was performed and augmented with an autograft gracilis tendon. The patient did well postoperatively, subsequently achieving equal stability and range of motion when compared with the opposite limb. He was back to competitive sports at 6 months.     

Differential sensitivity to NO-induced apoptosis between anterior cruciate and medial collateral ligament cells

It is well known that the anterior cruciate ligament (ACL) of the knee joint has poorer healing responses than the medial collateral ligament (MCL). Nitric oxide (NO) induces free radicals and plays a key role in the induction of apoptosis in various wound-healing models. We hypothesized that the poor healing response of the ACL may be ascribed to high susceptibility to apoptosis, and we investigated the difference in susceptibility to apoptosis between ACL and MCL cells after treatment with sodium nitroprusside, a NO donor. Apoptosis was evaluated by phase contrast microscopy, electron microscopy, DNA gel electrophoresis, and flow cytometric analysis. Although morphological changes and DNA ladders were observed in both ACL and MCL cells after 2mM sodium nitroprusside treatment, ACL cells were more prone to apoptosis at 1mM. Based on flow cytometric analysis, DNA fragmentation at 1mM sodium nitroprusside was significantly greater in ACL cells than in MCL cells (58.6% ± 1.6% vs. 11.9% ± 2.2%). Caspase-3 inhibitor (Ac-Asp-Glu-Val-Asp-CHO) and caspase-9 inhibitor (Ac-Leu-Glu-His-Asp-CHO) completely inhibited this DNA fragmentation. In conclusion, the ACL and MCL cells exhibit essential differences, and the differential sensitivity to NO-induced apoptosis between the ACL and MCL cells may be a reflection of these differences.