Semitendinosus tenodesis for medial instability of the knee

A new technique of semitendinosus tenodesis has been developed to treat medial instability of the knee. The semitendinosus tendon was sectioned at the musculotendinous junction. The accessory insertion of the tendon was dissected to be overlapping and parallel to the anterior band of the medial collateral ligament. An isometric point on the femur was located around the medial epicondyle. A bony trough was created just above the isometric point and a screw with washer was placed. The semitendinosus tendon was looped around the screw and the screw was tightened to hold the tendon in place. The free end of the tendon was pulled obliquely backward and passed through the insertion of the direct head of the semimembranosus tendon to reconstruct the posterior oblique ligament. The semitendinosus tendon reinforced both the medial collateral ligament and the posterior oblique ligament.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 17, No 6 (July-August), 2001: pp 660–663     

自体半腱肌肌腱重建膝内侧副韧带浅层的临床应用

目的分析自体半腱肌肌腱重建膝内侧副韧带浅层治疗陈旧性膝内侧副韧带Ⅲ度损伤的临床疗效。 方法回顾性研究十堰市太和医院骨1科自2013年4月至2016年4月收治的28例陈旧性Ⅲ度膝关节内侧副韧带损伤的患者,新鲜断裂的内侧副韧带、Ⅰ度和Ⅱ度损伤患者排除。术前应力位拍X片检查可见膝关节内侧间隙较健侧>5 mm,磁共振检查可见膝关节内侧副韧带皱缩或断裂。手术方法为取自体同侧的半腱肌,编织缝合,编织好的肌腱从胫骨的内侧脊前方穿入,从脊的后方穿出。然后将肌腱的两个尾端用导引针穿入股骨隧道,可吸收界面螺钉固定。术后在可调支具保护下行膝关节功能锻炼,术后随访12个月左右,拍摄膝关节内侧应力位片、应用Lyshlom评分、国际膝关节文献委员会膝关节评估表(IKDC)评分评判采用配对t检验分析比较。 结果患者术后Lyshlom评分(t＝7.449)、IKDC评分(t＝8.915)、膝内侧应力位片开口距离与健侧距离的差值(t＝5.014)均改善,术前术后差异有统计学意义(均为P<0.05)。 结论应用自体半腱肌肌腱重建膝内侧副韧带浅层对治疗膝内侧副韧带陈旧性损伤短期临床效果显著。     

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.     

采用自体腘绳肌腱重建膝关节多发韧带损伤

目的 探讨采用自体腘绳肌腱"人"字形加强修复膝关节内侧侧副韧带浅层(sMCL)和后斜韧带(POL)的新技术,分析其对膝关节内侧稳定的作用.方法 2002年8月至2004年2月,采用自体腘绳肌腱"人"字形加强修复损伤的sMCL和POL治疗19例患者,患者均合并交叉韧带损伤且需手术重建,故有时需取健侧腘绳肌腱作为韧带重建结构.结果 19例患者得到49～67个月(平均57个月)随访.根据国际膝关节文献委员会评分系统(IKDC),所有患者膝关节在O和30°位应力外翻试验时内侧稳定性完全恢复正常.术前膝关节Lysholm评分为(58.5±4.2)分(37～70分),终末随访时为(92.2±3.6)分(84～96分),差异有统计学意义(P<0.05).其中6例患者术后3个月因膝关节活动受限而接受手法松解.除2例患者主诉健侧膝关节内侧麻木外,所有健侧患肢在取腘绳肌腱后无功能受限.结论 采用自体腘绳肌腱"人"字形增强修复损伤的sMCL和POL能有效恢复膝关节内侧稳定.     

关节镜下保留残存纤维结合七股自体腘绳肌腱单束重建后交叉韧带

目的研究膝关节镜下保留残存后交叉韧带(PCL)纤维结合7股自体腘绳肌腱单束重建PCL的临床效果。方法对13例PCL损伤,采用胫骨隧道技术结合7股自体腘绳肌腱进行单束重建,术中保留残存PCL纤维,移植物使用悬吊式固定,手术前后采用Lysholm膝关节功能评价表和Tegner下肢运动能力评价表进行评估,并了解患者膝关节的稳定性、活动度。结果所有患者随访12～36个月,术前和术后12个月Lysholm评分分别为(50.20±8.32)分和(87.23±4.20)分(P<0.05),Tegner评分分别为(2.03±0.33)分和(4.11±0.13)分(P<0.05)。术后12个月后抽屉试验阴性7例,Ⅰ度阳性5例,Ⅱ度阳性1例,所有患膝运动能力均较术前有所改善。结论关节镜下采用经胫骨隧道技术保留残存纤维结合7股自体腘绳肌腱单束重建PCL是一种恢复膝关节稳定性和功能的可靠方法。     

Anatomical reconstruction of the medial collateral ligament and the posterior oblique ligament of the knee

Chronic medial knee instability is frequently due to a combination of superficial medial collateral ligament (sMCL) and posterior oblique ligament (POL) insufficiency. We present a new technique for simultaneous anatomical reconstruction of sMCL and POL, using an anterior tibialis tendon allograft with three reconstruction tunnels.     

Single–Achilles Allograft Posterior Cruciate Ligament and Medial Collateral Ligament Reconstruction: A Technique to Avoid Osseous Tunnel Intersection,Improve Construct Stiffness,and Save on Allograft Utilization

We present a method for single–Achilles allograft medial collateral ligament (MCL) and posterior cruciate ligament (PCL) reconstruction that eliminates the risk of tunnel intersection, stiffens the construct, and maximizes utilization of allograft tissue. An Achilles tendon allograft is prepared with an 11- to 12-mm bone plug with a gradual taper to 7 mm over approximately 15 cm. A transtibial PCL tunnel is created under fluoroscopic and arthroscopic guidance. The femoral tunnel is prepared in an “outside-in” fashion under direct arthroscopic visualization, originating at the anatomic origin of the MCL on the medial epicondyle and entering the joint at the anatomic origin of the anterolateral bundle of the PCL. The Achilles graft is pulled into the joint through the tibial tunnel and routed into the femoral tunnel so that the soft tissue exits at the medial epicondyle. The bone plug is fluoroscopically guided to the posterior aperture of the tibial tunnel and fixed with a bioabsorbable interference screw. The pretensioned graft is fixed in the femoral tunnel via interference screw fixation with the knee in 90° of flexion. The isometric position of the MCL insertion is identified with a K-wire isometer, and the graft is fixed in place at this point by use of an interference screw or screw and washer.     

Arthroscopic-assisted simultaneous reconstruction of the posterior cruciate ligament and the lateral collateral ligament using hamstrings and absorbable screws

Arthroscopic-assisted simultaneous reconstruction of the posterior cruciate ligament (PCL) and the lateral collateral ligament (LCL) using hamstring tendon grafts is described. The femoral tunnel is drilled through an incision over the medial femoral condyle and the tibial tunnel through the same skin incision used for harvesting the tendon graft. PCL reconstruction is performed using a 4-strand hamstring tendon graft and absorbable screw fixation. The tendon of the semitendinosus muscle of the uninvolved knee is used as a lateral loop for LCL reconstruction. After pulling the transplant through the fibular head, femoral fixation of the loop is made with an absorbable screw.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 17, No 8 (October), 2001: pp 892–897     

Arthroscopic Posterior Cruciate Ligament Augmentation Using an Autogenous Hamstring Tendon Graft and the Posterior-Posterior Triangulation Technique

We describe a modification of the currently practiced arthroscopic posterior cruciate ligament (PCL) reconstruction techniques. We augmented the injured PCL with quadrupled autogenous hamstring tendon grafts using the arthroscopic posterior-posterior triangulation method and a single-incision transtibial approach. The tibial drill guide was introduced through the anteromedial portal and positioned onto the fossa for the PCL on the tibia under arthroscopic guidance from the posterolateral portal. The femoral tunnel was made 10 mm posterior to the articular cartilage of the medial femoral condyle by use of the anterior cruciate ligament Beath pin (Arthrex, Naples, FL) introduced through the far-inferior anterolateral portal. The tendon graft was positioned in the knee joint by use of the tibial and femoral double-folded silk loops that traversed the bony tunnels. The graft was fixed by use of bioabsorbable Intrafix screw systems (DePuy Mitek, Raynham, MA) at both the ends. The arthroscopic posterior-posterior triangulation method provides adequate exposure of the posterior knee compartment; this allows for convenient instrumentation and safe and accurate placement of the bony tunnels with preservation of the PCL remnants. We believe that retention of the remnant PCL fibers is biologic and contributes to earlier healing and strengthening of the tendon graft.     

Reconstruction of the medial femoral condyle and medial collateral ligament in total knee arthroplasty using tendoachilles allograft with a calcaneal bone block

Absence or compromise of the medial collateral ligament (MCL) in conjunction with osseous defects of the medial femoral condyle in total knee arthroplasty (TKA) is a challenging reconstructive problem. Treatment usually requires a highly constrained TKA with or without ligamentous reconstruction. To restore the medial femoral condylar bone and to provide ligamentous stability on the medial side of the knee, the authors present a technique for reconstruction of the medial femoral condyle and MCL using a tendoachilles allograft with a calcaneal bone block. The construct also can be augmented with a semitendinosus tendon autograft. Two illustrative cases and a review of the literature are presented.     

Anatomic double-bundle posterior cruciate ligament reconstruction using hamstring tendons

Recent biomechanical studies have shown that an anatomic double-bundle posterior cruciate ligament (PCL) reconstruction is superior in restoring normal knee laxity compared with the conventional single-bundle isometric reconstruction. We describe a modification of an endoscopic PCL reconstruction technique using a double-bundle Y-shaped hamstring tendon graft. A double- or triple-bundle semitendinosus-gracilis tendon graft is used and directly fixed with soft threaded biodegradable interference screws. In the medial femoral condyle, 2 femoral tunnels are created inside-out through a low anterolateral arthroscopic portal. First, in 80° of flexion, the double-stranded gracilis graft is fixed with an interference screw inside the lower femoral socket, representing the insertion site of the posteromedial bundle. In full extension the combined semitendinosus-gracilis graft is pretensioned and fixed inside the posterior aspect of the single tibial tunnel. The double- or triple-stranded semitendinosus tendon is inserted in the higher femoral tunnel, presenting the insertion site of the anterolateral bundle. Finally, pretension is applied to the semitendinosus bundle in 70° of flexion and a third screw is inserted. Using this technique, the stronger semitendinosus part of the double-bundle graft, which mimics the anterolateral bundle of the PCL, is fixed in flexion, whereas the smaller gracilis tendon part (posteromedial bundle) is fixed in full extension. Thus, a fully arthroscopic anatomic PCL reconstruction technique is available that may better restore normal knee kinematics as compared to the single-stranded isometric reconstruction.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 17, No 1 (January), 2001: pp 88–97     

关节镜下半腱肌腱和股薄肌腱双隧道重建前十字韧带

目的探讨关节镜下联合应用半腱肌腱和股薄肌腱重建前十字韧带(anteriorcruciateligament,ACL)的方法及疗效。方法回顾自1998年4月～2000年5月在关节镜下联合应用半腱肌腱和股薄肌腱重建ACL的患者12例。于ACL前内侧束和后外侧束的附着部分别钻直径4.5mm的隧道,用半腱肌腱重建前内侧束,股薄肌腱重建后外侧束,保留半腱肌腱和股薄肌腱的附着点,在股骨隧道外口将半腱肌腱和股薄肌腱打结固定,不行内固定。所有患者术前及术后18个月行膝关节屈曲30°、60°、90°前抽屉试验,Lysholm评分方法评定膝关节功能。结果术后随访18～43个月,平均26个月。术前所有患者前抽屉试验均为阳性,术后9例阴性,2例屈膝30°位阳性,1例屈膝30°、60°位阳性。术前Lysholm评分为40～58分,平均50.5分,手术后18个月为62～92分,平均85分,总优良率为91.7%。结论应用半腱肌腱和股薄肌腱联合重建ACL,术后膝关节动态稳定性好,疗效满意。     

Revision anterior cruciate ligament reconstruction with doubled semitendinosus and gracilis tendons and lateral extra-articular reconstruction

BACKGROUND: The outcome of revision anterior cruciate ligament reconstruction has only rarely been reported. The purpose of this study was to evaluate the results of revision anterior cruciate ligament surgery with use of an autogenous doubled semitendinosus and gracilis graft in association with an extra-articular procedure. METHODS: Between 1997 and 2003, thirty patients underwent a repeat reconstruction of a previously reconstructed torn anterior cruciate ligament with use of a doubled semitendinosus and gracilis graft combined with an extra-articular reconstruction. Primary reconstruction had been done with an autogenous patellar tendon graft in twenty-six patients and with a prosthetic ligament in four patients; the average time from the primary reconstruction to the revision was five years. Functional outcomes, graft survival, and radiographic outcomes were evaluated at a mean of five years. A graft was considered to have failed when a revision was done or when the side-to-side difference on KT-1000 arthrometer testing was >5 mm and/or the pivot-shift test grade was greater than a trace. RESULTS: One patient underwent another revision reconstruction because of graft failure at three years postoperatively. The mean International Knee Documentation Committee (IKDC) subjective knee score for the remaining twenty-nine patients was 84 +/- 12 points, and the mean Lysholm knee score was 90 +/- 10 points. The side-to-side difference as measured with the KT-1000 arthrometer with maximum manual force was <3 mm in twenty patients (of the twenty-eight who returned for follow-up), between 3 and 5 mm in six patients, and >5 mm in two patients. The result of the pivot shift examination was normal in fifteen patients, slightly positive in eleven patients, and positive in two patients. Twenty-five percent of the patients showed no radiographic signs of degenerative joint disease. CONCLUSIONS: Revision anterior cruciate ligament reconstruction with use of an autogenous doubled semitendinosus and gracilis graft combined with an extra-articular procedure provided satisfactory functional outcomes, with a failure rate of 10%.     

Arthroscopically assisted combined anterior and posterior cruciate ligament reconstruction

This article presents the minimum 2-year results (range, 24 to 48 months) of 20 arthroscopically assisted combined anterior cruciate ligament/posterior cruciate ligament (ACL/PCL) reconstructions, evaluated preoperatively and postoperatively using the Tegner, Lysholm, and Hospital for Special Surgery knee ligament rating scales, and the KT 1000 knee ligament arthrometer (Medmetric Corp, San Diego, CA). There were 16 men or boys, 4 women or girls; 9 right, 11 left; 10 acute, and 10 chronic knee injuries. Ligament injuries included 1 ACL/PCL tear, 2 ACL/PCL/medial collateral ligament (MCL)/posterior lateral corner tears, 7 ACL/PCL/MCL tears, and 10 ACL/PCL/posterior lateral corner tears. ACLs were reconstructed using autograft or allograft patellar tendons. PCLs were reconstructed using allograft Achilles tendon, or autograft patellar tendon. MCL tears were successfully treated with bracing. Posterior lateral instability was successfully treated with long head of the biceps femoris tendon tenodesis. Teguer, Lysholm, and Hospital for Special Surgery knee ligament rating scales significantly improved preoperatively to postoperatively (P = .0001). Corrected anterior KT 1000 measurements improved from preoperative to postoperative status (P = .0078).     

A “sandwich” method of reconstruction of the medial patellofemoral ligament using a titanium interference screw for patellar instability in skeletally immature patients

Background

No standard surgical procedure for medial patellofemoral ligament (MPFL) reconstruction exists in skeletally immature patients with patellar instability. This study aimed to evaluate the clinical effectiveness of a novel reconstruction technique for the MPFL in patients with patellar instability because of non-closure of the epiphyseal line.

Methods

The “sandwich” method was fixation of the patella between a double-stranded semitendinosus tendon through the posterior third of the femoral insertion of the medial collateral ligament (MCL) as a pulley with a titanium interference screw in a single patellar tunnel. Five knees in five patients were studied: four with recurrent and one with habitual patellar dislocations. Subjects underwent MPFL reconstruction with or without lateral release. Patients were evaluated using pre-operative and post-operative physical and radiographic examinations, including apprehension testing, assessment of tilting and congruence angles, medial and lateral shift ratios under stress measured using X-ray imaging, and Kujala and Lysholm scores.

Results

No patient experienced recurrent post-operative episodes of dislocation or subluxation. By the final follow-up, patellar apprehension had disappeared in all patients. In addition, all patients showed significant improvement in the following: tilting angle, congruence angle, lateral shift ratio, Kujala score, and Lysholm score.

Conclusions

The MPFL reconstruction methods, using a double-stranded semitendinosus autograft and sparing the femoral physeal line in non-closure of the epiphyseal line, provide acceptable short-term results for the treatment of patellar instability.     

腘绳肌腱移植包埋法重建内侧髌股韧带治疗复发性髌骨脱位

目的 :探讨腘绳肌腱移植包埋法重建内侧髌股韧带治疗复发性髌骨脱位的疗效。方法 :2008年3月至2013年6月间收治复发性髌骨脱位67例,其中男28例,女39例;年龄10~42岁,平均22岁。临床表现为膝关节不稳感,"打软腿",髌骨错位感,膝前疼痛等。67例均行腘绳肌腱移植包埋法重建内侧髌股韧带。术前后采用Lysholm评分及Q角变化对疗效进行评估。结果:术后67例均获随访,随访时间4~60个月,平均(27.5±13.4)个月。术后切口均愈合良好,无髌骨脱位或半脱位发生。Lysholm评分由术前76.35±2.86提高到术后82.71±2.29;Q角从术前(18.75±2.33)°降至术后(13.28±1.75)°。结论:腘绳肌腱移植包埋方法重建内侧髌股韧带可以提供足够的张力,恢复髌骨稳定性,改善膝关节功能。     

Arthroscopically assisted combined anterior and posterior cruciate ligament reconstruction in the multiple ligament injured knee: 2- to 10-year follow-up

Purpose: This study presents the 2- to 10-year results of 35 arthroscopically assisted combined anterior cruciate ligament and posterior cruciate ligament (ACL/PCL) reconstructions evaluated preoperative and postoperatively using Lysholm, Tegner, and Hospital for Special Surgery knee ligament rating scales, KT-1000 arthrometer testing, stress radiography, and physical examination. Type of Study: Case series. Methods: This study population included 26 men and 9 women with 19 acute and 16 chronic knee injuries. Ligament injuries included 19 ACL/PCL/posterolateral instabilities, 9 ACL/PCL/medial cruciate ligament (MCL) instabilities, 6 ACL/PCL/posterolateral/MCL instabilities, and 1 ACL/PCL instability. All knees had grade III preoperative ACL/PCL laxity and were assessed preoperatively and postoperatively with arthrometer testing, 3 different knee ligament rating scales, stress radiography, and physical examination. Arthroscopically assisted combined ACL/PCL reconstructions were performed using the single-incision endoscopic ACL technique and the single femoral tunnel–single bundle transtibial tunnel PCL technique. PCLs were reconstructed with allograft Achilles tendon (in 26 cases), autograft bone–patellar tendon–bone (BPTB) (in 7 cases), and autograft semitendinosus/gracilis (in 2 cases). ACLs were reconstructed with autograft BPTB (16 cases), allograft BPTB (12 cases), Achilles tendon allograft (6 cases), and autograft semitendinosus/gracilis (1 case). MCL injuries were treated with bracing or open reconstruction. Posterolateral instability was treated with biceps femoris tendon transfer, with or without primary repair, and posterolateral capsular shift procedures as indicated. Results: Postoperative physical examination revealed normal posterior drawer/tibial step-off in 16 of 35 (46%) knees. Normal Lackman and pivot-shift test results were found in 33 of 35 (94%) knees. Posterolateral stability was restored to normal in 6 of 25 (24%) knees, and tighter than normal knee results were found in 19 of 25 (76%) knees evaluated with the external rotation thigh foot angle test. In this group, 30° varus stress testing was normal in 22 of 25 (88%) knees, and grade 1 laxity was found in 3 of 25 (12%) knees. 30° valgus stress testing was normal in 7 of 7 (100%) surgically treated MCL tears, and in 7 of 8 (87.5%) brace-treated knees. Postoperative KT-1000 arthrometer testing mean side-to-side difference measurements were 2.7 mm (PCL screen), 2.6 mm (corrected posterior), and 1.0 mm (corrected anterior) measurements, a statistically significant improvement from preoperative status (P = .001). Postoperative stress radiographic side-to-side difference measurements measured at 90° of knee flexion and 32 lb posteriorly directed proximal force were 0 to 3 mm in 11 of 21 (52.3%) knees, 4 to 5 mm in 5 of 21 (23.8%), and 6 to 10 mm in 4 of 21 (19%) knees. Postoperative Lysholm, Tegner, and HSS knee ligament rating scale mean values were 91.2, 5.3, and 86.8, respectively, showing a statistically significant improvement from preoperative status (P = .001). Conclusions: Combined ACL/PCL instabilities can be successfully treated with arthroscopic reconstruction and the appropriate collateral ligament surgery. Statistically significant improvement is noted from the preoperative condition at 2- to 10-year follow-up using objective parameters of knee ligament rating scales, arthrometer testing, stress radiography, and physical examination. Postoperatively, these knees are not normal, but they are functionally stable. Continuing technical improvements will probably improve future results.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 18, No 7 (September), 2002: pp 703–714     

关节镜下双束重建内侧髌股韧带联合半髌韧带内移治疗骨骺未闭合青少年复发性髌骨脱位

目的探讨关节镜下自体半腓骨长肌腱双束重建内侧髌股韧带联合半髌韧带内移手术治疗骨骺未闭合青少年复发性髌骨脱位的临床疗效。方法回顾性分析自2016-07—2018-09诊治的20例骨骺未闭合且胫骨结节-股骨滑车沟间距>20 mm的青少年复发性髌骨脱位,在关节镜下采用自体半腓骨长肌腱经大收肌肌腱止点悬吊双束重建内侧髌股韧带联合半髌韧带内移手术治疗。结果 20例均获得随访,随访时间平均21.2(12~36)个月。所有患者术后复查均未再发生髌骨脱位或半脱位,膝关节功能恢复满意。末次随访时髌股适合角为(-1.79±3.26)°,髌骨倾斜角为(11.11±1.08)°,较术前明显减小;末次随访时膝关节功能Lysholm评分为(94.60±2.58)分,髌股关节功能Kujala评分为(91.05±2.33)分,较术前明显提高,差异有统计学意义(P<0.05)。结论对于骨骺未闭合且胫骨结节-股骨滑车沟间距>20 mm的青少年复发性髌骨脱位患者,关节镜下采用自体半腓骨长肌腱双束重建内侧髌股韧带联合半髌韧带内移手术治疗可获得稳定的髌骨滑动轨迹,髌骨脱位矫正良好。     

自体骨-髌腱-骨移植重建膝后交叉韧带

目的 介绍以自体骨－髌腱－骨重建膝关节后交叉韧带的方法并评价其对治疗膝关节后不稳定的临床效果。方法 采用膝前方入路,经胫骨－肌骨等长点骨隧道植入自体髋腱重建后交叉韧带（ＰＣＬ）,治疗陈旧性ＰＣＬ断裂所致慢性膝关节不稳病例２０例。采用Ｌａｒｓｏｎ膝关节功能评分、患者主观评价和膝关节稳定性检查评价其临床疗效。结果 ２０例患者术前Ｌａｒｓｏｎ评分平均６２分,沐后经６￣５８个月随访,平均评分达９２分,１８