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1.
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2.
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3.
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4.
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5.
Seong Hwan Kim Young Bok Jung Min Ku Song Sang Hak Lee Ho Joong Jung Han Jun Lee Hyoung Seok Jung Hawa-Tahir Siti 《Knee surgery, sports traumatology, arthroscopy》2014,22(9):2085-2093
Purpose
The purpose of this study was to evaluate the stability and functional outcomes of anterior cruciate ligament (ACL) reconstruction by tensioning of the ACL remnant using pull-out sutures compared with ACL double-bundle reconstruction.Methods
Forty-four patients were included in single-bundle reconstruction with remnant tensioning group (Group 1), and 56 patients were included in the double-bundle reconstruction group (Group 2). The remnant tissue was tensioned to the direction of posterolateral bundle, which unrelated to the type of remnant bundle. Objective knee stability was evaluated by anterior stress radiography, KT-1000 and lateral pivot shift tests. The Tegner activity scale, International Knee Documentation Committee and OrthopädischeArbeitsgruppeKnie scoring systems were used for clinical evaluation.Results
No statistically significant intergroup differences were observed in mechanical stability and clinical results (n.s). However, surgical time of remnant tensioning group is shorter than double-bundle reconstruction group (P = 0.005).Conclusion
Remnant tensioning suture with single-bundle reconstruction could be used with positive results as good as double-bundle technique if a good ACL remnant was found bridging the femur and tibia, rather than debride or damage to the remnant tissue during operation.Level of evidence
Retrospective, comparative cohort study, Level IV. 相似文献6.
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7.
Stephane Plaweski Mathieu Grimaldi Aur��lien Courvoisier Simon Wimsey 《Knee surgery, sports traumatology, arthroscopy》2011,19(8):1277-1286
Purpose
Based on biomechanical anatomical studies, double-bundle reconstruction of the anterior cruciate ligament (ACL) was introduced to achieve better stability in the knee, particularly in respect of rotatory loads. An in vivo, computer-assisted, double-bundle (DB) ACL reconstruction is superior to a single-bundle (SB) ACL reconstruction at reducing rotatory, and AP laxities of the tibia at 20 degrees of knee flexion and also during the pivot shift test. 相似文献8.
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9.
Kenan Keklikci Can Yapici Donghwi Kim Monica Linde-Rosen Patrick Smolinski Freddie H. Fu 《Knee surgery, sports traumatology, arthroscopy》2013,21(8):1915-1921
Introduction
Notchplasty is frequently performed by many orthopaedic surgeons during anterior cruciate ligament (ACL) reconstruction. The effect of notchplasty on tunnel placement and knee biomechanics with ACL reconstruction is not known.Methods
Twelve (n = 12) porcine knees were tested using a robotic testing system. Four knee states were compared: (1) intact ACL, (2) ACL-deficient, (3) anatomic single bundle (SB) ACL reconstruction and (4) anatomic SB ACL reconstruction with a 5-mm notchplasty. The graft was fixed at 60° of flexion (full extension of porcine knee is 30°) with an 80-N tension. The knees were subjected to two loading conditions: an 89-N anterior tibial load (ATT) and 4 Nm internal (IR) and external tibial (ER) rotational torques. The kinematics and in situ force obtained from the different knee conditions were compared.Results
There were no significant differences between pre- and post-notchplasty in the ER at 30° and 60° of knee flexion (n.s.). However, a significant difference was found between pre- and post-notchplasty in ATT at 30° and 60° of flexion (p < 0.05). The in situ force in the anatomic SB reconstruction with notchplasty was significant lower than the intact and anatomic reconstructed ACL pre-notchplasty at 30°, 60° and 90° of knee flexion (p < 0.05). In response to the IR tibial torque, there were significant differences between pre- and post-notchplasty in IR at 60° (p < 0.05) of knee flexion.Conclusion
Notchplasty had greater effect on anterior stability than rotational stability. This change in knee kinematics could be detrimental to a healing bone graft, ligamentization and could lead to failure of the reconstruction in early post-operative period. 相似文献10.
Lee S Kim H Jang J Seong SC Lee MC 《Knee surgery, sports traumatology, arthroscopy》2012,20(4):752-761
Purpose
To prospectively assess the anterior tibial translation and rotational kinematics of the knee joint as well as the clinical outcome after single-bundle (SB) and double-bundle (DB) anterior cruciate ligament (ACL) reconstruction. 相似文献11.
A. Maeyama Y. Hoshino Y. Kato A. Debandi P. Lertwanich J. H. Wang P. Smolinski F. H. Fu 《Knee surgery, sports traumatology, arthroscopy》2018,26(5):1414-1419
Purpose
To compare the different types of ACL reconstructions in terms of knee dynamic laxity evaluated by acceleration.Methods
Sixteen fresh frozen cadaveric knees were used. Pivot shift test was manually performed while monitoring the tibial acceleration by use of a triaxial accelerometer. The test was repeated before and after the ACL resection and reconstruction. Three types of ACL reconstruction were tested: (1) Anatomic Single-Bundle reconstruction (n = 8), the graft was placed at the center of the ACL footprint for the both femoral and tibial sides (tunnel diameter: 8mm); (2) Conventional Single-Bundle reconstruction (n = 8), the graft was placed from the tibial PL footprint to femoral high AM position (tunnel diameter: 8mm) and (3) Anatomic Double-Bundle reconstruction (n = 8). The acceleration in each of three x-y-z directions and the overall magnitude of acceleration was calculated to evaluate dynamic rotational laxity and compared between different ACL reconstructions.Results
The overall magnitude of acceleration was significantly different between ACL intact and deficient knees (p < 0.0001). The acceleration was reduced by the DB ACL reconstruction to the intact level (n.s.), but the two SB ACL reconstruction failed to achieve the intact level of the acceleration (p = 0.0002non-anatomic SB, p < 0.0001 anatomic SB).Conclusion
The anatomic DB reconstruction better restores dynamic rotational laxity when compared to the SB ACL reconstructions no matter if the tunnel placement was anatomic. The anatomic DB reconstruction better restores dynamic rotational laxity when compared to both anatomic and non-anatomic SB ACL reconstruction. For this reason anatomic DB ACL reconstruction is recommended for cases where rotational laxity is an issue.12.
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13.
Yoshinari Tanaka Yasukazu Yonetani Yoshiki Shiozaki Takashi Kanamoto Keisuke Kita Hiroshi Amano Masashi Kusano Masashi Hirakawa Shuji Horibe 《Knee surgery, sports traumatology, arthroscopy》2014,22(7):1541-1548
Purpose
The purpose of the study was to evaluate the entire course of ACL grafts on coronal oblique MR images, focusing on differences in graft morphology and graft-to-tunnel healing among single-bundle (SB), double-bundle (DB), and triple-bundle (TB) reconstructions.Methods
Eighty-three patients underwent anatomical ACL reconstruction using the semitendinosus tendon. SB reconstruction was performed on 20 patients, DB on 29 patients, and TB on 34 patients. The anteromedial-bundle (AMB) and posterolateral-bundle (PLB) images were extracted from coronal oblique images of grafts at 6 months to visualize their entire course. Signal intensity of grafts was measured independently in three regions: (1) intra-femoral tunnel region, (2) intra-articular region, and (3) intra-tibial tunnel region, followed by calculation of the signal-to-noise quotient (SNQ). To evaluate graft-to-tunnel healing, T2-weighted images were examined for the presence of a high signal-intensity lesion between the graft and bone tunnel around the tunnel aperture.Results
AMB images showed that SB graft was thick throughout the entire course, while DB graft was thinner than SB graft. TB graft showed a fan shape approaching the tibial tunnels. The SNQ in the femoral tunnel of SB graft was significantly lower than in the DB and TB grafts. High signal-intensity lesions were frequently observed around the femoral tunnel aperture in PLB images of DB and TB grafts compared to SB grafts.Conclusion
Gross morphology of TB grafts resembled that of the natural ACL. However, the graft-to-tunnel healing around the femoral tunnel seemed to be insufficient in PLB images of DB and TB compared to SB grafts.Level of evidence
III. 相似文献14.
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15.
An��bal Debandi Akira Maeyama Songcen Lu Chad Hume Shigehiro Asai Bunsei Goto Yuichi Hoshino Patrick Smolinski Freddie H. Fu 《Knee surgery, sports traumatology, arthroscopy》2011,19(5):728-735
Purpose
Different tunnel configurations have been used for double-bundle (DB) anterior cruciate ligament (ACL) reconstruction. However, controversy still exists as to whether three-tunnel DB with double-femoral tunnels and single-tibial tunnel (2F-1T) or with single-femoral tunnel and double-tibial tunnels (1F-2T) better restores intact knee biomechanics than single-bundle (SB) ACL reconstruction. The purpose was to compare the knee kinematics and in situ force in the grafts among SB and two types of three-tunnel DB ACL reconstructions performed in an anatomic fashion. 相似文献16.
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17.
Shigehiro Asai Akira Maeyama Yuichi Hoshino Bunsei Goto Umberto Celentano Shigeaki Moriyama Patrick Smolinski Freddie H. Fu 《Knee surgery, sports traumatology, arthroscopy》2014,22(5):972-978
Purpose
Recently, single-bundle (SB) anterior cruciate ligament (ACL) reconstruction has been advanced by the anatomic concept, but the biomechanical outcome of the anatomic method has not been fully investigated, especially for rotational instability. Anatomic SB and the single over-the-top procedures are the treatment of choice for primary cases and revision or skeletally immature cases, respectively. The purpose of this study was to investigate the dynamic rotational instability of anatomic SB and over-the-top reconstruction during a pivot shift test using triaxial accelerometry.Methods
Eight fresh frozen human cadaveric knees were used in this study. Rotational instability measurement was conducted during a pivot shift test by the use of a triaxial accelerometer attached to the tibia. The tests were performed in the ACL-intact, ACL-deficient and ACL-reconstructed knees with two different procedures (anatomic SB and over-the-top). The acceleration in three directions and the magnitude of acceleration were measured to evaluate rotational instability and compare between four different knee states.Results
The overall magnitude of acceleration was significantly different (P < 0.01) between the ACL-intact knees and the ACL-deficient knees. Both anatomic SB and over-the-top ACL reconstruction significantly reduced the overall magnitude of acceleration compared to the ACL-deficient knees, but still had larger accelerations compared to the ACL-intact knees. There was no significant difference for the overall magnitude of acceleration between anatomic SB and over-the-top reconstruction procedure.Conclusion
Over-the-top reconstruction provides comparable result to anatomic SB reconstruction in terms of controlling the dynamic rotational stability. Over-the-top reconstruction might be one of the options for revision cases and in skeletally immature patients. 相似文献18.
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19.
Stefano Zaffagnini Tommaso Bonanzinga Alberto Grassi Giulio Maria Marcheggiani Muccioli Costanza Musiani Federico Raggi Francesco Iacono Vittorio Vaccari Maurilio Marcacci 《Knee surgery, sports traumatology, arthroscopy》2013,21(4):934-941
Purpose
To report the medium-term clinical and radiographic outcomes of a group of patients who underwent anterior cruciate ligament (ACL) surgery combined with high tibial osteotomy (HTO) for varus-related early medial osteoarthritis (OA) and ACL deficiency knee.Methods
Thirty-two patients underwent single-bundle over-the-top ACL reconstruction or revision surgery and a concomitant closing-wedge lateral HTO. The mean age at surgery was 40.1 ± 8.1 years. Evaluation at a mean of 6.5 ± 2.7 years of follow-up consisted of subjective and objective IKDC, Tegner Activity Level, EQ-5D, VAS for pain and AP laxity assessment with KT-1000 arthrometer. Limb alignment and OA changes were evaluated on radiographs.Results
All scores significantly improved from pre-operative status to final follow-up. KT-1000 evaluation showed a mean side-to-side difference of 2.2 ± 1.0 mm. Two patients were considered as failures. The mean correction of the limb alignment was 5.6° ± 2.8°. Posterior tibial slope decreased at a mean of 1.2° ± 0.9°. At final follow-up, the mechanical axes crossed the medial–lateral length of tibial plateau at a mean of 56 ± 23 %, with only 1 patient (3 %) presenting severe varus alignment. OA progression was recorded only on the medial compartment (p = 0.0230), with severe medial OA in 22 % of the patients. No patients underwent osteotomy revision, ACL revision, UKA or TKA.Conclusions
The described technique allowed patients with medial OA, varus alignment and chronic ACL deficiency to restore knee laxity, correct alignment and resume a recreational level of activity at 6.5 years of follow-up.Level of evidence
Case series with no comparison group, Level IV. 相似文献20.
Jae Gyoon Kim Joon Ho Wang Jin Hwan Ahn Hak Jun Kim Hong Chul Lim 《Knee surgery, sports traumatology, arthroscopy》2013,21(4):830-838