A prospective randomized study of anterior cruciate ligament reconstruction: a comparison of patellar tendon and quadruple-strand semitendinosus/gracilis tendons fixed with bioabsorbable interference screws

BACKGROUND: Debate exists regarding the optimal graft for anterior cruciate ligament reconstruction. Few studies have compared the differences in outcome after reconstruction using similar fixation methods. HYPOTHESIS: Similar outcomes will be seen after anterior cruciate ligament reconstruction with bone-patellar tendon-bone or quadruple-strand semitendinosus/gracilis tendons fixed with bioabsorbable interference screws. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS: Ninety-nine patients were prospectively randomized to bone-patellar tendon-bone (46 patients) or quadruple-strand semitendinosus/gracilis (53 patients) reconstruction groups. The bone-patellar tendon-bone group had slightly lower preinjury Tegner scores (6.7 vs 7.1, P = .03); otherwise, the groups were similar. All surgeries were performed by a single surgeon using an endoscopic technique with bioabsorbable interference screw fixation. Patients were evaluated at 3, 6, 12, and 24 months. RESULTS: Forty-six bone-patellar tendon-bone and 50 quadruple-strand semitendinosus/gracilis patients were available at 24 months (97%). No differences in International Knee Documentation Committee grade, Lysholm score, Tegner activity level, range of motion, single-legged hop test, KT-1000 arthrometer manual maximum difference, Short Form-36, or patient knee rating were found. The bone-patellar tendon-bone group had better flexion strength in the operated leg than in the nonoperated leg (102% vs 90%, P = .0001), fewer patients complaining of difficulty jumping (3% vs 17%, P = .03), and a greater number of patients returning to preinjury Tegner level (51% vs 26%, P = .01). The quadruple-strand semitendinosus/gracilis group had better extension strength in the operated leg than in the nonoperated leg (92% vs 85%, P = .04), fewer patients with sensory deficits (14% vs 83%, P = .0001), and fewer patients with difficulty kneeling (6% vs 20%, P = .04). Both groups showed significant improvement in KT-1000 arthrometer manual maximum difference, Lysholm score, Tegner activity level, International Knee Documentation Committee grade, and patient knee rating score. CONCLUSIONS: Good outcomes were seen in both the bone-patellar tendon-bone and quadruple-strand semitendinosus/gracilis groups. Subtle differences were noted between the groups, which may help guide optimal graft choice.     

Differences in the rehabilitation period following two methods of anterior cruciate ligament replacement: semitendinosus/gracilis tendon vs. ligamentum patellae

This study compared patient outcome during the early rehabilitation phase following two different methods of anterior cruciate ligament (ACL) reconstruction: ligamentum patellae (LP) and semitendinosus/gracilis tendon (SG) based reconstruction. The study included 50 consecutive patients treated by each method, examined 6 weeks and 3, 6 and 12 months after surgery. Patients in the SG group showed significantly better Lysholm scores at 6 and 12 months, Tegner Activity Scale scores at 3 months, and pain profile assessments at 6 weeks and 3 months than those in the LP group. Significant advantages were observed in LP group in the Overall Knee Score at 6 weeks and in range-of-motion at 6 weeks and 3 and 6 months post-surgery. Stability tests revealed no significant differences between patients in the two groups. SG-based reconstruction of the ACL thus demonstrates advantages over LP-based reconstruction regarding pain and function, while LP-based reconstruction was associated with an earlier return of motion.     

Functional and muscle morphometric effects of ACL reconstruction. A prospective CT study with 1 year follow‐up

Computed tomography (CT) was used to explore if changes in muscle cross‐sectional area and quality after anterior cruciate ligament (ACL) injury and reconstruction would be related to knee function. Fourteen females and 23 males (16–54 years) underwent clinical tests, subjective questionnaires, and CT 1 week before and 1 year after ACL surgery with semitendinosus‐gracilis (STG) graft and rehabilitation. Postoperatively, knee laxity was decreased and functional knee measures and subjective patient scores improved. The most obvious remaining deficit was the quadriceps atrophy, which was significantly larger if the right leg was injured. Right‐leg injury also tended to cause larger compensatory hypertrophy of the combined knee flexor and tibial internal rotator muscles (preoperatively). The quadriceps atrophy was significantly correlated with the scores and functional tests, the latter also being related to the remaining size of the gracilis muscle. Biceps femoris hypertrophy and, in males only, semimembranosus hypertrophy was observed following the ACL reconstruction. The lack of semimembranosus hypertrophy in the women could, via tibial internal rotation torque deficit, contribute to the less favorable functional and subjective outcome recorded for the women. The results indicate that the quadriceps, the combined knee flexor/tibial internal rotator muscles, side of ACL injury, and sex are important to consider in rehabilitation after STG graft.     

Prospective evaluation of arthroscopically assisted anterior cruciate ligament reconstruction. Patellar tendon versus semitendinosus and gracilis tendons

Eighty consecutive patients with chronic laxity due to a torn ACL underwent arthroscopically assisted reconstruction with either autogenous patellar tendon or doubled semitendinosus and gracilis tendons. Reconstructions were performed on a one-to-one alternating basis. Preoperatively, no significant differences between the two groups were noted with respect to age, sex, level of activity, and degree of laxity (chi square analysis). A standard rehabilitation regimen was used for all patients after surgery including immediate passive knee extension, early stationary cycling, protected weightbearing for 6 weeks, avoidance of resisted terminal knee extension until 6 months, and return to activity at 10 to 12 months postoperatively. Seventy-two patients were evaluated at a minimum of 24 months postoperatively (range, 24 to 40 months). No significant differences were noted between groups with respect to subjective complaints, functional level, or objective laxity evaluation, including KT-1000 measurements. Seventeen of 72 patients (24%) experienced anterior knee pain after ACL reconstruction. Overall, 46 of 72 patients (64%) returned to their preinjury level of activity. Mean KT-1000 scores were 1.6 +/- 1.4 mm for the patellar tendon group and 1.9 +/- 1.3 mm for the semitendinosus and gracilis tendons group. This study did find a statistically significant weakness in peak hamstrings torque at 60 deg/sec when reconstruction was performed with double-looped semitendinosus and gracilis tendons.     

膝关节镜下半腱肌及股薄肌肌腱重建前交叉韧带的临床观察

目的探讨膝关节镜下前交叉韧带重建的方法和效果。方法回顾分析26例膝关节镜下应用自体半腱肌及股薄肌腱以界面挤压螺钉及Endobutton固定重建前交叉韧带的临床资料,对患膝关节功能进行评估。结果术后随访12-18个月,根据Lysholm膝关节评分标准,由术前（54．7±9．13）分提高到术后（86．6±6．97）分。结论膝关节镜下采用自半腱肌及股薄肌肌腱重建前交叉韧带的方法可行,疗效满意,可作为重建前交叉韧带的方法广泛应用。     

Decrease of knee flexion torque in patients with ACL reconstruction: combined analysis of the architecture and function of the knee flexor muscles

A decrease of deep knee flexion torque after anterior cruciate ligament (ACL) reconstruction, using a semitendinosus (and gracilis) tendon, has been reported. However, the cause of this weakness remains controversial. Architectural and functional differences in the knee flexor muscles influence this weakness. the fiber length of the semitendinosus, gracilis, semimembranosus, and biceps femoris were directly measured in six human cadavers. The flexion torque and EMG of the hamstrings were measured in both limbs of 16 patients (23±5 years) after ACL reconstruction (12–43 months post-operation), using ipsilateral semitendinosus tendon. Magnetic resonance imagings were taken, over both the thighs of those patients, to measure muscle volume and to confirm a state of semitendinosus tendon regeneration. The position of the musculotendinous junction of the semitendinosus was also analyzed. The fiber length of the semitendinosus and gracilis were three to four times longer than that of the semimembranosus and biceps femoris. The difference of flexion torque between the normal and ACL reconstructed limbs significantly increased as the knee flexion angle increased. The EMG value for the semimembranosus and biceps femoris of both limbs as well as the semitendinosus of the ACL reconstructed limbs, significantly reduced as the knee flexion angle was increased. The volume of the semitendinosus in the reconstructed limb was significantly smaller than in normal limbs. The regeneration of the semitendinosus tendon was confirmed in all subjects, and the musculotendinous junction position of the reconstructed limb in almost all subjects was found in further image from the knee joint space than that for the normal limb. The decrease of deep knee flexion torque, after ACL reconstruction, could be due to the atrophy and shortening of the semitendinosus after its tendon has been harvested, as well as the lack of compensation from the semimembranosus and biceps femoris, due to the architectural differences between the semitendinosus and the semimembranosus and biceps femoris.     

Anterior cruciate ligament reconstruction. A prospective randomized study of three surgical methods

A prospective randomized study was performed to determine the differences in results between three methods of anterior cruciate ligament reconstruction: autogenous bone-patellar tendon-bone graft (group 1), semitendinosus and gracilis tendon graft reconstruction combined with an extraarticular procedure (group 2), and semitendinosus and gracilis tendon graft reconstruction alone (group 3). Preoperatively, there were no significant differences between groups. At a mean of 35.4 +/- 11.6 months postoperatively, 102 patients returned for evaluation. International Knee Documentation Committee knee evaluation revealed no significant differences in symptoms, function, return to pre-injury activity, harvest site abnormalities, or limitation of motion between groups 1 and 3. Patients in group 2 had a higher incidence of patellofemoral crepitation and loss of motion than did patients in group 3. The mean manual maximum KT-1000 arthrometer side-to-side difference was 2.1 +/- 2.0 mm in group 1, which was statistically significantly better than the difference in group 3 (3.1 +/- 2.3 mm). Final knee rating showed that 34 of 35 patients in group 1, 23 of 34 patients in group 2, and 26 of 33 patients in group 3 had a normal or nearly normal overall knee rating. Anterior cruciate ligament reconstruction with a semitendinosus and gracilis or a patellar tendon autograft may yield similar subjective results; however, the patellar tendon autograft may provide better objective stability in the long term. In addition, there appears to be no benefit to combining an intraarticular anterior cruciate ligament reconstruction with an extraarticular procedure.     

Single-versus two-incision technique in anterior cruciate ligament replacement: influence on postoperative muscle function.

The purpose of this study was to find out whether the single-incision technique for anterior cruciate ligament repair has advantages over the two-incision technique in terms of muscular function up to 1 year postoperatively. Twenty patients who underwent unilateral anterior cruciate ligament reconstruction with bone-patellar tendon-bone autografts were randomly assigned to one of the two procedures. Both groups (10 patients in each) were followed up at 1 year. Lysholm and International Knee Documentation scores and thigh circumferences were markedly reduced after surgery in both groups but improved up until the last follow-up examination at 12 months postoperatively. Clinical examination, functional scores, stabilometry measurements, and thigh circumferences did not differ between the two groups. Isokinetic evaluation revealed a significant reduction of extensor peak torques in both groups that was most pronounced at 3 months, then improved continuously but was still present 12 months postoperatively. A significant reduction of peak torques, up to 35%, was seen in the flexor muscles of the involved legs compared with the contralateral legs, but this deficit vanished completely after 12 months in both groups. At 3 and 6 months, for the flexor as well as the extensor muscles, the deficits in peak torque on the injured sides were found to have improved faster in the single-incision group. These results indicate improved dynamic muscle function with use of the single-incision technique because the dissection of the vastus lateralis muscle that occurs in the two-incision technique is avoided.     

Augmentation of femoral fixation in hamstring anterior cruciate ligament reconstruction with a bioabsorbable bead: a prospective single-blind randomized clinical trial

BACKGROUND: The EndoPearl is an adjunct to bioabsorbable interference screw fixation in the femoral tunnel in anterior cruciate ligament (ACL) reconstruction. The purpose of the study was to assess the clinical effectiveness of the EndoPearl using the KT-1000 Knee Arthrometer and the Mohtadi ACL Quality of Life (ACL-QOL) Questionnaire. HYPOTHESIS: The application of the EndoPearl in hamstring ACL reconstruction has no significant benefit when compared to conventional treatment in KT-1000 and ACL-QOL Questionnaire outcomes. STUDY DESIGN: Prospective single-blind randomized clinical trial. METHODS: ACL reconstruction with autogenous semitendinosus and gracilis tendons was performed on 35 patients. Preoperatively, 3 months, 6 months, and 18 months postoperatively, patients' knees were evaluated using the KT-1000 Knee Arthrometer and the ACL-QOL Questionnaire. RESULTS: Statistically significant differences were achieved in terms of KT-1000 side-to-side differences between the study group and the control group at 6 months and 18 months postoperatively; the mean side-to-side differences are significantly less in the study group when compared to the control group. Statistically significant differences were not detected when comparing the ACL-QOL Questionnaire between the two groups at all time intervals. CONCLUSION: The application of the EndoPearl in conjunction with a bioscrew in the femoral tunnel in autogenous ACL reconstruction using semitendinosus and gracilis tendon grafts provides a significantly decreased laxity up to 18 months postoperatively in terms of KT-1000 side-to-side differences.     

Influence of medial hamstring tendon harvest on knee flexor strength after anterior cruciate ligament reconstruction. A detailed evaluation with comparison of single- and double-tendon harvest

BACKGROUND: The advantages of hamstring tendon autografts for anterior cruciate ligament reconstruction are well known; however, concerns have arisen regarding the influence of hamstring tendon harvest on postoperative weakness in knee flexion. PURPOSE: To evaluate the influence of hamstring tendon harvest on knee flexion strength in patients undergoing anterior cruciate ligament reconstruction. STUDY DESIGN: Prospective randomized study. METHODS: Ninety patients were randomly assigned at surgery to undergo anterior cruciate ligament reconstruction with either a semitendinosus tendon autograft or a semitendinosus and gracilis tendon autograft. Quadriceps and hamstring muscle strength was tested before surgery and at 6, 12, and 18 months after surgery. RESULTS: There was no significant difference in clinical results between the groups and neither group showed a significant decrease in isokinetic hamstring muscle strength. However, when the subjects' knees were at positions of 70 degrees or more of flexion, both isokinetic and isometric measurements revealed a significant decrease in hamstring muscle strength in both groups. The strength in the group with semitendinosus and gracilis tendons was considerably less than that in the group with semitendinosus tendon alone at 18 months. CONCLUSIONS: Tendon harvest causes significant weakness of hamstring muscle strength at high knee flexion angles, but such weakness can be minimized if the gracilis tendon is preserved.     

Knee flexor strength after ACL reconstruction: comparison between hamstring autograft, tibialis anterior allograft, and non-injured controls

Hamstring muscle group dysfunction following anterior cruciate ligament reconstruction (ACL) using a semitendinosus–gracilis autograft is a growing concern. This study compared the mean peak isometric knee flexor torque of the following three groups: subjects 2 years following ACL reconstruction using semitendinosus–gracilis autografts (Group 1), subjects 2 years following ACL reconstruction using tibialis anterior allografts (Group 2), and a non-injured, activity-level-matched control group (Group 3). We hypothesized that Group 1 would have greater mean involved lower extremity peak isometric knee flexor torque deficits than the other groups. Handheld dynamometry with subjects in prone and the test knee at 90° flexion was used to determine bilateral peak isometric knee flexor torque. Group 1 (86.4 ± 11) and Group 2 (80.5 ± 13) had similar 2000 IKDC Subjective Knee Evaluation Form scores (P = NS). Group 1 had a mean involved lower extremity peak isometric knee flexor torque deficit of −17.0 ± 14 Nm. Group 2 had a mean involved lower extremity peak isometric knee flexor torque deficit of −0.8 ± 9 Nm. Group 3 (control) had a mean left and right lower extremity peak isometric knee flexor torque difference of −0.7 ± 14 Nm. Group 1 had decreased involved lower extremity peak isometric knee flexor torque compared to Groups 2 and 3 (two-way ANOVA; group × side interaction P < 0.05, Tukey HSD = 0.008). Long-term knee flexor strength deficits exist following hamstring autograft use for ACL reconstruction that does not occur when a tibialis anterior allograft is used. Early identification of impaired knee flexor strength among this group and modified rehabilitation may reduce these deficits. Adding quantitative biomechanical testing of sprinting and sudden directional change movements to the standard physical therapy evaluation will better elucidate the clinical and functional significance of the observed knee flexor strength impairments and aid in determining sport specific activity training readiness.     

Joint laxity and isokinetic thigh muscle strength characteristics after anterior cruciate ligament reconstruction: bone patellar tendon bone versus quadrupled hamstring autografts.

OBJECTIVES: To analyze ligamentous stability and isokinetic strength of knee extensor and flexor muscles after anterior cruciate ligament reconstruction using 2 different autografts with identical fixation. DESIGN: This study implements a comparative case series design. SETTING: Schulthess Clinic, Switzerland. PATIENTS: A total of 153 consecutive patients (n = 87 bone-patellar tendon-bone [BPTB]/66 quadruple semitendinosus/gracilis tendons [QSGT] patients) who underwent BPTB and QSGT surgery were functionally assessed. INTERVENTION: All patients were functionally assessed (knee extension/flexion isokinetic strength and knee joint laxity) at a mean follow-up time of 11 months. MAIN OUTCOME MEASUREMENTS: Laxity was measured utilizing the Kneelax arthrometer, whereas isokinetic strength of the knee extensor/flexor muscle groups was measured using the Biodex Multi Joint System 2 (180 degrees/s and 300 degrees/s). RESULTS: The QSGT group had significantly greater knee joint laxity when compared with the BPTB group (P < 0.001). Furthermore, females in the QSGT group demonstrated the greatest knee joint laxity overall (P < 0.001). Additionally, a significant flexor torque deficiency was demonstrated in the QSGT group (P < 0.001); however, no differences in extensor torque were observed. CONCLUSIONS: The use of a BPTB autograft achieved better knee joint stability as well as greater knee flexor torque than the QSGT autograft. Both grafts exhibited a similar knee extensor torque deficit, indicating that only quadriceps strength is not graft-dependent.     

Factors affecting anterior knee pain following anatomic double-bundle anterior cruciate ligament reconstruction

Purpose

The purpose of this study was to evaluate the prevalence of anterior knee pain in anatomic double-bundle anterior cruciate ligament (ACL) reconstruction and to identify critical factors affecting postoperative anterior knee pain development.

Methods

Subjects comprised 171 patients (171 knees) who underwent anatomic double-bundle ACL reconstruction with a follow-up period of ≥2?years. The procedure used bone-patellar tendon-bone plus gracilis tendon (BTB-G) in 56 knees, semitendinosus tendon (ST) in 71 knees, and ST-G in 44 knees. Clinical results and prevalence and severity of anterior knee pain were assessed at 3?months and 2?years postoperatively. Clinical variables influencing anterior knee pain development at each postoperative period were subjected to univariate analysis, followed by logistic regression analysis to identify risk factors for anterior knee pain.

Results

Overall prevalences of anterior knee pain at 3?months and 2?years postoperatively were 42.0 and 11.1%, respectively. Use of BTB-G graft represented the highest prevalence of anterior knee pain between the 3 different grafts (P?=?0.001); however, this statistical significance disappeared at 2?years postoperatively. Prevalence of postoperative extension deficit was significantly higher in anterior knee pain-positive cohort than in anterior knee pain-negative cohort at 3?months postoperatively. Level of quadriceps strength was significantly lower, and Lysholm score was significantly worse in anterior knee pain-positive cohort than in anterior knee pain-negative cohort at 2?years postoperatively. According to logistic regression analysis, knee extension deficit was a predisposing factor for the development of anterior knee pain at 3?months postoperatively (odds ratio, 2.76; P?=?0.004); however, there was no significant predisposing factor for anterior knee pain at 2?years postoperatively.

Conclusions

Knee extension deficit was an important predisposing factor for postoperative anterior knee pain in the early postoperative period, and anterior knee pain was associated with impaired quadriceps function and inferior subjective results over 2?years postoperatively. Early recovery of full extension may prevent postoperative development of anterior knee pain and achieve successful outcomes for ACL reconstruction.

Level of evidence

Retrospective comparative study, Level III.     

Effect of harvesting the hamstrings tendon for anterior cruciate ligament reconstruction on the morphology and movement of the hamstrings muscle: a novel MRI technique

This study evaluated intramuscular movement of hamstrings muscle after reconstruction of the ACL with a hamstrings tendon graft. The movement of the muscles during knee flexion was measured using a novel MRI technique called the "tagging snapshot" technique, which labels multiple tagging bands within the musculature. Eleven patients who underwent ACL reconstruction using autogenous semitendinosus and gracilis tendons were studied. The difference in the maximum active knee flexion angle between the ACL-reconstructed and the intact knee was calculated as knee flexion lag. Knee flexion strength was measured in 8 of the 11 patients. The semitendinosus muscle of the ACL-reconstructed knee exhibited three different morphological patterns; group I, similar shape to the intact knee with distal tendonlike structures; group II, smaller proximally than the intact knee with distal tendonlike structures; and group III, considerably smaller proximally than the intact knee without distal tendonlike structures. Each group was associated with a different knee flexion lag and different knee flexion strength. Our results indicated that the effect of hamstrings tendon harvest on knee function is not uniform.     

Internal and external tibial rotation strength after anterior cruciate ligament reconstruction using ipsilateral semitendinosus and gracilis tendon autografts

The internal and external tibial rotation torques of subjects who had undergone anterior cruciate ligament reconstruction using semitendinosus and gracilis tendon grafts were measured to determine whether harvest of the tendons results in weakness of tibial internal and external rotation. Cybex NORM dynamometer examinations were performed to measure internal and external tibial torque at angular velocities of 60, 120, and 180 deg/sec in 23 subjects. The sex-specific average torque data of the reconstructed limbs were compared with those of the contralateral limbs. Relative internal and external torque scores were calculated for each subject by subtracting the peak torque of the reconstructed knee from that of the contralateral knee. These relative scores were averaged and compared with the null hypothesis that each score should be statistically similar to zero. Subjects were evaluated at an average of 51 +/- 40 months postoperatively. The mean relative internal torque scores of the reconstructed limbs showed a statistically significant decrease from those of the contralateral limbs at all angular velocities. The mean relative external torque scores of the reconstructed limbs were statistically similar to those of the contralateral limbs at all angular velocities. Subjects who had undergone ligament reconstruction using semitendinosus and gracilis tendons demonstrated internal tibial rotation weakness in their reconstructed knees compared with their contralateral knees at all angular velocities tested. These results suggest that semitendinosus and gracilis tendon harvest causes weakness of internal tibial rotation.     

Isokinetic quadriceps training in patients with patellofemoral pain syndrome

The aims of the present investigation were (a) to evaluate the effect of eccentric quadriceps training in patients with unilateral patellofemoral pain and (b) to compare the effect of eccentric and concentric quadriceps training in patients with bilateral patellofemoral pain. Fifteen patients (9 male and 6 female, aged 17–36 years with a mean of 27.5 years) participated in this study. Nine patients had unilateral pain and trained their painful leg eccentrically, while six had bilateral pain and trained one leg eccentrically and the other concentrically. Quadriceps muscle training was performed on a Kin-Com dynamometer at 90°/s and 120°/s angular velocity twice a week for 8 weeks. Before and after the treatment period the thigh muscle torques were measured on the Kin-Com dynamometer at 60°/s, 90°/s, 120°/s and 180°/s for quadriceps and at 60°/s and 180°/s for hamstrings. Nine controls, matched for gender and age with the group with unilateral pain, were tested in the same way on the Kin-Com dynamometer. For functional evaluation a knee score was calculated before training, after 8 weeks of training and at a mean of 3.4 years after completion of the training. After 8 weeks of training and at follow-up times of 1 and 3.4 years the patients were also questioned regarding whether or not they felt improvement from the training programme. To determine the degree of knee pain during the training Borg's pain scale was used. The results showed that, compared with the controls, the patients had a significantly lower knee extensor torque in their painful leg at all velocities measured. The greatest difference was found during eccentric actions. However, in comparison with the controls there were no significant differences in eccent ic and concentric knee flexor torques. After training there was a significant increase particularly in eccentric but also in concentric torque of the knee extensor in the painful leg of the eccentrically trained group. Of the six patients in the bilateral training group there were five who increased their concentric knee extensor torque and three who increased their eccentric torque. There were no significant differences in concentric and eccentric knee flexor torques before and after training in either of the legs in both training groups. The hamstring/quadriceps ratio was significantly higher in the patients' painful leg before training. However, due to increased quadriceps strength the hamstring/quadriceps ratio dropped after training. Patients in both groups reported no pain or mild pain during the training sessions. The eccentrically trained group was significantly improved both after 8 weeks of treatment and at follow-up 3.4 years later as evaluated using the knee score. The bilaterally trained group was significantly improved 3.4 years after completion of the training programme as evaluated using the knee score.     

优秀击剑运动员下肢三关节等速肌力测试分析

目的:研究我国优秀击剑运动员下肢髋、膝、踝三关节肌群等速肌力表现,找出薄弱肌群。方法:国家击剑队备战2008年奥运会重点队员26名,男女各13名,年龄23.1±2.36岁。在60°/s、240°/s速度下测定运动员双侧下肢髋、膝、踝屈伸肌群等速向心峰力矩。结果发现:(1)髋关节:在240°/s下双侧伸肌峰力矩均明显低于60°/s(P<0.05),60°/s和240°/s下双侧髋关节屈肌峰力矩无显著差异(P>0.05);男运动员两个速度下前腿伸肌峰力矩均显著高于后腿(P<0.05),女运动员无显著差异(P>0.05);两个速度下,运动员双腿屈伸肌峰力矩比值低于正常。(2)膝关节:60°/s时男运动员双腿屈伸肌峰力矩有显著差异(P<0.05),240°/s时双侧伸肌峰力矩有显著差异(P<0.05),女运动员两个速度下均无显著差异(P>0.05);60°/s时,女运动员前后腿屈伸肌峰力矩比值分别为0.56和0.54,男运动员分别为0.63和0.67;240/°s时男女前后腿屈伸肌峰力矩比值均在正常范围。(3)踝关节:60°/s时男运动员前腿踝关节屈伸肌峰力矩显著大于后腿(P<0.05),240°/s时无显著差异(P>0.05);两个速度下,女运动员踝关节屈伸肌峰力矩均无显著性差异(P>0.05);运动员踝关节屈伸峰力矩比值在两个速度下均低于正常。结论:优秀男子击剑运动员下肢关节等速肌力双侧不对称,女运动员不对称表现不明显;击剑运动员下肢薄弱肌群为后腿髋关节伸肌群、股后肌群、前腿股后肌群及踝关节背伸肌群。     

Poly-L-lactic acid — hydroxyapatite (PLLA-HA) bioabsorbable interference screws for tibial graft fixation in anterior cruciate ligament (ACL) reconstruction surgery: MR evaluation of osteointegration and degradation features

Purpose

We evaluated with magnetic resonance imaging (MRI) the degradation and osteointegration features of a new type of bioabsorbable interference (BioRCI) screw composed of poly-L-lactic acid and hydroxyapatite (PLLA-HA) used for tibial graft fixation in anterior cruciate ligament (ACL) reconstruction.

Materials and methods

Thirty-one patients underwent arthroscopic surgery for ACL reconstruction using doubled gracilis and semitendinosus tendons fixed to the tibial tunnel with PLLA-HA (BioRCI-HA) screws. Two groups of patients were evaluated, one group 10–13 months after surgery and the other after 30–40 months. The standard knee ligament evaluation form of the International Knee Documentation Committee (IKDC) was used for clinical assessment and MRI for the radiological assessment.

Results

MRI after 10–13 months revealed findings referable to healing and integration of the bone-graft-screw system, findings that disappeared at later follow-up examinations. The BioRCI-HA screw remained constantly visible in all patients, although with changes in signal intensity over time.

Conclusions

BioRCI-HA screws allow adequate primary stability and superior osteoconduction and biocompatibility in comparison with plain PLLA screws. The absence of ferromagnetic artefacts allows accurate MRI follow-up and adequate evaluation of ligament synovialisation, screw degradation and graft osteointegration.     

Early post-operative morbidity following anterior cruciate ligament reconstruction: patellar tendon versus hamstring graft

This study documented postoperative morbidity during the first 4 months following anterior cruciate ligament (ACL) reconstruction using either patellar tendon or hamstring tendon autograft. Sixty-five patients undergoing primary arthroscopically assisted single-incision ACL reconstruction were randomized to have a central third bone patellar tendon bone autograft (PT) or a doubled semitendinosus/doubled gracilis autograft (HS). Postoperatively patients undertook a standard 'accelerated' rehabilitation protocol. Patients were reviewed after 2 weeks, 8 weeks, and 4 months. At each review the location and severity of general knee pain and the presence and severity of anterior knee pain (AKP) were recorded as were the presence and size of an effusion as well as the active and passive flexion and passive extension deficits compared to the contralateral limb. Pain on kneeling, KT-1000 measured side to side difference in anterior tibial displacement, isokinetic assessment of quadriceps and hamstring peak torque deficits, IKDC score and Cincinnati sports activity level were also recorded after 4 months. After 2 weeks more patients in the PT group complained of AKP and reported that the pain was more severe. After 8 weeks there was no significant difference between the groups for any variable. After 4 months the severity of general pain experienced and the incidence of pain on kneeling were greater in the PT group. The PT group also demonstrated a significantly greater quadriceps peak torque deficit at 240 degrees /s. IKDC scores were higher in the HS group, but Cincinnati sports activity scores were higher in the PT group. Although we observed a lower morbidity in the HS group, primarily related to pain, the severity of pain in both groups was relatively low and, in light of the higher mean sports activity level observed in the PT group at 4 months the clinical impact of the difference may not be significant.