Medial collateral ligament insertion site and contact forces in the ACL-deficient knee.

The objectives of this research were to determine the effects of anterior cruciate ligament (ACL) deficiency on medial collateral ligament (MCL) insertion site and contact forces during anterior tibial loading and valgus loading using a combined experimental-finite element (FE) approach. Our hypothesis was that ACL deficiency would increase MCL insertion site forces at the attachments to the tibia and femur and increase contact forces between the MCL and these bones. Six male knees were subjected to varus-valgus and anterior-posterior loading at flexion angles of 0 degrees and 30 degrees. Three-dimensional joint kinematics and MCL strains were recorded during kinematic testing. Following testing, the MCL of each knee was removed to establish a stress-free reference configuration. An FE model of the femur-MCL-tibia complex was constructed for each knee to simulate valgus rotation and anterior translation at 0 degrees and 30 degrees, using subject-specific bone and ligament geometry and joint kinematics. A transversely isotropic hyperelastic material model with average material coefficients taken from a previous study was used to represent the MCL. Subject-specific MCL in situ strain distributions were used in each model. Insertion site and contact forces were determined from the FE analyses. FE predictions were validated by comparing MCL fiber strains to experimental measurements. The subject-specific FE predictions of MCL fiber stretch correlated well with the experimentally measured values (R2 = 0.95). ACL deficiency caused a significant increase in MCL insertion site and contact forces in response to anterior tibial loading. In contrast, ACL deficiency did not significantly increase MCL insertion site and contact forces in response to valgus loading, demonstrating that the ACL is not a restraint to valgus rotation in knees that have an intact MCL. When evaluating valgus laxity in the ACL-deficient knee, increased valgus laxity indicates a compromised MCL.     

Factors for the presence of anteromedial rotatory instability of the knee

Anteromedial rotatory instability (AMRI) of the knee joint was investigated with an instrument newly designed to simulate the manual AMRI test and to quantify its magnitude. Thirty healthy subjects, 20 patients with anterior cruciate ligament (ACL) injury, and 10 with both ACL and medial collateral ligament (MCL) injuries were examined. Using the instrument, 100N of anterior force was applied to the proximal part of the tibia with the foot in neutral rotation, 30° of internal rotation, and 30° of external rotation, and the magnitude of anterior displacement was recorded. The measurement was carried out at 20° and 90° of flexion. A significant increase in anterior laxity was observed in all three rotation positions in the injured patients. However, the magnitude of laxity in external rotation was less than that in neutral rotation in the ACL injured patients, whereas it was the greatest in external rotation in ACL + MCL injured patients. Thus, we conclude that an injury involving both the ACL and MCL causes AMRI.     

Biomechanical studies of the ligaments of the knee joint (anterior cruciate ligament and medial collateral ligament) using amputated limbs

In order to study the biomechanical behavior of the ligaments around the knee joint (anterior cruciate ligament-ACL and medial collateral ligament-MCL), experiments were carried out using ten human amputated specimens. Specially designed small omega-shaped transducers were attached on the selected surface of the ligaments, and elongation of the ligaments were measured under valgus or anterior drawer stress in various flexion or rotation of the joint which was made by specific jig sets. The results showed that the load-elongation response varied depending on the sites of the ligaments and that the anterior instability caused by transection of the ACL gave definite effect on the strain behavior of the MCL and, vice versa, the medial instability caused by transection of the MCL gave considerable effect on that of the ACL. This experiment demonstrated a quantitative relationship between these ligaments which suggests the clinical importance of these ligaments for the knee joint stability.     

Instability of knees with ligament lesions. Cadaver studies of the anterior cruciate ligament

We studied the importance of the two parts of the anterior cruciate ligament (ACL), the medial collateral ligament (MCL), and the posterior medial capsule (PMC) to translatory and spontaneous axial rotatory instability in 15 osteoligamentous knee preparations. Instability was recorded continuously from zero to 90 degrees of flexion with application of a constant force to the tibia. Isolated cutting of the ACL caused a moderate anterior translatory movement, which increased if the MCL was also cut. Transection also of the PMC resulted in an even larger range of anterior translatory movement. Combined lesions to the MCL and the PMC and the posterolateral part of the ACL did not cause such instability provided the anteromedial part of the ACL was intact. Application of a valgus moment to specimens with injured ACL and medial structures induced a spontaneous anteromedial subluxation of the tibia in a semiflexed position. When flexion was increased to 70-80 degrees, a sudden reduction was observed.     

Instability of knees with ligament lesions: Cadaver studies of the anterior cruciate ligament

We studied the importance of the two parts of the anterior cruciate ligament (ACL), the medial collateral ligament (MCL), and the posterior medial capsule (PMC) to translatory and spontaneous axial rotatory instability in 15 osteoligamentous knee preparations. Instability was recorded continuously from zero to 90 degrees of flexion with application of a constant force to the tibia. Isolated cutting of the ACL caused a moderate anterior translatory movement, which increased if the MCL was also cut. Transection also of the PMC resulted in an even larger range of anterior translatory movement. Combined lesions to the MCL and the PMC and the posterolateral part of the ACL did not cause such instability provided the anteromedial part of the ACL was intact.

Application of a valgus moment to specimens with injured ACL and medial structures induced a spontaneous anteromedial subluxation of the tibia in a semiflexed position. When flexion was increased to 70–80 degrees, a sudden reduction was observed     

Instability of knees with ligament lesions: Cadaver studies of the anterior cruciate ligament

We studied the importance of the two parts of the anterior cruciate ligament (ACL), the medial collateral ligament (MCL), and the posterior medial capsule (PMC) to translatory and spontaneous axial rotatory instability in 15 osteoligamentous knee preparations. Instability was recorded continuously from zero to 90 degrees of flexion with application of a constant force to the tibia. Isolated cutting of the ACL caused a moderate anterior translatory movement, which increased if the MCL was also cut. Transection also of the PMC resulted in an even larger range of anterior translatory movement. Combined lesions to the MCL and the PMC and the posterolateral part of the ACL did not cause such instability provided the anteromedial part of the ACL was intact.

Application of a valgus moment to specimens with injured ACL and medial structures induced a spontaneous anteromedial subluxation of the tibia in a semiflexed position. When flexion was increased to 70-80 degrees, a sudden reduction was observed     

Valgus medial collateral ligament rupture causes concomitant loading and damage of the anterior cruciate ligament

This study tested the hypothesis that application of a valgus force necessary to create a complete medial collateral ligament (MCL) injury causes damage to the anterior cruciate ligament (ACL). Twelve cadaveric knees were used to measure concomitant loading and damage to the ACL in valgus knee loading sufficient to cause a grade III MCL injury. Displacement sensors were placed on the anteromedial bundle of the ACL and posterior oblique ligament to monitor tensile strain during creation of the MCL injury. A valgus moment was applied to knees flexed at 30 degrees, displacing the joint into valgus rotation beyond MCL rupture. Following valgus loading and MCL injury, femur-ACL-tibia specimens were tested to failure to compare ACL mechanical integrity to noninjured control specimens. Average ACL strength in MCL ruptured knees (1250 +/- 90 N) was statistically lower (P < or = .05) than that for control knees (2110 +/- 50 N). Strain measurements exhibited concomitant posterior oblique ligament strain during valgus loading, whereas ACL strain increased substantially only after MCL rupture. These data indicate that the ACL can be compromised in isolated grade III MCL injuries.     

Posttraumatic incarceration of medial collateral ligament into knee joint with anterior cruciate ligament injury

Medial collateral ligament of the knee is an important coronal stabiliser and often injured in isolation or as combination of injuries. The article reports a case of incarcerated medial collateral ligament (MCL) injury in combination with anterior cruciate ligament (ACL) injury in 20 year old male who presented to us 4 weeks after injury. Clinical examination and MRI was correlated to complete ACL tear with torn distal MCL and incarceration into the joint. Patient was taken up for ACL hamstring graft reconstruction with mini-arthrotomy and repair of the torn MCL. Patient was followed up with dedicated rehabilitation protocol with good functional results. At one year follow-up, patient exhibited full range of motion with negative Lachman, Pivot shift and valgus stress tests. This article highlights the rare pattern of MCL tear and also reviews the literature on this pattern of injury.     

Periarticular ligament changes following ACL/MCL transection in an ovine stifle joint model of osteoarthritis.

Anterior cruciate ligament (ACL) injuries often lead to significant functional impairment, and are associated with increased risk for induction of degenerative joint disease. However, few studies have described the effect of ligament transection on the remaining intact knee ligaments. This study sought to determine specifically what impact combined ACL/medial collateral ligament (MCL) transection had on the remaining intact knee ligaments, particularly from the histological, biochemical, and molecular perspectives. Twenty weeks post-ACL/MCL transection, the cut ends of sheep MCLs were bridged by scar, while the posterior cruciate ligaments (PCLs) and lateral collateral ligaments (LCLs) seemed gross morphologically normal. Water content and cell density increased significantly in the MCL scars and the intact PCLs but were unchanged in the LCLs. Collagen fibril diameter distribution was significantly altered in both MCL scar tissue and uninjured PCLs from transected joints. MMP-13 mRNA levels in MCL scars and PCLs from ligament transected joints were increased, while TIMP-1 mRNA levels were significantly decreased in the PCLs only. This study has shown that some intact ligaments in injured joints are impacted by the injury. The joint appears to behave like an integrated organ system, with injury to one component affecting the other components as the "organ" attempts to adapt to the loss of integrity.     

Vascular adaptation of intact joint stabilizing structures in the posterior cruciate ligament deficient rabbit knee.

Loss of the posterior cruciate ligament (PCL) of the knee has a significant impact on joint stability and biomechanical function. Changes in joint biomechanics may result in mal-adaptive tissue degeneration and functional alteration of supporting ligaments. This study examines the effects of joint laxity on the vascular physiology of the intact anterior cruciate (ACL) and medial collateral (MCL) ligaments after PCL transection in rabbits.One-year-old female New Zealand white rabbits were assigned to control (n=12), sham-operated (n=12) or PCL transected (2, 6 or 16 weeks, n=12 per time point) groups. Half of the animals (n=6 per group) were used for ACL and MCL blood flow determination using coloured microsphere infusion (ml/min/100 g), and half were used for vascular volume determination (given as vascular index, micro l/g).In the MCL, PCL transection induced large, significant (4-5-fold) increases in blood flow (peak at 2 weeks) and vascular index (peak at 6 weeks) compared to sham-operated animals that returned towards control values by 16 weeks. In contrast, the ACL showed no increase in blood flow in lax joints, and a relatively small (2-fold) increase in vascular index at 6 weeks only. The wet weight and water content of both the MCL and ACL were significantly increased in PCL-deficient joints.We conclude that joint laxity (instability) subsequent to loss of the PCL in rabbits impacts the vascular physiology of intact supporting ligaments, inducing both vasomotor and angiogenic responses in the MCL. Changes in wet weight and water content of both the MCL and ACL demonstrate prolonged physiological adaptation of intact structures in lax joints.     

The anterior cruciate ligament of the knee: An experimental study of its importance in rotatory knee instability

Summary The importance of the anterior cruciate ligament (ACL) in relation to valgus-varus and axial rotation stability in the knee joint was investigated. Mobility patterns were drawn from ten osteoligamentous preparations after successive transection of the two parts of the ACL and the medial (MCL) and lateral collateral ligaments (LCL). The knee joint remained grossly stable after partial injury of the ACL, while sectioning of the entire ACL caused an increase in internal rotation in the extended-semiflexed position. Combined lesions to the ACL and the MCL caused considerable valgus instability increasing with flexion, the joints remaining stable in extension. Moreover, marked anteromedial instability occurred, while only slight posteromedial instability was found. Combined lesions to the ACL and the LCL caused varus instability, worst in the semiflexed position, and a consistent pivot shift in applying a valgus torque in flexion was noted. Moreover, moderate posterolateral instability was found, at its maximum in the semiflexed position. External rotatory stability is secured primarily by the MCL, secondarily by the posterior medial capsule, and finally by the ACL. The existence of lateral pivot shift is proof of damage to the ACL.

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Zusammenfassung Die Bedeutung des vorderen Kreuzbandes (ACL) des menschlichen Kniegelenkes bezüglich der Varus-Valgus- and der axialen Rotationsinstabilität wurde untersucht. An osteoligamentären Kniegelenkpräparaten werden die Bewegungsabläufe nach schrittweiser Duchtrennung der beiden Anteile des ACL and des medialen (MCL) und lateralen (LCL) Seitenbandes aufgezeichnet. Das Kniegelenk blieb nach nur teilweiser Durchtrennung des ACL im wesentlichen stabil, während eine vollständige Durchtrennung eine zunehmende Innenrotation, sowohl bei voller Streckung als auch in halbgebeugter Stellung des Kniegelenkes zur Folge hatte. Kombinierte Verletzungen des ACL and des MCL riefen bei zunehmender Beugung eine beträchtliche Valgus-Instabilität hervor, wobei das Gelenk bei vol ler Streckung jedoch immer noch stabil war. Darüber hinaus konnte eine deutliche anteromediale — bei nur geringer posteromedialer — Rotationsinstabilität verzeichnet werden. Eine kombinierte Durchtrennung des ACL and des LCL erzeugte eine Varus-Instabilität, am deutlichsten in halbgebeugter Stellung des Gelenkes. Regelmaßig konnte ein Pivotshift-Phänomen ausgelöst werden. Hinzu kam eine mäßige posterolaterale Instabilität mit maximaler Ausprägung in halbgebeugter Stellung. Die außenrotatorische Stabilität des Kniegelenkes wird in erster Linie durch das MCL, danach durch die hintere Gelenkkapsel and erst zuletzt durch das ACL gewährleistet.

     

Fixed‐bearing medial unicompartmental knee arthroplasty restores neither the medial pivoting behavior nor the ligament forces of the intact knee in passive flexion

Medial unicompartmental knee arthroplasty (UKA) is an accepted treatment for isolated medial osteoarthritis. However, using an improper thickness for the tibial component may contribute to early failure of the prosthesis or disease progression in the unreplaced lateral compartment. Little is known of the effect of insert thickness on both knee kinematics and ligament forces. Therefore, a computational model of the tibiofemoral joint was used to determine how non‐conforming, fixed bearing medial UKA affects tibiofemoral kinematics, and tension in the medial collateral ligament (MCL) and the anterior cruciate ligament (ACL) during passive knee flexion. Fixed bearing medial UKA could not maintain the medial pivoting that occurred in the intact knee from 0° to 30° of passive flexion. Abnormal anterior–posterior (AP) translations of the femoral condyles relative to the tibia delayed coupled internal tibial rotation, which occurred in the intact knee from 0° to 30° of flexion, but occurred from 30° to 90° of flexion following UKA. Increasing or decreasing tibial insert thickness following medial UKA also failed to restore the medial pivoting behavior of the intact knee despite modulating MCL and ACL forces. Reduced AP constraint in non‐conforming medial UKA relative to the intact knee leads to abnormal condylar translations regardless of insert thickness even with intact cruciate and collateral ligaments. This finding suggests that the conformity of the medial compartment as driven by the medial meniscus and articular morphology plays an important role in controlling AP condylar translations in the intact tibiofemoral joint during passive flexion. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1868–1875, 2018.

     

Pressure distribution at the knee joint

Traumata or repetitive microtraumata, malalignment with varus or valgus deviation, or chronic joint instability are discussed in the aetiology of osteoarthritis and osteochondritis dissecans of the knee. Biomechanical factors influencing the patterns of pressure distribution at the articular surface and the subchondral bone are suggested to be most important in the pathogenesis. Consequently, the patterns of pressure distribution at the femoral condyles of weight-bearing knee joints were investigated in a cadaveric biostatic model. The pressure in the articular joint space was evaluated with pressure-sensitive films of the knee in different joint positions in the coronal plane (10° varus, 10° valgus, and neutral position) without and with medial collateral ligament (MCL), lateral CL (LCL), MCL + anterior cruciate ligament (ACL) or LCL + ACL ligament division. Results demonstrated that the location of the contact area and the peak pressure depended on the joint position and stage of ligamentous division. Without ligament division, a maximum peak pressure was observed at the medial condyle in the neutral and varus positions. Only in the valgus position did the lateral condyle show a higher peak of pressure than the medial condyle. Ligament division of the LCL and LCL + ACL resulted in an increase of peak pressure at the medial condyle, particularly in the varus position. Division of the MCL and MCL + ACL ligament complex reduced the differences between the medial and lateral condyle. In the valgus position, the peak pressure was significantly higher at the lateral condyle. The absolute maximum peak pressure was measured in the varus position at the medial condyle after division of the LCL and ACL. The absolute minimum was found in the valgus position at the medial condyle after division of the MCL and ACL. No significant change of the location of the centre of peak pressure area was observed due to the different joint positions.Presented in part at the 21st Congress of the Austrian Society of Orthopaedic Surgery, 5 May–1 June 1991, Linz, Austria     

Vascular physiology and long-term healing of partial ligament tears.

Functional outcomes of anterior cruciate ligament (ACL) injury are generally poorer than those of medial collateral ligament (MCL) tears. Following ligament damage, all phases of ligament healing require an adequate blood supply. We hypothesized that the differences in healing properties of the ACL and MCL would reflect their vascular responses to joint injury. This paper examines the long-term changes in blood flow and vascular volume of rabbit knee ligaments after direct injury, and under conditions of chronic joint instability induced by section of the posterior cruciate ligament (PCL). Standardized injuries were surgically induced in adult rabbit knee ligaments: partial MCL transection, partial ACL transection, or complete PCL transection (joint instability). Sixteen weeks later the blood flow and vascular volume of the ACL and MCL were measured and compared to control and sham-operated animals. Direct ligament injury induced significant increases in standardized blood flow and vascular volume of both ACL and MCL after 16 weeks; however, the vascular volume of the ACL was not higher than the control levels in the MCL. We conclude that direct injury to both the anterior cruciate and MCLs induces long-term physiological responses. Joint laxity is a common sequel to PCL injury. Chronic joint laxity failed to induce adaptive vascular responses in the ACL, while the MCL shows significant amplification of blood supply. Although both MCL and ACL showed increased weight after PCL transection, the lack of a long-term vascular response in the ACL may be a major factor in its the diminished healing potential.     

The effect of medial collateral ligament insufficiency on the reconstructed anterior cruciate ligament: A study in the rabbit

The treatment for severe combined anterior cruciate ligament (ACL) and medial collateral ligament (MCL) ruptures is disputed. Using a rabbit model, we examined the effect of insufficiency of medial structures on the reconstructed ACL in combined ACL and MCL injury. 40 rabbits were divided into 2 groups. In both groups, ACL was subjected to in situ freezethaw treatment. In group F, only freeze-thaw treatment of ACL was given. In group FM, partial resection of MCL was also done. We killed 5 rabbits on each of 4 occasions: immediately after the operation (time 0), at 6, 12 and 24 weeks postoperatively. At each time, we measured valgus instability and mechanical properties of the ACL. Valgus instability in group FM persisted from time 0 to 24 weeks, and was significantly greater than that in group F. The tensile strength and tangent modulus of the ACL in group FM were lower than those in group F. We found that continuous valgus instability reduces the mechanical properties of the in situ frozen ACL.     

The effect of medial collateral ligament insufficiency on the reconstructed anterior cruciate ligament: a study in the rabbit

The treatment for severe combined anterior cruciate ligament (ACL) and medial collateral ligament (MCL) ruptures is disputed. Using a rabbit model, we examined the effect of insufficiency of medial structures on the reconstructed ACL in combined ACL and MCL injury. 40 rabbits were divided into 2 groups. In both groups, ACL was subjected to in situ freeze-thaw treatment. In group F, only freeze-thaw treatment of ACL was given. In group FM, partial resection of MCL was also done. We killed 5 rabbits on each of 4 occasions: immediately after the operation (time 0), at 6, 12 and 24 weeks postoperatively. At each time, we measured valgus instability and mechanical properties of the ACL. Valgus instability in group FM persisted from time 0 to 24 weeks, and was significantly greater than that in group F. The tensile strength and tangent modulus of the ACL in group FM were lower than those in group F. We found that continuous valgus instability reduces the mechanical properties of the in situ frozen ACL.     

Ligament tension pattern in the flexed knee in combined passive anterior translation and axial rotation.

Twenty-two fresh-frozen specimens were used to measure tensions generated in selected bands of the major ligaments of the flexed knee (40-90 degrees) when an axially prerotated tibia is subjected to passive anterior shear and when an anteriorly pretranslated tibia is subjected to passive axial torque. The tensions were measured using the buckle transducer attached to the anteromedial band of the anterior cruciate ligament [ACL (am)], the posterior fibers of the posterior cruciate ligament [PCL (pf)], the long fibers of the medial collateral ligament [MCL (lf)], and in the total lateral collateral ligament [LCL]. The knee specimens were subjected to the combined motions in a 6-df passive loading apparatus. The results indicated that the joint resistance to anterior translation increased markedly with internal prerotation and only marginally with external prerotation. This increase in joint resistance, however, was associated with a decrease in ACL function. It has been inferred that the posterior structures, capsular and meniscal, contribute significantly to joint resistance when the tibia is prerotated in either sense. For internal prerotation, the interference between the medial femoral condyle and the central tibial eminence was found to be an additional mechanism of resistance to anterior translation. Also, it has been found that although the ACL (am) tension increased with internal rotation in the normal case, it decreased with internal rotation in the presence of an anterior pretranslation. It is concluded that ACL response to combined joint motion cannot be ascertained by a simple summation of its responses to individual motions.     

Kinematics of partial and total ruptures of the medial collateral ligament of the elbow

In this study the kinematics of partial and total ruptures of the medial collateral ligament of the elbow are investigated. After selective transection of the medial collateral ligament of 8 osteoligamentous intact elbow preparations was performed, 3-dimensional measurements of angular displacement, increase in medial joint opening, and translation of the radial head were examined during application of relevant stress. Increase in joint opening was significant only after complete transection of the anterior part of the medial collateral ligament was performed. The joint opening was detected during valgus and internal rotatory stress only. After partial transection of the anterior bundle of the medial collateral ligament was performed, there was an elbow laxity to valgus and internal rotatory force, which became significant after transection of 100% of the anterior bundle of the medial collateral ligament and was maximum between 70 degrees to 90 degrees of flexion. No radial head movement was seen after partial or total transection of the anterior bundle of the medial collateral ligament was performed. In conclusion, this study indicates that valgus or internal rotatory elbow instability should be evaluated at 70 degrees to 90 degrees of flexion. Detection of partial ruptures in the anterior bundle of the medial collateral ligament based on medial joint opening and increased valgus movement is impossible.     

双束异体韧带三角形矢量重建内侧副韧带的临床研究

目的 探讨异体韧带双束重建膝关节内侧副韧带的手术方法,并经随访观察其临床疗效.方法 以2007年6月至2010年3月收治的53例慢性膝关节内侧副韧带损伤的患者为研究对象,术前应力位X线片检查示膝关节内侧间隙较对侧增宽,且增宽间隙＞5 mm,MRI检查示内侧副韧带连续性中断,外翻应力试验阳性,对所有患者行内侧副韧带重建手术.手术方法为股骨内侧髁至关节线下方5 cm行纵行切口,于胫骨前内侧关节线下方4.5 cm至后内侧关节线下方2 cm斜向钻取直径5 mm(或)6 mm骨隧道,股骨内侧髁由内向外导针定位并沿导针钻直径6 mm(或)7 mm,长2.5～3.0 cm的骨隧道,将异体肌腱两端编织后绕过胫骨隧道导入股骨隧道并用可吸收界面螺钉固定,使重建韧带呈三角形状.术后积极康复功能锻炼.术后1年应用Lyshlom评分、国际膝关节文献委员会膝关节评估表(IKDC)评价临床效果;外翻应力位X线片评估关节稳定性.结果 所有患者术后Lyshlom评分(89.7±3.4)、IKDC评分[A或B评分46例(86.79％)]较术前(Lyshlom评分51.8±4.9,t=- 79.724,P＜0.05;IKDC评分A或B者0例)均有明显改善;外翻应力位X线片测量内侧关节增宽间隙由术前(10.4±2.4)mm减小到术后(2.8±1.5)mm,差异有统计学意义(t=41.727,P＜0.05);其中46例患者≤3 mm,7例患者3～5 mm.术前关节活动度135.4°±2.5°,与术后(132.7°±3.7°)比较差异无统计学意义.9例患者术后1年有不同程度的膝内侧局限性疼痛且存在明显压痛点.结论 应用异体肌腱双束三角形重建内侧副韧带能明显改善膝关节内侧稳定性,短期临床疗效确定.     

关节镜下LARS人工韧带及4股半腱肌肌腱重建前交叉韧带

目的评价LARS人工韧带和自体4股半腱肌肌腱关节镜下重建膝前交叉韧带（ACL）的临床疗效。方法对28例膝ACL断裂患者行关节镜下ACL重建术,根据重建材料的来源分为LARS人工韧带组（13例）和自体4股半腱肌肌腱组（15例）。采用ACL解剖等长重建技术建立胫骨、股骨骨道。并对两组的关节稳定性和Lysholm膝关节功能评分进行对比研究。结果术后膝关节稳定性LARS人工韧带组优于4股半腱肌肌腱组（P〈0.05）。移植后两组Lyshrolm膝关节功能评分较移植前提高（P〈0.05）。术后6个月LARS人工韧带组Lysholm评分（90.4分±5.3分）高于4股半腱肌肌腱组（81.2分±4.7分）（P〈0.05）。结论在关节镜下重建ACL术中,LARS人工韧带可作为自体材料的良好替代物。