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1.
Yong Seuk Lee Shin Woo Nam Jae Ang Sim Beom Koo Lee 《Knee surgery, sports traumatology, arthroscopy》2014,22(11):2803-2810
Purpose
The objective of this study was to compare the clinical and radiologic results of preserved ligament remnants in the selective bundle anterior cruciate ligament (ACL) reconstruction and totally sacrificed ligament remnant in the double-bundle ACL reconstruction in order to confirm the evidence of selective bundle reconstruction.Methods
This retrospective comparative study was conducted for comparison between preserved ligament remnants in the selective bundle ACL reconstruction and totally sacrificed ligament remnant in the double-bundle ACL reconstruction. From 2008 to 2010, 16 patients (group I) underwent selective bundle ACL reconstruction and 30 patients (group II) underwent double-bundle ACL reconstruction. Clinical, stability and radiologic results (tunnel locations of femoral tunnels using 3-D computed tomography and graft signal intensity using magnetic resonance imaging) were compared.Results
In comparison with functional results, no statistical differences in the Lysholm, Tegner and International Knee Documentation Committee scores were observed between the two groups (n.s.). In comparison with stability results between the two groups, no statistical differences were observed in the Lachman, pivot shift and anterior drawer stress tests using a Telos® device at 30° and 90° flexed positions (n.s.). In evaluation of the femoral tunnel location, no statistical significant differences in the tunnel position were observed between the groups (n.s.). No statistically significant differences in signal intensity were observed between the two groups (n.s.).Conclusions
Compared to the double-bundle ACL reconstruction, selective bundle ACL reconstruction produced comparable clinical and radiologic results. Selective bundle ACL reconstruction could be performed instead of double-bundle ACL reconstruction if some intact bundle exists.Level of evidence
Comparative study, Level III. 相似文献2.
Yan Xu Ying-fang Ao Jian-quan Wang Guo-qing Cui 《Knee surgery, sports traumatology, arthroscopy》2014,22(2):308-316
Purpose
To determine if anatomic double-bundle anterior cruciate ligament (ACL) reconstruction is superior to anatomic single-bundle reconstruction in restoring the stabilities and functions of the knee joint.Methods
A prospective randomized clinical study was done to compare the results of 32 cases of anatomic single-bundle ACL reconstruction and 34 cases of anatomic double-bundle ACL reconstruction with average follow-up of 16.3 ± 3.1 months. Tunnel placements of all the cases were measured on 3D CT. Clinical results were collected after reconstruction; graft’s appearance, meniscus status and cartilage state under arthroscopy were compared and analysed too.Results
Tunnel placements, confirmed with 3D CT, were in the anatomic positions as described in literature both in SB and DB group. No differences were found between SB and DB groups in clinical outcome scores, pivot shift test and KT 1000 measurements (average side-to-side difference for anterior tibial translation was 0.7 mm in SB group and 1.0 mm in DB group). More than 70 % of the single-bundle graft and AM bundle graft in DB group appeared excellent, but only 44.1 % of PL bundle grafts in DB group were excellent and 11.8 % were in poor state. No new menisci tear was found either in SB or DB group, however, in DB group cartilage damages in medial patella-femoral joint occurred in 38.2 % cases. This rate was significantly higher than in the SB group which is only 9.3 %.Conclusion
Both single- and double-bundle anatomic ACL reconstruction can restore the knee’s stability and functions very well. However, more incidences of poor PL status and medial patellar-femoral cartilage damage may occur in double-bundle ACL reconstruction.Level of evidence
Randomized controlled trial, Level I. 相似文献3.
Kawakami Y Hiranaka T Matsumoto T Hida Y Fukui T Uemoto H Doita M Tsuji M Kurosaka M Kuroda R 《Knee surgery, sports traumatology, arthroscopy》2012,20(8):1503-1510
Purpose
The first purpose of this study was to examine whether fluoroscopic-based navigation system contributes to the accuracy and reproducibility of the bone tunnel placements in single-bundle anterior cruciate ligament (ACL) reconstruction. The second purpose was to investigate the application of the navigation system for double-bundle ACL reconstruction.Methods
A hospital-based case–control study was conducted, including a consecutive series of 55 patients. In 37 patients who received single-bundle ACL reconstruction, surgeries were performed with this system for 19 knees (group 1) and without this system for 18 knees (group 2). The positioning of the femoral and tibial tunnels was evaluated by plain sagittal radiographs. In 18 patients who received double-bundle ACL reconstruction using the navigation system (group 3), the bone tunnel positions were assessed by three-dimensional computed tomography (3D-CT). Clinical assessment of all patients was followed with the use of Lysholm Knees Score and IKDC.Results
Taking 0% as the anterior and 100% as the posterior extent, the femoral tunnels were 74.9?±?3.0% in group 1 and 71.5?±?5.8% in group 2 along Blumensaat’s line, and the tibial tunnels were 42.3?±?1.4% in group 1 and 42.5?±?4.6% in group 2 along the tibia plateau. The bone tunnel positions in group 1 were located significantly closer to the position planned preoperatively and varied less in both femur and tibial side, compared with those without navigation (group 2). (Femur: P?0.05, Tibia: P?0.001) 3D-CT evaluation of double-bundle ACL reconstruction (group 3) also demonstrated that the bone tunnel positions of both anteromedial (AM) and posterolateral (PL) were placed as we expected.Conclusion
The fluoroscopic-based navigation system contributed to the more reproducible placement of the bone tunnel during single-bundle ACL reconstruction compared with conventional technique. Additionally, this device was also useful for double-bundle ACL reconstruction.Level of evidence
Case–control study, Therapeutic study, Level III. 相似文献4.
Neel Desai Haukur Björnsson Volker Musahl Mohit Bhandari Max Petzold Freddie H. Fu Kristian Samuelsson 《Knee surgery, sports traumatology, arthroscopy》2014,22(5):1009-1023
Purpose
To determine whether anatomic double-bundle anterior cruciate ligament (ACL) reconstruction compared to anatomic single-bundle ACL reconstruction more effectively restored antero–posterior (A–P) laxity, rotatory laxity and reduced frequency of graft rupture. Our hypothesis was that anatomic double-bundle ACL reconstruction results in superior rotational knee laxity and fewer graft ruptures due to its double-bundle tension pattern, compared with anatomic single-bundle ACL reconstruction.Methods
An electronic search was performed using the PubMed, EMBASE and Cochrane Library databases. All therapeutic trials written in English reporting knee kinematic outcomes and graft rupture rates of primary anatomic double- versus single-bundle ACL reconstruction were included. Only clinical studies of levels I–II evidence were included. Data regarding kinematic tests were extracted and included pivot-shift test, Lachman test, anterior drawer test, KT-1000 measurements, A–P laxity measures using navigation and total internal–external (IRER) laxity measured using navigation, as well as graft failure frequency.Results
A total of 7,154 studies were identified of which 15 papers (8 randomized controlled trials and 7 prospective cohort studies, n = 970 patients) met the eligibility criteria. Anatomic ACL double-bundle reconstruction demonstrated less anterior laxity using KT-1000 arthrometer with a standard mean difference (SMD) = 0.36 (95 % CI 0.214–0.513, p < 0.001) and less A–P laxity measured with navigation (SMD = 0.29 95 % CI 0.01–0.565, p = 0.042). Anatomic double-bundle ACL reconstruction did not lead to significant improvements in pivot-shift test, Lachman test, anterior drawer test, total IRER or graft failure rates compared to anatomic single-bundle ACL reconstruction.Conclusion
Anatomic double-bundle ACL reconstruction is superior to anatomic single-bundle reconstruction in terms of restoration of knee kinematics, primarily A–P laxity. Whether these improvements of laxity result in long-term improvement of clinical meaningful outcomes remains uncertain.Level of evidence
II. 相似文献5.
M. Ettinger M. Petri D. Guenther C. Liu C. Krusche E. Liodakis U-V Albrecht C. Krettek M. Jagodzinski 《Knee surgery, sports traumatology, arthroscopy》2013,21(9):2057-2062
Purpose
Double-bundle ACL reconstruction has been demonstrated to be at least as effective as single-bundle reconstruction in terms of restoring knee rotational and translational stability. Until now, the influence on knees with hyperextension has not been evaluated. It was the purpose of this study to evaluate whether double-bundle ACL reconstruction restricts extension in hyperextendable knees.Methods
Hamstring tendon reconstructions of 10 human cadaveric knees with the ability of hyperextension (age: 48 ± 14 years) were performed as single bundle (SB) on one side and double bundle (DB) on the other side. A surgical navigation system (BrainLab, Germany) was used to assess the kinematics of each knee at the intact and reconstructed state. A difference with regard to the anterior-to-posterior translation (AP) and rotational stability at 30° of knee flexion, 90° of flexion and the hyperextension capability of each specimen was analysed.Results
The difference in AP translation before and after the reconstruction was not significantly different in 30° and 90° of flexion (n.s). Both single- and double-bundle reconstructions restored the preoperative kinematics at 30° and 90° of knee flexion (n.s). The knee extension was 4° ± 1.8° with the intact ACL and 4° ± 1.7° after reconstruction in the SB group (n.s). The knee extension was 5° of hyperextension ± 1.1° with the intact ACL and 0° ± 0.4° after reconstruction in the DB group; the limitation of the extension was significantly larger in this group (p = 0.013).Conclusion
Both single- and double-bundle ACL reconstruction techniques are capable of restoring knee anteroposterior and rotational stability. Double-bundle reconstructions significantly reduce knee extension in knees with hyperextension capability. Care must be taken when using double-bundle techniques in patients with knee hyperextension as this procedure may limit the knee extension after double-bundle ACL reconstruction. 相似文献6.
Marcus Hofbauer Bart Muller Christopher D. Murawski Michael Baraga Carola Franziska van Eck Freddie H. Fu 《Knee surgery, sports traumatology, arthroscopy》2013,21(9):2072-2080
Purpose
The purpose of this article was to discuss pre- and intra-operative considerations as well as surgical strategies for different femoral and tibial tunnel scenarios in revision surgery following primary double-bundle anterior cruciate ligament (ACL) reconstruction.Methods
Based on the current literature of ACL revision surgery and surgical experience, an algorithm for revision surgery after primary double-bundle ACL reconstruction was created.Results
A guideline and flowchart were created using a case-based approached for revision surgery after primary double-bundle ACL reconstruction.Conclusion
Revision surgery after primary double-bundle ACL reconstruction can be a challenging procedure that requires flexibility and a repertoire of surgical techniques. The combination of pre-operative planning with 3D-CT reconstruction, in addition to careful intra-operative assessment, and the use of this flowchart can simplify the ACL revision procedure.Level of evidence
V. 相似文献7.
Hui Jun Kang Yan Ling Su Hui Jian Cao Fei Wang Da Hai Yu Zhi Min Zheng Ying Ze Zhang 《Knee surgery, sports traumatology, arthroscopy》2013,21(9):2066-2071
Purpose
The objective of present study was to introduce a modified double-layer bone-patellar tendon-bone (BPTB) allograft for arthroscopic single-bundle ACL reconstruction and investigate the clinical outcomes.Methods
From 2007 to 2009, a total of 136 patients underwent arthroscopic single-bundle ACL reconstructions with BPTB allograft. Of which, 66 patients were with double-layer BPTB allograft (Group 1), and 70 patients were with conventional BPTB allograft (Group 2). Clinical outcomes including Lachman and pivot-shift tests, KT-1000 arthrometer measurements, and Lysholm and Tegner activity scores were compared between the two groups at a 2-year minimum follow-up.Results
Forty-six patients in each group were at a two-year minimum follow-up. The mean side-to-side difference on the KT-1000 arthrometer was 1.2 ± 1.2 mm for group 1 and 2.1 ± 1.9 mm for group 2, with significant difference between the two groups (p = 0.017). The knee function was significantly better for group 1 than for group 2, because the mean Lysholm score was 94.2 ± 4.8 points versus 86.6 ± 7.1 points (p = 0.000), and the median Tegner score was 8 (range 5–10) points versus 6 (range 4–10) points (p = 0.001).Conclusions
On the basis of the KT-1000 arthrometer evaluation and clinical measures, single-bundle ACL reconstruction with double-layer BPTB allograft achieves significantly lesser anterior laxity and better knee function than a single-layer allograft reconstruction.Level of evidence
Therapeutic, retrospective comparative study, Level III. 相似文献8.
S. Aldrian P. Valentin B. Wondrasch I. Krusche-Mandl R. C. Ostermann P. Platzer M. Hofbauer 《Knee surgery, sports traumatology, arthroscopy》2014,22(9):2145-2152
Purpose
Female patients not only demonstrate an increased risk for injury, but also a poorer response following anterior cruciate ligament (ACL) rupture. However, no study has investigated gender-related differences between computer-navigated single-bundle (SB) and double-bundle (DB) ACL reconstruction. The aim of this study was to evaluate the effects of gender on the outcome of computer-navigated SB and DB ACL reconstruction and to present reference values.Methods
A retrospective review of 55 consecutive patients who underwent SB (15 males, 12 females) and DB (18 males, 10 females) ACL reconstruction with autogenous hamstring tendon grafts and showed a minimum follow-up of 24 months was conducted. Intraoperatively, the anteroposterior and rotational laxity were measured and the follow-up examination included pivot-shift testing, KT-1000 arthrometer testing, International Knee Documentation Committee (IKDC) form, the Lysholm score and Tegner score.Results
Pre-operatively, female patients showed a significant higher internal rotation in (p < 0.001) both the SB and DB group. Regarding the post-operative reduction in internal rotation, females in the SB group revealed a greater reduction compared to males (p < 0.001), whereas females in the DB group revealed a significantly greater post-operative reduction in anterior–posterior translation (p = 0.04). Female patients following DB ACL reconstruction presented a significant worse IKDC score, Lysholm score and Tegner score compared to male patients. All score values of the female DB group were worse than in the female SB group. In contrast, male patients showed better results of all examined clinical scores following DB procedure compared to SB technique.Conclusion
Female patients who underwent computer-navigated DB ACL reconstruction exhibited significantly worse outcome scores than males who underwent DB ACL reconstruction. The gender-based relationship between joint function and outcome after ACL reconstruction remains unclear and requires further investigation.Level of evidence
Retrospective case–control series, Level III. 相似文献9.
Ying Zhu Ren-kuan Tang Peng Zhao Shi-sheng Zhu Yong-guo Li Jian-bo Li 《Knee surgery, sports traumatology, arthroscopy》2013,21(5):1085-1096
Purpose
To compare the short- and long-term clinical outcomes of the double-bundle (DB) anterior cruciate ligament (ACL) reconstruction with those of single-bundle (SB) ACL reconstruction.Methods
An electronic search of the database PubMed (1966–September 2011), EMBASE (1984–September 2011), and Cochrane Controlled Trials Register (CENTRAL; 3rd Quarter, 2011) was undertaken to identify relevant studies. Main clinical outcomes were knee stability measurements including KT-1000 arthrometer measurement, Pivot shift test, and Lachman test, and clinical outcome measurements including International Knee Documentation Committee (IKDC), Lysholm knee score, Tegner activity score, and complications.Results
Eighteen studies were finally included in this meta-analysis, which were all classified as high risk of bias according to the Collaboration’s recommended tool. It is seen that compared to SB ACL reconstruction, DB ACL reconstruction results in a KT-1000 arthrometer outcome 0.63 and 1.00 mm closer to the normal knee in a short- and long-term follow-up, respectively. Our results also reveal that DB-treated patients have a significantly higher negative rate of the pivot shift test (p < 0.00001 and = 0.006 in a short- and long-term follow-up, respectively) and Lachman test (n.s. and p < 0.0001 in a short- and long-term follow-up, respectively) compared to SB-treated patients. As for the clinical outcome measurements, a significant difference is found between SB versus DB ACL reconstruction regarding the IKDC (p = 0.006 and < 0.0001 in a short- and long-term follow-up, respectively) and complications (p = 0.03), while there is no significant difference between the two groups regarding Lysholm knee score (n.s.) and Tegner activity score (n.s.).Conclusion
Overall, double-bundle ACL reconstruction yields better clinical outcomes when compared to single-bundle ACL reconstruction.Levels of evidence
II. 相似文献10.
Piia Suomalainen Anna-Stina Moisala Antti Paakkala Pekka Kannus Timo Järvelä 《Knee surgery, sports traumatology, arthroscopy》2013,21(3):646-653
Purpose
To investigate whether the locations of the grafts in single-bundle (SB) anterior cruciate ligament (ACL) reconstruction have changed to more anatomical as the double-bundle (DB) method has become more familiar.Methods
Operation using anteromedial (not transtibial) portal and freehand technique [Group A (N = 25) in 2003, Group B (N = 25) in 2007]. The evaluation methods preoperatively and at the 2-year follow-up (two blinded examiners): clinical examination, stability measurement (KT-1000 arthrometer), the International Knee Documentation Committee (IKDC), and the Lysholm knee scores. A musculoskeletal radiologist made tunnel measurements from the magnetic resonance imaging (MRI).Results
The average tunnel placement in the femoral side: from Blumensaat’s line 27 % (Group A) and 26 % (Group B), from the posterior edge of the femur 32 % (Group A) and 29 % (Group B). The average tunnel placement in the tibial side: from the anterior edge 45 % (Group A) and 45 % (Group B), from the lateral side 57 % (Group A) and 54 % (Group B) (P = 0.024). Graft failures ending up to revision ACL surgery: 4 (Group A) and 0 (Group B) (P = 0.045). Operation time reduced 19 min (P = 0.001).Conclusion
Tunnel placement at the femoral side was already very low (anatomical) in patients operated in 2003. No significant difference was found when comparing to the patients operated in 2007. There were significantly more graft failures in the Group A, suggesting that the use of the DB method in ACL surgery in 2007 may have also improved the technique and results of the SB ACL reconstruction.Level of evidence
Prospective comparative study, Level II. 相似文献11.
Daniel Hensler Motoko Miyawaki Kenneth D. Illingworth Carola F. van Eck Freddie H. Fu 《Knee surgery, sports traumatology, arthroscopy》2014,22(5):995-1001
Purpose
The native anterior cruciate ligament (ACL) is composed of two distinct bundles, the anteromedial (AM) and posterolateral (PL), and both have been shown to be reliably measured on magnetic resonance imaging (MRI). The purpose of this study was to measure the size of the AM and PL bundles after ACL double-bundle reconstructions on MRI and compare this to the relative graft size at the time of surgery.Methods
Between January 2007 and April 2010, 85 knees were identified after allograft double-bundle ACL reconstruction with post-operative MRI (1.5 T) and met inclusion criteria. On standard sagittal, coronal and oblique coronal MRIs, the AM and PL bundles were delineated and the midsubstance width of the ACL graft was measured. The images were independently measured in a blinded fashion by two observers. Linear and curvilinear regression analysis was used to analyse the relationship between graft size and time after reconstruction.Results
The mean age of the patients was 24.6 years (SD 10.4). Mean time from surgery to post-operative MRI was 271.5 days (SD 183.4). The mean percentage of the original size of the AM bundle was 86.9 % (SD 9.9) and of the PL bundle was 88.6 % (SD 9.9). There was no correlation between the relative size of the AM graft and the time from surgery (r = 0.3, n.s.) and no significant relationship for the PL graft (r = 0.1, n.s).Conclusion
On average, there was no graft enlargement of the AM and PL grafts 275.1 days after allograft ACL double-bundle reconstruction, as the mean relative graft size was less than 100 % on MRI. This study suggests that surgeons, who use allografts, should measure the ACL and replace it with a similar size, as there is a low risk of hypertrophy of the graft within one year post-operative.Level of evidence
IV. 相似文献12.
Hideyuki Koga Takeshi Muneta Kazuyoshi Yagishita Toshifumi Watanabe Tomoyuki Mochizuki Masafumi Horie Tomomasa Nakamura Ichiro Sekiya 《Knee surgery, sports traumatology, arthroscopy》2014,22(11):2811-2820
Purpose
To evaluate the effect of the femoral tunnel position of the anteromedial bundle (AMB) and the posterolateral bundle (PLB) on the graft tension curves and knee stability in anatomic double-bundle anterior cruciate ligament (ACL) reconstruction.Methods
Forty-five patients who underwent anatomic double-bundle ACL reconstruction were included. AMB and PLB were provisionally fixed to a graft tensioning system in the following settings during surgery: (1) AMB at 20° and PLB at 0° (A20P0), (2) AMB at 20° and PLB at 20° (A20P20), and (3) AMB at 20° and PLB at 45° (A20P45). Bundle tension was recorded during knee flexion–extension. A pivot shift test was also evaluated. Femoral tunnel positions of the AMB and PLB were then assessed by three-dimensional computed tomography, and the correlation between femoral tunnel position and tension change pattern or residual pivot shift was evaluated.Results
The depth of the PLB tunnel position was correlated with the extent of tension reduction in the PLB between 0° and 30° irrespective of graft fixation settings, while neither the AMB tunnel position nor the height of the PLB tunnel position affected the tension change pattern. Ten cases showed grade 1 pivot shift only in the A20P0 setting. The PLB tunnel position in the pivot shift-positive cases was significantly deeper than that in the pivot shift-negative cases (27.5 ± 6.2 and 34.1 ± 5.5 %, respectively, P = 0.002).Conclusions
In anatomic double-bundle reconstruction, deeper PLB tunnel position was correlated with the larger tension reduction in the PLB between 0° and 30°. Fixation of the AMB at 20° and the PLB at 0° resulted in residual pivot shift phenomenon in 10/45 cases, and the PLB tunnel position in the pivot shift-positive cases was significantly deeper than that in the pivot shift-negative cases. In anatomic double-bundle reconstruction, the placement of PLB femoral tunnel must not be too deep, as it might lead to significant tension reduction in the PLB near extension and thus insufficient tension in the PLB, resulting in residual pivot shift phenomenon.Level of evidence
IV. 相似文献13.
Kondo E Yasuda K Miyatake S Kitamura N Tohyama H Yagi T 《Knee surgery, sports traumatology, arthroscopy》2012,20(7):1261-1267
Purpose
The aim of this study was to compare the operation time required and the clinical outcome 2?years postoperatively, after anatomic double-bundle ACL reconstructions using hamstring tendon grafts fixed with either the EndoButton-CL-BTB? (ECL-BTB) or the EndoButton-CL? (ECL).Methods
Forty-six patients, who underwent anatomic double-bundle ACL reconstruction, were non-randomly divided into 2 groups. Patients with a combined ligament injury or complete meniscal tear were excluded from this study. In group I, an ECL was used with 23 patients. In group II, an ECL-BTB was used with the remaining 23 patients. In groups I and II, the ECL or ECL-BTB was attached to the femoral ends of the hamstring tendon autografts. In both groups, a polyester tape was connected in series with the tibial ends of the grafts. The patients were examined with standard clinical evaluations at 2?years after surgery.Results
The operation time in group II was significantly shorter than that in group I (P?=?0.0459). Concerning the intra- and postoperative complications, there were no serious complications in either group. No significant differences were found between the 2 groups in terms of knee laxity measurements, the peak muscle torque of quadriceps and hamstrings, the Lysholm score and the IKDC evaluation.Conclusions
This study demonstrated that the usage of the ECL-BTB for graft preparation significantly shortens the total operation time in comparison with the ECL and that there were no significant differences in the 2-year clinical outcome and the intra- and postoperative complications between the 2 graft preparation procedures of the anatomic double-bundle ACL reconstruction. The ECL-BTB can be an alternative device for the hamstring tendon graft in double-bundle ACL reconstruction.Level of evidence
Prospective comparative cohort study, Level II. 相似文献14.
Takeshi Muneta Hideyuki Koga Young-Jin Ju Masafumi Horie Tomomasa Nakamura Ichiro Sekiya 《Knee surgery, sports traumatology, arthroscopy》2013,21(4):906-913
Purpose
A cohort study was conducted to evaluate the correlation of anterior cruciate ligament (ACL) remnant volume with preoperative status and postoperative outcome of the patients after a remnant-preserving double-bundle (DB) ACL reconstruction.Methods
Eighty-eight patients of 105 unilateral DB anatomic ACL reconstructions performed between 2006 and 2008 were followed up for 24 months or more. They were evaluated with regard to preoperative knee laxity data under anaesthesia. Postoperative outcome was evaluated based on knee extension and flexion strength, manual laxity tests, KT measurements, etc. Overall knee condition and sports performance were evaluated with Lysholm knee score and subjective rating scale. Overall correlation of the remnant volume with the preoperative and postoperative evaluation was assessed. Then, the patients were divided into three subgroups based on the remnant volume (remnant volume: ≦30, 35–55 and ≦60 %). The evaluation was performed and analysed statistically among the three subgroups.Results
Generally, preoperative laxity tests showed a weak correlation with the ACL remnant volume. Postoperative knee stability also indicated a weak correlation with the ACL remnant volume. Statistical analyses revealed that there were significant differences among the three groups regarding age at surgery, preoperative period, number of giving-way and preoperative KT measurements. Postoperatively, there were significant differences in Lachman test, KT measurements, Lysholm knee scale, subjective and sports performance recovery scores. As the clinical relevance, the study suggests that the remnant volume will be important as a background of preoperative condition and a predictor of operative outcome for each patient and that a remnant preserving surgery may not be simply better than a non-preserving technique with regard to subjective evaluation and sports performance recovery.Conclusion
The preoperative condition of patients with ACL injury was different depending upon the remnant volume. The remnant volume was also weakly correlated with the postoperative outcome regarding objective stability and subjective recovery.Level of evidence
Retrospective cohort study, Level III. 相似文献15.
Eric J. Kropf Wei Shen Carola F. van Eck Volker Musahl James J. Irrgang Freddie H. Fu 《Knee surgery, sports traumatology, arthroscopy》2013,21(3):720-725
Purpose
The purpose of this study was to: (1) define the relationship between the ACL and PCL in normal knees; (2) determine whether ACL–PCL impingement occurs in native knees; and (3) determine whether there is a difference in impingement between double-bundle reconstructed and native knees.Methods
Eight subjects were identified (age 20–50; 6 females, 2 males). All were at least 1-year status postanatomic double-bundle ACL reconstruction (allograft; AM = 8 mm; PL = 7 mm) and had no history of injury or surgery to the contralateral knee. MRIs of both knees were performed with the knee at 0 and 30° of flexion. The images were evaluated by a non-treating surgeon and two musculoskeletal radiologists. Coronal and sagittal angles of AM and PL bundles, Liu’s PCL index and the distance between ACL and PCL on modified axial oblique images were recorded. Impingement was graded (1) no contact; (2) contact without deformation; or (3) contact and distortion of PCL contour.Results
Seventy-five percent (6) of the native ACL’s showed no contact with the roof of the intercondylar notch or PCL, compared to 25 % (2) of the double-bundle reconstructed ACLs. One double-bundle reconstructed ACL showed intercondylar notch roof and ACL–PCL impingement (12.5 %). Significant differences were found between the native ACL and the double-bundle reconstructed ACL for the coronal angle of the AM (79° vs. 72°, p = 0.002) and PL bundle (75° vs. 58°, p = 0.001). No differences in ROM or stability were noted at any follow-up interval between groups based on MRI impingement grade.Conclusion
ACL–PCL contact occurred in 25 % of native knees. Contact between the ACL graft and PCL occurred in 75 % of double-bundle reconstructed knees. ACL–PCL impingement, both contact and distortion of the PCL, occurred in one knee after double-bundle reconstruction. This study offers perspective on what can be considered normal contact between the ACL and PCL and how impingement after ACL reconstruction can be detected on MRI.Level of evidence
Cohort Study, Level III. 相似文献16.
Yuki Kato Akira Maeyama Pisit Lertwanich Joon Ho Wang Sheila J. M. Ingham Scott Kramer Cesar Q. A. Martins Patrick Smolinski Freddie H. Fu 《Knee surgery, sports traumatology, arthroscopy》2013,21(4):816-823
Purpose
Recent reports have highlighted the importance of an anatomic tunnel placement for anterior cruciate ligament (ACL) reconstruction. The purpose of this study was to compare the effect of different tunnel positions for single-bundle ACL reconstruction on knee biomechanics.Methods
Sixteen fresh-frozen cadaver knees were used. In one group (n = 8), the following techniques were used for knee surgery: (1) anteromedial (AM) bundle reconstruction (AM–AM), (2) posterolateral (PL) bundle reconstruction (PL–PL) and (3) conventional vertical single-bundle reconstruction (PL-high AM). In the other group (n = 8), anatomic mid-position single-bundle reconstruction (MID–MID) was performed. A robotic/universal force-moment sensor system was used to test the knees. An anterior load of 89 N was applied for anterior tibial translation (ATT) at 0°, 15°, 30° and 60° of knee flexion. Subsequently, a combined rotatory load (5 Nm internal rotation and 7 Nm valgus moment) was applied at 0°, 15°, 30° and 45° of knee flexion. The ATT and in situ forces during the application of the external loads were measured.Results
Compared with the intact ACL, all reconstructed knees had a higher ATT under anterior load at all flexion angles and a lower in situ force during the anterior load at 60° of knee flexion. In the case of combined rotatory loading, the highest ATT was achieved with PL-high AM; the in situ force was most closely restored with MIDMID, and the in situ force was the highest AM–AM at each knee flexion angle.Conclusion
Among the techniques, AM–AM afforded the highest in situ force and the least ATT. 相似文献17.
Takashi Nagai Nicholas R. Heebner Timothy C. Sell Takumi Nakagawa Freddie H. Fu Scott M. Lephart 《Knee surgery, sports traumatology, arthroscopy》2013,21(9):2048-2056
Purpose
To investigate the restoration of knee proprioception after anatomic double-bundle ACL reconstruction.Methods
Eleven subjects who underwent anatomic double-bundle ACL reconstruction (12.5–15 months following surgery) and eleven healthy control subjects participated in the study. Sagittal and transverse plane threshold to detect passive motion (TTDPM) were assessed utilizing a customized isokinetic dynamometer by passively rotating the tibia about a fixed femur in both the sagittal plane and transverse plane at 0.25°/s until the subject signalled recognition of movement and movement direction. Based on the normality assumption, either dependent t test or Wilcoxon test was utilized to determine whether significant differences were present between the ACL-reconstructed and the uninjured contralateral limbs. Independent t test or Mann–Whitney test was utilized to compare between the ACL-reconstructed/uninjured contralateral and the external control limbs.Results
There were no significant differences in TTDPM measurement in eleven out of twelve comparisons between the ACL-reconstructed and the uninjured contralateral/external control limbs. The only statistical significant difference was found on TTDPM towards internal rotation direction from the externally rotated-test position between the ACL-reconstructed and the uninjured contralateral limbs (p = 0.01).Conclusions
Based on a small sample of eleven subjects, the current results indicate a restoration of both sagittal and transverse plane TTDPM following the anatomic double-bundle ACL reconstruction.Level of evidence
III. 相似文献18.
K. K. Middleton T. Hamilton J. J. Irrgang J. Karlsson C. D. Harner F. H. Fu 《Knee surgery, sports traumatology, arthroscopy》2014,22(7):1467-1482
Purpose
In August 2011, orthopaedic surgeons from more than 20 countries attended a summit on anatomic anterior cruciate ligament (ACL) reconstruction. The summit offered a unique opportunity to discuss current concepts, approaches, and techniques in the field of ACL reconstruction among leading surgeons in the field.Methods
Five panels (with 36 panellists) were conducted on key issues in ACL surgery: anatomic ACL reconstruction, rehabilitation and return to activity following anatomic ACL reconstruction, failure after ACL reconstruction, revision anatomic ACL reconstruction, and partial ACL injuries and ACL augmentation. Panellists’ responses were secondarily collected using an online survey.Results
Thirty-six panellists (35 surgeons and 1 physical therapist) sat on at least one panel. Of the 35 surgeons surveyed, 22 reported performing “anatomic” ACL reconstructions. The preferred graft choice was hamstring tendon autograft (53.1 %) followed by bone-patellar tendon-bone autograft (22.8 %), allograft (13.5 %), and quadriceps tendon autograft (10.6 %). Patients generally returned to play after an average of 6 months, with return to full competition after an average of 8 months. ACL reconstruction “failure” was defined by 12 surgeons as instability and pathological laxity on examination, a need for revision, and/or evidence of tear on magnetic resonance imaging. The average percentage of patients meeting the criteria for “failure” was 8.2 %.Conclusions
These data summarize the results of five panels on anatomic ACL reconstruction. The most popular graft choice among surgeons for primary ACL reconstructions is hamstring tendon autograft, with allograft being used most frequently employed in revision cases. Nearly half of the surgeons surveyed performed both single- and double-bundle ACL reconstructions depending on certain criteria. Regardless of the technique regularly employed, there was unanimous support among surgeons for the use of “anatomic” reconstructions using bony and soft tissue remnant landmarks.Level of evidence
V. 相似文献19.
Qiang Zhang Shu Zhang Xuecheng Cao Lifeng Liu Ya Liu Rui Li 《Knee surgery, sports traumatology, arthroscopy》2014,22(1):166-173
Purpose
To investigate the effect of remnant preservation on tibial tunnel enlargement in a single-bundle anterior cruciate ligament (ACL) reconstruction with a hamstring autograft.Methods
From 2006 to 2009, a total of 62 patients who underwent single-bundle ACL reconstruction with a quadrupled hamstring tendon autograft were enrolled in this study. The patients were randomly divided into two groups: the preserving-remnant group and the removing-remnant group. Plain radiographs were taken at 1 week, and 3, 6, and 24 months postoperatively, and tibial tunnel enlargement was evaluated. The postoperative clinical assessment included the Lysholm rating scale and KT-1000 measurement.Results
In total, 27 patients in the preserving-remnant group and 24 patients in the removing-remnant group were followed up and the median follow-up was 24.5 months (range 24–27 months). Tibial tunnel enlargement occurred within 6 months postoperatively. Positive enlargement was observed in 8 patients (29.6 %) in the preserving-remnant group and 14 patients (58.3 %) in the removing-remnant group (P = 0.0388). The percentage of tibial tunnel enlargement was 25.7 ± 6.7 and 34.0 ± 8.9 % in the preserving- and removing-remnant groups, respectively (P = 0.0004). In the preserving-remnant group, the average Lysholm score increased from 60.3 ± 5.3 (51–69) to 93.0 ± 3.5 (88–100), and the side-to-side difference of the KT-1000 changed from 6.3 ± 0.9 (5.1–8.0) to 1.4 ± 0.6 (0.5–2.4) mm. In the removing-remnant group, the average Lysholm score increased from 58.7 ± 6.5 (48–71) to 91.1 ± 3.9 (85–100), and the side-to-side difference of the KT-1000 changed from 6.5 ± 0.8 (5.4–8.2) to 1.7 ± 0.6 (0.6–2.8) mm.Conclusions
It is confirmed that remnant preservation in ACL reconstruction can resist tibial tunnel enlargement but that this technique does not affect the short-term clinical outcome of ACL reconstruction.Level of evidence
I. 相似文献20.
Double-bundle versus single-bundle anterior cruciate ligament reconstruction: a prospective,randomize clinical study 总被引:8,自引:3,他引:5
Timo Järvelä 《Knee surgery, sports traumatology, arthroscopy》2007,15(5):500-507
Anatomical observation and biomechanical studies have shown that the anterior cruciate ligament (ACL) mainly consists of two
distinct bundles, the anteromedial (AM) bundle and posterolateral (PL) bundle. Conventional single-bundle ACL reconstruction
techniques have focused on the restoration of the AM bundle while giving limited attention to the PL bundle. The purpose of
this prospective, randomized clinical study is to compare the outcomes of ACL reconstruction when using either double-bundle
or single-bundle technique and bioabsorbable interference screw fixation, and similar rehabilitation with both techniques.
Sixty-five patients were randomized into either double-bundle (n = 35) or single-bundle (n = 30) ACL reconstruction with hamstring tendons and bioabsorbable screw (Hexalon, Inion Company, Tampere, Finland) fixation
in both groups. The evaluation methods were clinical examination, KT-1000 arthrometer measurements, radiographic evaluation,
as well as International Knee Documentation Committee and Lysholm knee scores. There were no differences between the study
groups preoperatively. For an average of 14 months of follow-up (range 12–20 months), 30 patients of the double-bundle group
and 29 patients of the single-bundle group were available (91%). At the follow-up, the rotational stability, as evaluated
by pivot shift test, was significantly better in the double-bundle group than in the single-bundle group. However, in anterior
stability of the knee, there was no significant difference between the groups. None of the patients in the double-bundle group
had graft failure, while four patients in the single-bundle group had. In addition, knee scores were equal at the follow-up,
and all the results were significantly better at the follow-up than preoperatively, in both groups. 相似文献