关节镜下重建前交叉韧带移植物的选择

关节镜下重建前交叉韧带的移植物有十几种可供选取,但目前尚无一种理想的移植物可以适应所有的患者。自体骨-髌腱-骨,腘绳肌腱,异体骨-髌腱-骨是关节镜医生最常选用的三种移植物。因受供端并发症的影响,自体骨-髌腱-骨的应用已呈减少趋势,而后两者因不存在供端并发症,创伤更小,也足以恢复膝关节的稳定性,应用呈增多趋势。     

关节镜下自体骨-髌韧带-骨重建前交叉韧带效果评价

目的　评价关节镜下用自体1/3髌骨-髌韧带-骨重建前交叉韧带的技术和疗效。 方法　自2003年1月至2010年1月对35例前交叉韧带断裂患者行关节镜下自体髌骨-髌韧带-骨重建前交叉韧带术,其中男22例,女13例,年龄23.0岁（20.0 -28.0岁）,左膝关节18例,右膝17例。35例患者均为急性损伤,受伤前均为体育运动爱好者。 结果　随访1-6年,平均3.0年,采用lysholm评分标准评价膝关节功能,术前平均59.40分（45-81分）,术后平均91.80分（72-100分）,术后与术前相比有显著差异性（p<0.5）。35例患者术后均无前叉韧带再断裂,术后34例恢复受伤前运动水平,1例运动水平较受伤前降低。术后1年有2例患者在膝极度屈曲位时有轻微膝前疼痛,但对运动水平无显著影响。 结论　关节镜下自体髌骨-髌韧带-骨重建前交叉韧带是一种微创有效的手术方法,尤其对年轻、活动量大、要求早期恢复高强度运动的患者是一种较佳的选择。     

LARS韧带在前交叉韧带重建中的临床应用与关注热点

文题释义： LARS韧带：于1985 年由法国Dr.Laboureau 应用聚对苯二甲酸乙二醇酯材料模仿人体韧带的解剖结构和生物力学原理设计而成。近年来因其出色的生物相容性和力学特性,被较多的应用于膝关节前交叉韧带损伤后的重建。 前交叉韧带重建：前交叉韧带是维持膝关节稳定的重要结构,整个韧带的纤维束从股骨向胫骨近似扇形散开,内部纤维束以特定的排列方式从前向后分布。目前大多数学者主张将前交叉韧带分为2束,根据其在胫骨附着的相对位置分为前内侧束及后外侧束。由于膝关节前交叉韧带自身的解剖学特性,其完全断裂后无法自行修复,若不及时进行手术治疗往往造成半月板及关节软骨的损伤,因此如果诊断明确,应及早行前交叉韧带重建,用新的移植物替代损伤的前交叉韧带。 背景：虽然目前重建前交叉韧带的移植物选择包括自体移植物、同种异体移植物和人工合成移植物3种主要类型,但移植物的选择仍是当今的热门研究以及争议点的所在。 目的：综述LARS韧带在关节镜下前交叉韧带重建中的早期、中期以及长期临床疗效的国内外研究现状。 方法：应用计算机检索CNKI数据库、PubMed数据库的2019年4月前发表的相关文献,检索词为“LARS韧带,前交叉韧带,人工韧带,前交叉韧带重建,LARS ligament,anterior cruciate ligament,artificial ligament,anterior cruciate ligament reconstruction”。通过阅读文章标题和摘要进行初步筛选,排除与文章主题不相关的文献,根据纳入和排除标准最终纳入46篇文献进行综述。 结果与结论：①LARS韧带拥有出色的生物相容性和力学特性,它的独特结构使成纤维细胞包裹、穿透似生长,且韧带周围没有炎性反应,巨噬细胞少,由于长入的组织增加了韧带的黏弹性且减少了纤维间的摩擦,可有效防止碎屑引起的生物反应;LARS人工韧带弹性模量好,抗扭转、抗疲劳性强;②LARS韧带重建前交叉韧带具有快速康复、低失败率和低并发症等优点,表明LARS韧带适用于前交叉韧带重建。 ORCID: 0000-0001-7923-9839(陈伟) 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程     

自体腘绳肌腱与人工韧带加强系统重建前交叉韧带的比较

目的比较自体腘绳肌腱(HT)和人工韧带加强系统(LARS)重建前交叉韧带(ACL)的效果。方法选择61例ACL断裂患者(均为单侧断裂),其中男性37例,女性24例;年龄17~57岁,平均年龄36岁。采用自体HT重建ACL30例(HT组),采用LARS重建ACL31例(LARS组)。按Lysholm评分系统及KT-2000检查评估功能。结果全部病例均获随访,随访时间26~30个月。Lysholm评分术后2年HT组和LARS组分别为(90.80±8.87)分、(91.70±6.54)分;KT-2000测试膝关节移动距离分别为(2.58±2.18)mm、(2.39±2.09)mm。两组膝关节Lysholm评分在术后均较术前改善,差异有统计学意义(P0.05)。两组间术后Lysholm评分及膝关节稳定性KT-2000检查比较,差异无统计学意义(P0.05)。结论两种移植物均能够获得满意的临床效果,明显改善膝关节功能,LARS是一种良好的替代移植物。     

人工韧带重建前交叉韧带的膝关节功能评价

目的：探讨韧带增强重建系统( LARS)人工韧带重建前交叉韧带( ACL)手术的临床效果。方法采用随机数字表法将我院2011年9月至2013年5月收治的60例ACL损伤患者分为LARS组和自体腘肌腱( ST/G组)组,各30例,比较2组患者治疗前与治疗后3、6、9、18个月的Lysholm评分、主客观IKDC评分、末次随访的临床疗效及骨隧道扩大情况的差异。结果LARS组扶拐下地时间、弃拐行走时间、恢复运动时间3项指标均显著短于ST/G组(P<0.05)。与术前相比,2组Lysholm评分及IKDC评分术后3、6、9、18个月均显著好转(P<0.05);术前2组Lysholm评分及IKDC评分比较差异不显著(P>0.05);术后3、6、9个月LARS组Lysholm评分及IKDC评分显著优于ST/G组,至术后18个月2组患者的Lysholm评分及IKDC评分差异不显著(P>0.05)。末次随访时,LARS组疗效分布显著优于 ST/G 组(P <0.05);LARS 组优良率93.33%高于 ST/G 组的76.67%,但差异不显著(P>0.05)。 LARS组共6例患者出现骨隧道扩大,ST/G组14例患者出现骨隧道扩大,ST/G组出现骨隧道扩大率显著高于LARS组(P<0.05)。结论韧带增强重建系统人工韧带重建前交叉韧带较自体腘肌腱重建能够显著加快患者的恢复,同时提高术后疗效及降低术后骨隧道扩大的发生率。     

交叉韧带重建手术中可吸收挤压螺钉的应用

目的探讨交叉韧带重建术中可吸收挤压螺钉的使用方法和疗效。方法总结53例交叉韧带重建病例使用可吸收挤压螺钉的情况，在术中、术后并发症、术后康复、膝关节功能状况等方面进行回顾性分析。结果三例出现韧带切割现象。两例股骨侧螺钉拧入后导引针无法拔出。一例挤压螺钉断裂。术后Lysholm评分平均92.4±4．1。结论交叉韧带重建术中使用可吸收挤压螺钉固定的方法固定牢固，术后恢复快，利于早期康复。     

关节镜下前交叉韧带重建移植物的研究进展

膝关节前交叉韧带（Anterior Crueiate LigamentACL）是膝关节重要的静力与动力性稳定结构，与其他韧带一起共同保持胫股关节的正常运动。在解剖学上一般将其分为长而细小的前内侧束（AM束）和大而粗短的后外侧束（PL束），亦有作者将其分为三个束：即前内、中间和后外侧束（AM，IM及PL束）。     

关节镜下前交叉韧带重建术康复护理

前交叉韧带（anteriorcruciateligament，ACL）是膝关节的重要稳定结构，能够起到防止胫骨过度前移和过度内旋的作用，一旦断裂可引起膝关节不同程度的不稳定，影响关节功能。若治疗不当发展为ACL缺失膝关节而导致膝关节进一步损害。因此，ACL损伤后4～6周进行修复或重建。ACL重建术后正确指导患者康复训练十分重要。现将我科48例关节镜下前交叉韧带重建术的康复护理报告如下。     

前交叉韧带断裂的力学机制与功能重建

前交叉韧带断裂的力学机制与功能重建邵建康综述王以进审校（上海市嘉定区中心医院上海大学生物力学研究室）自从１９１７年ＨｅｒＧｒｏｖｅｓ首先报导修复前交叉韧带（ＡｎｔｅｒｉｏｒＣｒｕｃｉａｔｅＬｉｇａｍｅｎｔ）以来，许多学者相继从生物力学、组织学以及替代...     

LARS人工韧带同时重建前、后交叉韧带

目的探讨关节镜下LARS（Ligament Advanced Reinforcement System，LARS）人工韧带同时重建前（An-terior cruciate ligament，ACL）、后交叉韧带（posterior cruciate ligament，PCL）的方法和临床疗效。方法从2006年1月至2007年4月，用LARS人工韧带同时重建ACL、PCL2例。应用Lysholm功能评分表评估膝关节功能，采用抽屉实验检查膝关节前后松弛度。结果2例均获得随访，随访时间分别为8月、3月。2例患者术后患膝关节不稳定症状消失，胫骨后坠征阴性，前、后抽屉试验阴性。膝关节功能评估采用Lysholm功能评分标准，术前平均分别为45．6±7．6分，术后平均为80．3±9．1分。结论关节镜下应用LARS人工韧带同时重建ACL、PCL可更好地恢复膝芙节的稳定性，且创伤小，并发症少，近期疗效满意，但远期效果仍需进一步观察。     

Validating the forgotten joint score-12 in patients after ACL reconstruction

Background

The forgotten joint score-12 (FJS-12), used to measure postoperative joint awareness, has been extensively validated to assess outcomes after arthroplasty, however the new score has never been validated in evaluating anterior cruciate ligament (ACL) reconstruction. The purpose of our study was to validate the FJS-12 versus the knee injury and osteoarthritis outcome score (KOOS) for patients who have undergone ACL reconstruction.

Allograft use in ACL reconstruction

This paper will provide information concerning the specifics of allograft use in ACL reconstruction. A detailed discussion of the science of allografts, both technical and theoretical, along with experimental studies will be followed by information concerning graft preparation and the advantages and disadvantages of allografts, as well as a review of the clinical literature surrounding allograft use in ACL reconstruction.     

Early rehabilitation with weight-bearing standing-shaking-board exercise in combination with electrical muscle stimulation after anterior cruciate ligament reconstruction

The objective of early rehabilitation after anterior cruciate ligament (ACL) reconstruction is to increase the muscle strength of the lower extremities. Closed kinetic chain (CKC) exercise induces co-contraction of the agonist and antagonist muscles. The purpose of this study was to compare the postoperative muscle strength/mass of subjects who performed our new CKC exercise (new rehabilitation group:group N) from week 4, and subjects who received traditional rehabilitation alone (traditional rehabilitation group:group T). The subjects stood on the device and maintained balance. Then, low-frequency stimulation waves were applied to 2 points each in the anterior and posterior region of the injured thigh 3 times a week for 3 months. Measurement of muscle strength was performed 4 times (before the start, and then once a month). Muscle mass was evaluated in CT images of the extensor and flexor muscles of 10 knees (10 subjects) in each group. The injured legs of group N showed significant improvement after one month compared to group T. The cross-sectional area of the extensor muscles of the injured legs tended to a show a greater increase at 3 months in group N. This rehabilitation method makes it possible to contract fast-twitch muscles, which may be a useful for improving extensor muscle strength after ACL reconstruction.     

Hamstring antagonist torque generated in vivo following ACL rupture and ACL reconstruction

Hamstring motor behaviour and resultant antagonist torque during knee extension has been quantified in uninjured individuals however, the effect of ACL rupture and ACL reconstruction (ACLR) on the morphology of hamstring antagonist torque generated in vivo is unknown. The purpose of this cross-sectional study was to quantify the hamstring antagonist torque generated in vivo during isokinetic knee extension in ACLD and ACLR patients relative to uninjured control subjects. Ten male ACL deficient (ACLD) subjects (18–35 years), 14 matched males who had undergone ACLR using the bone–patellar tendon–bone graft and 22 matched male control subjects participated. We used a mathematical model to estimate the opposing torque generated by the hamstrings during isokinetic knee extension in 10° intervals from 80° to 10° knee flexion. Control group hamstring antagonist torque was significantly lower at 80–70° knee flexion compared with that of the ACLD (% Diff = 40.2; p = 0.019) and ACLR (% Diff = 34.8; p = 0.036) groups. For all subject groups, hamstring antagonist torque demonstrated a descending–ascending curve; decreasing significantly from 80–70° to 50–40° knee flexion (% Diff = 40.8 to 63.3; p = < 0.001 to 0.009) but then increasing significantly from 50–40° to 20–10° knee flexion (% Diff = 37.6 to 59.0; p = < 0.001 to 0.012). ACL status and therefore, the ACL-hamstring reflex has little effect on the magnitude of hamstring antagonist torque generated during quadriceps-induced knee joint loading. Capsular afferents are thought to dictate the hamstring torque profile which decreased then increased during knee extension to maintain dynamic joint stability.     

Calcium phosphate-hybridised tendon graft to reduce bone-tunnel enlargement after ACL reconstruction in goats

Bone-tunnel enlargement can have a negative impact on long-term clinical success. To solve the problem, we developed a novel technique to improve tendon-bone healing by hybridising calcium phosphate (CaP) with a tendon graft using an alternate soaking process. The objective of this study was to analyse bone-tunnel enlargement, mechanical properties and histological features, especially the number of osteoclasts at the tendon-bone interface using a CaP-hybridised tendon graft and an untreated tendon graft 6 months after anterior cruciate ligament (ACL) reconstruction in goats. The percentage of bone-tunnel enlargement for the CaP group was decreased compared with that for the control group for the femoral side (p<0.05). The failure load was not statistically different between the CaP group and the control group, and was all midsubstance rupture for both groups. In the CaP group, cartilage layer was more observed at the tendon-bone interface of the joint aperture site than in the control group (p<0.05). Many osteoclasts on the femoral side of the tendon-bone interface in the control were observed compared with that in the CaP group (p<0.05). At the femoral side, the CaP-hybridised tendon graft reduced bone-tunnel enlargement associated with tendon-bone healing 6 months after ACL reconstruction in goats. Clinically, the CaP-hybridised tendon graft for ACL reconstruction can reduce bone-tunnel enlargement.     

Evaluation of outcomes in conservatively managed concomitant Type A and B posterolateral corner injuries in ACL deficient patients undergoing ACL reconstruction

IntroductionThere is paucity of literature regarding the outcomes of ACL reconstruction in ACL deficient knees with concomitant Type A and Type B PLC injuries.Materials and methodsA total of 102 patients undergoing isolated ACL reconstruction for an ACL injury were evaluated prospectively in this study. The patients with divided into three groups: group A with isolated ACL injury, group B1 with concomitant Type A PLC injury and group B2 with concomitant Type B PLC injury. The associated PLC injury in all these patients was managed conservatively. Outcome assessment was based on IKDC scores measured preoperatively and at last follow up visits.ResultsThe mean age of the patients was 25.33 years (16–38 years) with 95 males and seven females. The average follow up was almost 2.5 years (13–46 months). Group A had 88 patients while groups B1 and B2 had six and eight patients respectively. The preoperative IKDC scores were comparable for all the groups. The follow up IKDC scores were similar (statistically insignificant, p value: 0.421) for group A and group B1. Group B2 had poorer follow up IKDC scores as compared to group A and this result was found to be statistically significant (p value: 0.0001).ConclusionConservative management of a concomitant Type B PLC injury adversely affects the outcomes of ACL reconstruction in these patients. Type A PLC injuries, on the other, do well without surgery and can be left as such even when associated with a concomitant ACL tear.Level of evidence: Level 2     

Evaluation of proprioception in patients who underwent ACL reconstruction: measurement in functional position

Background/aimAnterior cruciate ligament (ACL) injuries cause mechanoreceptor loss in the joint; therefore, proprioceptive deficits are observed after injury. In particular, proprioceptive measurements made in the functional position give more accurate results, and this is an area that requires further studies. This study aimed to evaluate proprioception in patients who had undergone ACL reconstruction (ACLR) in functional positions used in daily life (closed kinetic chain position), according to joint angles where ACL injuries occur more frequently, in comparison with healthy controls.Materials and methodsThirty-four participants who underwent ACLR using a hamstring tendon graft (aged 29.18 ± 8.16 years; body mass index (BMI), 26.58 ± 4.02 kg/cm²) and 31 healthy participants (aged 27.35 ± 5.74 years; BMI, 24.76 ± 2.98 kg/cm²) were included. Proprioception was assessed with an active angle repetition test, using an inclinometer in the closed kinetic chain position while standing. Participants were asked to perform single-leg squats until the angle at the knee joint was 30°. After the targeted angle was defined, the participants were asked to find the targeted angle. The difference between the targeted angle and the angle reached by the participants was calculated.ResultsA statistically significant difference in the active joint position sense was found among the ACLR extremity, uninvolved extremity, and control extremity (p < 0.05). The proprioceptive sense between the two extremities in the ACLR group was similar, and the proprioceptive sense was worse than that of the control group.ConclusionTo our knowledge, this is the first study to evaluate closed kinetic chain position in patients who underwent ACLR, and it showed that proprioceptive sense was still poor in patients with ACLR compared with the control group, even if an average of 24 months have elapsed since surgery.     

The evolution of osteoarthritis in 103 patients with ACL reconstruction at 17 years follow-up

AIM: To evaluate the functional and radiological outcome of a bone-tendon-bone anterior cruciate ligament reconstruction, at long-term follow-up. METHODS: A retrospective study of 148 patients, of which 103 were available for long-term follow-up. Complete functional and radiological evaluation (International Knee Documentation Committee scale) were performed in 89 out of the 103 patients [Anderson AF. Rating scales. In: Fu FH, Harner CD, Vince KG, (Eds.). Knee Surgery, Baltimore, Williams and Wilkins vol. 1, 1994; 12, pp. 275-296]. RESULTS: The mean follow-up time was 17.4 years. Subjectively, 88% of the patients were very satisfied or satisfied. According to the IKDC score 55% had type A symptoms, 29% type B, 12% type C, and 4% type D. The IKDC ligament evaluation showed 14.9% type A, 44.8% type B, 35.8% type C, and 4.5% type D. At the review 22.7% had a narrowing <50% (C) and 4.7% a narrowing >50% (D). Onset of osteoarthritis showed an association with the status of the medial meniscus. Knees with a preserved (healthy or sutured) medial meniscus had a significantly (p < 0.05) better radiological outcome. Among these, 9% had a joint space narrowing <50% (C) and 2% had a narrowing >50% (D). Medial meniscectomy, residual laxity, and femoral chondral defects were associated with osteoarthritis. CONCLUSION: The outcome of anterior cruciate ligament reconstruction plus extra-articular tenodesis is good in the very long term, particularly in knees with a preserved medial meniscus.