同种异体组织重建关节韧带临床疗效的初步观察

目的评价同种异体组织重建膝关节前交叉韧带(ACL)、后交叉韧带(PCL)、内侧副韧带(MCL)、外侧副韧带(LCL)和肩关节喙锁韧带(CCL)的疗效. 方法回顾调查43例患者,将其分为3组,A组ACL或ACL/MCL损伤34例;B组PCL或PCL/LCL 损伤6例;C组完全肩锁关节损伤3例.分别应用同种异体骨-髌腱-骨(B-PT-B) 、半腱肌腱与股薄肌腱、胫后肌腱、跟腱-骨重建. 结果平均随访19个月, A、B两组术前Lysholm评分63.0±5.6,术后89.0±5.9,手术前后差异有非常显著性意义(P<0.01); 术后国际膝关节文献委员会(IKDC)评分A级3例(8%),B级23例(58%),C级12例(30%),D级2例(5%).KT2000测定A组手术前后胫骨前移分别为(13.10±0.29)mm和(4.70±1.37)mm;B组胫骨后移则分别为(10.53±2.50)mm和(5.74±1.33)mm,手术前后差异有非常显著性意义 ( P<0.01).术后健患侧比较A、B两组健患差异<3 mm 33例(83%);>5 mm 4例(10%);前后抽屉试验36例(90%)由术前3度恢复至术后平均1.3度.合并MCL/LCL损伤患者的侧方应力试验由术前3度恢复至术后平均1.2度,并呈现明显的硬终点;单纯与复合性ACL或PCL损伤,伸屈正常分别占91%和88%.喙锁韧带重建后X线片显示肩锁关节间隙基本正常,肩锁与肩肱关节活动良好. 结论同种异体移植物重建膝关节ACL、PCL、MCL、LCL与肩关节喙锁韧带疗效满意,是自体组织重建的良好替代物.     

同种异体骨-髌腱-骨组织移植重建前交叉韧带36例临床分析

目的:回顾性研究并评估采用同种异体骨-髌腱-骨组织移植重建前交叉韧带患者的临床疗效。方法:从2004年12月至2006年8月,对36例ACL损伤病例进行了同种异体骨-髌腱-骨组织移植重建。男性16例,女性20例;平均年龄28岁(15~56岁);急性损伤11例,慢性损伤25例。对所有患者进行了主观评估(包括手术前后Lysholm评分、IKDC评分和症状改善情况)和客观评估(包括Lachman试验、轴移试验、KT-1000测量,以及关节活动范围),并对比了患者术前以及术后的MR影像和关节镜手术探查影像,还对术后发热情况以及并发症进行了记录。结果:本组病例平均随访23.6个月(12~32个月)。主观评估:术前Lyshrolm评分为63.61±13.4分(46~90分),术后最终评分为98.03±3.6分(85~100分),与术前对比差异有统计学意义(P<0.01);术后IKDC评分总体优良率达到91.7%。客观评估:KT-1000测量结果:术前两侧胫骨前移的差别为7.05±2.15mm(2~11mm),术后最终测量值为1.15±1.43mm(0~6mm),与术前对比差异有统计学意义(P<0.01)。所有患者均未出现明显的术后并发症以及病毒和细菌感染。1例患者移植物松弛度增加,给予固缩治疗后好转。另1例部分韧带磨损,但主观评估良好,给予清创和髁间窝成形术处理。结论:短期观察显示,采用同种异体骨-髌腱-骨组织移植重建ACL能够获得满意的临床疗效,具备有效性和安全性。     

关节镜下屈膝外翻位经前内侧辅助入路重建前交叉韧带手术体会

目的探讨关节镜下屈膝外翻位经前内侧辅助入路重建前交叉韧带(ACL)疗效。方法2014年1月—2017年1月泸州市中医医院治疗38例因ACL损伤而接受重建手术患者,其中男性22例,女性16例;年龄17～63岁,平均36岁;右膝21例,左膝17例。致伤原因:运动伤22例,道路交通伤12例,其他4例。采用关节镜下屈膝外翻位经前内侧辅助入路建立股骨隧道方式进行ACL重建。术后12个月,对患者膝关节采用Lysholm评分表及IKDC 2000膝关节主观评价表进行疗效评价。结果 38例患者均获得随访,时间12～18个月,平均14个月。术中无后壁破裂情况发生,术后无感染、神经血管损伤、深静脉血栓等严重并发症发生。Lysholm评分由术前的(52. 71±7. 50)分提高至(90. 39±3. 26)分; IKDC评分由术前的(48. 87±9. 05)分提高至(89. 16±4. 29)分(P <0. 05)。术后1年随访显示4例出现Ⅰ度松弛(11. 76%)。结论屈膝外翻位经前内侧辅助入路更有利于ACL重建,具有视野开阔、操作简单、安全有效等优势。     

深低温保存的异体骨-髌腱-骨重建膝关节前交叉韧带

目的评价深低温保存的异体骨-髌腱-骨(bone-patellar tendon-bone,B-PT-B)重建膝关节前交叉韧带的方法和初步疗效.方法采用异体B-PT-B重建膝关节前交叉韧带共15例,平均年龄25.9岁,平均随访时间23.7个月.手术前后采用Lysholm评分评定关节功能.结果术后恢复均顺利.Lysholm评分,由术前(60.1±5.8)分提高至术后(90.8±5.2)分(P＜0.01),优良率80%.结论采用深低温保存的异体B-PT-B重建膝关节交叉韧带是一种较好的、可供选择的手术方式.     

后内束减张经胫骨骨道双束重建后交叉韧带

目的:评估采用后内束减张技术经胫骨骨道双束重建后交叉韧带的初步临床效果。方法:2005年7月至2008年6月,关节镜下后内束减张技术经胫骨骨道双束重建后交叉韧带的24名患者纳入本研究。围手术期观察止血带时间和手术并发症。所有患者平均随访37.0个月(至少24个月),随访内容包括术后膝关节IKDC功能评分、Lysholm评分以及KT-2000膝关节后向松弛度检查。结果:手术平均止血带时间为92分钟,未出现并发症。术后膝关节检查IKDC标准分级结果:A级8例、B级13例、C级3例;Lysholm评分平均89.8±2.8(85～95);双侧膝关节后向KT-2000差值为(2.1±1.3)mm。结论:后内束减张技术经胫骨骨道双束重建后交叉韧带可有效改善膝关节后向稳定性并获满意临床效果。     

关节镜辅助下的同种异体半月板移植(附4例术后20个月以上随访报告)

目的:介绍同种异体半月板移植并总结4例关节镜辅助下的同种异体半月板移植的初步临床效果。材料和方法:2005年6月～7月,4例半月板切除术后的患者接受关节镜辅助的同种异体半月板移植手术,其中男性3例、女性1例,平均年龄30.78±7.71岁(21.5～38.5岁)。3例内侧半月板移植,1例外侧半月板移植。随访采用症状询问,体征检查,IKDC、Lysholm和Tegner评分及KT2000测量关节稳定性的方法。4例患者均每半年进行一次X线片及MRI检查,分别观察膝关节的关节间隙改变及移植半月板状态。对所得结果,因病例只有4例,故只进行数据描述,不进行统计学分析。结果:对4例患者均进行了平均21.80±0.81(20～22)个月的随访。所有患者随访时关节活动度均正常,均无明显的膝关节疼痛和肿胀,原来长时间活动后被切除半月板的间室不适完全消失。患者可以胜任日常活动和体育锻炼,无并发症出现。IKDC、Lysholm、Tegner评分均较术前明显提高。KT2000测量发现术后膝关节的稳定性有所改善。X线片检查提示术后患者关节间隙无明显变化。每半年一次的MRI检查提示移植半月板术后1年时替代存活已经很好。结论:关节镜辅助下的同种异体半月板移植安全可行,半月板移植可缓解半月板切除后出现的关节疼痛、肿胀等症状,促进关节功能恢复并使膝关节的稳定性有所改善。     

关节镜下双带线锚钉前交叉韧带止点足印重建治疗胫骨髁间嵴撕脱骨折

目的:探讨关节镜下复位、双带线锚钉前交叉韧带(ACL)止点足印解剖重建治疗胫骨髁间嵴撕脱骨折的手术方法及临床疗效。方法:2009年4月～2011年4月,对15例胫骨髁间嵴撕脱骨折患者在关节镜下行骨折解剖复位、双带线锚钉ACL止点足印解剖固定术。胫骨髁间嵴撕脱骨折的Meyers-McKeever分型:Ⅱ型8例,Ⅲ型5例,Ⅳ型2例;男12例,女3例;年龄21～57岁,平均30.6岁。术前前抽屉试验及Lachman试验均呈阳性,Lysholm评分为(49.9±3.7)分,IKDC 2000主观膝关节评分为(53.3±5.3)分。结果:患者均获随访,随访时间9～15个月,平均12个月。术后6个月X线片复查示髁间嵴骨折均愈合,骨折复位良好。末次随访时,患肢膝关节活动范围达0～120°;Lysholm评分为(89.6±3.2)分,IKDC2000主观膝关节评分为(90.8±5.7)分,两项评分与术前比较差异均有统计学意义(t1=22.100,t2=20.700,P=0.000)。结论:关节镜下复位、双带线锚钉ACL止点足印解剖重建治疗胫骨髁间嵴撕脱骨折,有利于实现ACL胫骨止点解剖原点重建,对于恢复ACL正常生理功能有重要意义。     

关节镜下应用同种异体跟腱双束重建后交叉韧带

目的:探讨应用同种异体跟腱双束重建后交叉韧带(posterior crucial ligament,PCL)的方法并观察其早期效果.方法:2003年3月～2004年8月,对10例PCL受损患者实施关节镜下采用同种异体跟腱双束重建PCL术.其中2例合并前交叉韧带(anterior crucial ligament,ACL)损伤,同期取自体半腱股薄肌腱重建ACL;3例合并半月板后外侧角损伤,同期取自体半腱股薄肌腱重建后外侧角.术后随访6～24个月,平均13.2个月,其中6例获得12个月以上的随访.结果:采用Lysholm评分法评价患者手术前后患膝关节功能,术前平均50.3分,术后平均91.2分.客观检查结果显示,术前所有患者均出现胫骨结节后沉,后抽屉试验及Lachman试验阳性;术后所有患者后抽屉试验及Lachman试验阴性,有3例病史较长(大于1年)的患者胫骨结节有轻度后沉.合并ACL损伤的2例患者,膝关节屈曲活动轻度受限(5°～20°).结论:应用同种异体跟腱双束重建PCL可减少自体取材造成的损伤及相应的并发症;提前制作供材,软腱端容易通过骨道,缩短镜下操作时间,减轻手术创伤.     

关节镜下应用深低温冷冻异体骨跟腱复合体重建膝前交叉韧带

目的 探讨关节镜下应用深低温冷冻异体骨跟腱复合体重建损伤的前交叉韧带的方法及疗效.方法 回顾了2005年～2006年间我科收治并在关节镜下应用深低温冷冻异体骨跟腱复合体重建损伤的前交叉韧带11例,随访时间12～20个月.对其术前和随访过程中的症状、体征及Lysholm膝关节评分[1]和国际膝关节文献委员会(IKDC)的分级标准评定[2]的情况进行分析.结果 11例术前弹响、交锁和打软腿的症状均消失,无关节不稳的主诉.浮髌试验均为阴性,均无过伸痛,Lachman征、前抽屉试验、轴移试验均为阴性.残留关节轻度疼痛2例.Lysholm评分:术前评分55.26±9.20,术后12个月以上随访评分(90.23±10.55)分(P＜0.01).优秀率81.82%.IKDC评定结果明显优于术前.结论 关节镜下应用深低温冷冻异体骨跟腱复合体重建损伤的前交叉韧带的方法可有效改善膝关节的稳定性;减少了自体肌腱移植所带来的供区损伤;肌腱强度大,供应充足,解决了多根韧带损伤所带来的重建材料匮乏的问题;简化手术步骤,缩短手术时间.未出现明显的免疫反应及关节内感染.     

关节镜下股骨双隧道“Y”形LARS人工韧带移植重建膝后交叉韧带

目的 探讨在关节镜下应用人工LARS韧带重建膝关节后交叉韧带(PCL)的手术技巧及临床疗效. 方法 选择2006年6月- 2010年8月关节镜下采用LARS人工韧带重建PCL断裂患者14例,其中男10例,女4例;年龄19 ～58岁,平均38岁.致伤原因:运动扭伤9例,交通伤3例,摔伤2例.左侧5例,右侧9例.病程10 d ～1个月,平均15.7d.MRI示:PCL完全撕裂直接征象14例,前交叉韧带(ACL)完全撕裂直接征象2例,合并内侧半月板损伤5例,合并外侧半月板损伤3例,合并髋臼后壁骨折1例.Lysholn膝关节功能评分20～55分[(40 ±7.9)分].按照国际膝关节文件编制委员会( IKDC)评分:C级3例,D级11例.PCL在股骨及胫骨止点、隧道均用定位器完成. 结果 本组所有患者伤口均为Ⅰ/甲愈合,术后无慢性滑膜炎、韧带断裂、韧带松动、活动明显受限等并发症.所有患者均获随访6 ～ 60个月,平均20.5个月.Lysholm膝关节功能评分84 ～93分[(88±3.6)分],与术前比较差异有统计学意义(P＜0.05).术后12个月根据IKDC评分标准分级:A级10例,B级4例. 结论 在关节镜下运用LARS人工韧带重建膝PCL有效恢复了膝关节稳定性,避免了采用自体肌腱重建取材的并发症,也避免了同种异体肌腱移植材料的排斥及传染疾病的并发症.其手术操作简便,创伤小,康复快.     

Operative and nonoperative treatments of medial collateral ligament rupture with early anterior cruciate ligament reconstruction: a prospective randomized study

BACKGROUND: The apparent consensus is that solitary medial collateral ligament rupture can be treated nonoperatively, but treatment of severe combined ruptures of the medial collateral ligament and anterior cruciate ligament remains controversial. HYPOTHESES: Nonoperative and early operative treatments of grade III medial collateral ligament rupture lead to similar results when the anterior cruciate ligament is reconstructed in the early phase. STUDY DESIGN: Randomized controlled clinical trial; Level of evidence, 1. METHODS: Forty-seven consecutive patients with combined anterior cruciate ligament and grade III medial collateral ligament injuries were randomized into 2 groups. The medial collateral ligament injury was treated operatively in group 1 (n = 23) and non-operatively in group 2 (n = 24). In both groups, the anterior cruciate ligament injury was treated with early reconstruction, using bone-patellar tendon-bone graft and interference screw. Two years postoperatively, knee stability was measured with a KT-1000 arthrometer and Telos valgus radiography and knee extension strength with a Biodex dynamometer and a 1-legged hop test. An International Knee Documentation Committee evaluation form and Lysholm score were completed. RESULTS: All 47 patients were available for clinical evaluation for a mean of 27 months (range, 20-37 months) after surgery. There were no statistically significant differences between the 2 groups with respect to subjective function of the knee, postoperative stability, range of motion, muscle power, return to activities, Lysholm score, and overall International Knee Documentation Committee evaluation. The subjective outcome and Lysholm score were good and anteroposterior knee stability excellent in both groups. CONCLUSION: Nonoperative and operative treatments of medial collateral ligament injuries lead to equally good results. Medial collateral ligament ruptures need not be treated operatively when the anterior cruciate ligament is reconstructed in the early phase.     

关节镜下4股半腱肌腱单束重建前交叉韧带部分损伤

目的 介绍关节镜下单束蕈建增强治疗前交叉韧带(anterior cruciate ligament,ACL)后外侧束部分损伤方法 ,探讨其临床效果. 方法 对26例单纯ACL后外侧柬部分损伤患者,在关节镜下采用自体半腱肌腱进行单束解剖重建.按照国际膝关节评分委员会(internationalknee documentation committee,IKDC)和Lysholm膝关节功能评分表对患膝功能进行评估,通过KT-1000检查比较膝关节的前向松弛度. 结果 术后无活动受限,屈膝活动度130°～150°,平均142°.术后随访12～18个月,最后随访时IKDC评分为A级25例(96%),B级1例(4%);IKDC评分从术前的(71.4±3.7)分提高到随访结束时的(95.8±3.4)分(t=9.836,P<0.01).屈膝25°位KT-1000检查,双侧膝关节胫骨结节前移差异从术前的(5.1±1.2)mm减少到终末随访的(2.1±1.3)mm(t=10.48,P<0.01).患者术前Lysholm膝关节功能评分为(76.7±3.2)分,终末随访时为(95.7±2.4)分(t=7.356,P<0.01). 结论 在关节镜下采用自体半腱肌腱单束解剖重建增强治疗ACL后外侧束部分损伤,能取得良好效果.     

Anterior cruciate and medial collateral ligament injury

Since August 1989 we have treated acute anteromedial instabilities with medial instability of 1+ and 2+ by augmentated anterior cruciate ligament (ACL) reconstruction alone. Subsequently, functional therapy for the lesion of the medial collateral ligament (MCL) was carried out. In a follow-up examination, we evaluated Lysholm, Marshall, OAK and IKDC scores, measured stability with the KT 1000, and tested isokinetic muscle function in 28 patients. The majority demonstrated stable healing of the MCL and ACL and good or excellent knee functions and muscle strength.     

Percutaneous medial collateral ligament release in arthroscopic medial meniscectomy in tight knees

Purpose

Visualization and surgery of tears in the posterior medial meniscus are difficult in tight knees. Iatrogenic chondral lesions might cause serious morbidity, and residual tears may result in inadequate symptom relief. We evaluated the clinical and radiological results of superficial medial collateral ligament (MCL) release during arthroscopic medial meniscectomy in tight knees.

Methods

Eighteen patients [median age: 43 years (22–59); median follow-up: 8.3 months (6–12)] who underwent arthroscopic meniscectomy were included in the study. Patients with ligamentous injuries, severe chondral damage or meniscal repairs were excluded. Preoperatively, anteroposterior knee radiographs were obtained with 11-kg valgus stress using a specialized instrument. During the operation, if opening of the medial knee in 30° flexion under 11-kg valgus stress was inadequate, controlled release of the posterior portion of the MCL was performed using a 16-gauge needle. Intraoperative valgus stress was monitored using a specially designed lateral support with mounted load cell. MCL injury was evaluated both with magnetic resonance imaging (MRI) and valgus stress radiographs, which were obtained in the 1st week and 3rd and 6th months postoperatively to monitor healing of the elongated MCL.

Results

In all patients, meniscectomy could be performed with adequate visualization of the posterior medial meniscus and without iatrogenic chondral injury. The median medial joint space width on valgus stress radiographs was 7.1 mm preoperatively and 9.1, 8.0 and 7.2 mm in the 1st week, and 3rd and 6th months, respectively (p < 0.0001). On MRI, the injured structure was the posterior two-thirds of the MCL. Median Lysholm score, which was 42 points before the operation, had increased to 94 points at the final follow-up (p = 0.0002).

Conclusion

Controlled release of the MCL in tight knees allowed easier handling in posterior medial meniscus tears and a better understanding of tear configurations, avoiding iatrogenic chondral lesions. The MCL injury healed uneventfully.

Level of evidence

IV.     

Arthroscopic posterior cruciate ligament reconstruction with bone-tendon-bone patellar graft

We present a retrospective study of 24 patients with chronic injury of the posterior cruciate ligament (PCL) treated by arthroscopically assisted reconstruction with bone-tendon-bone patellar autograft. At a mean follow-up of 26.5 months (range 24–53 months) the International Knee Documentation Committee (IKDC) evaluation form, Lysholm and Tegner rating systems were used to evaluate symptoms, functional limitations during sports and daily activities, and changes in activity level. At the final IKDC evaluation we found 6 patients (25%) with grade A (normal), 13 patients (54.2%) with grade B (nearly normal), 3 patients (12.5%) with grade C (abnormal) and 2 patients (8.3%) with grade D (severely abnormal). The average side-to-side difference, as measured by the KT-2000 arthrometer, was 8.38 (± 1.95) preoperatively and 4.08 (± 2.09) mm postoperatively at 89 N with the knee flexed at a neutral quadriceps knee angle of approximately 70°. The worst results significantly correlated with the time elapsed from injury to surgery (P < 0.001). The preoperative Lysholm score was 56 ± 12 (range 41–79) and at follow-up 94 ± 8 (range 76–100). The Tegner activity score improved for all patients after surgical treatment. Average preinjury score was 7.4 (range 4–9), decreasing to 3.40 (range 2–7) preoperatively and increasing to 5.4 (range 4–9) postoperatively. At follow-up, 12 patients (50%) regained to their preinjury scores after surgery. Our study suggests that this arthroscopic technique, which allows a more precise placement of tunnels, can improve the results of the PCL reconstruction with a bone-tendon-bone autograft. Received: 5 December 1996 Accepted: 14 May 1997     

Simultaneous anterior and posterior cruciate ligament reconstruction in chronic knee instabilities: surgical concepts and clinical outcome

The purpose of this study was to evaluate the clinical results of simultaneous arthroscopically assisted reconstruction of anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) using autogenous tendon grafts in chronic knee injuries. Nineteen patients (17 men and 2 women) with chronic multi-ligamentous injuries underwent one-stage ACL and PCL reconstruction. ACL, PCL and medial collateral ligament were reconstructed in seven knees, and ACL, PCL and posterolateral structure were reconstructed in two knees. Function of the operated knee was evaluated according to the International Knee Documentation Committee (IKDC) and Lysholm scale. Anterior and posterior knee laxity was examined with a KT-2000 arthrometer. Eighteen of 19 patients were able to return for follow-up and were evaluated objectively and subjectively. The average patient age at surgery was 30.5 years, and the average postoperative follow-up was 3.5 years. No patients showed loss of knee extension more than 5 degrees , while three patients revealed loss of knee flexion more than 16 degrees . The mean postoperative total anterior-posterior side-to-side difference was 1.9 +/- 1.5 mm at 20 degrees and 2.1 +/- 1.9 mm at 70 degrees . The average of the Lysholm score was 95.1 points at the final follow-up. At the IKDC evaluation, three patients were grade A, 11 were grade B, 3 were grade C, and 1 patient was grade D. The results showed the effectiveness and safety of one-stage reconstruction of combined ligamentous injuries of the knee that can adequately restore satisfactory stability.     

Short- to mid-term outcomes of anatomic MCL reconstruction with Achilles tendon allograft after multiligament knee injury

Purpose

Multiple techniques have been described in the literature for reconstruction of the medial collateral ligament. The purpose of this study is to describe functional outcome, range of motion, and knee stability following anatomic MCL reconstruction utilizing an Achilles tendon bone allograft after multiligament knee injury.

Methods

A comprehensive search of a single-hospital multiligament knee injury (MLKI) procedural database was conducted to identify all patients that underwent reconstruction of the MCL utilizing an Achilles tendon bone allograft and with 2-year clinical follow-up. Medical charts were retrospectively reviewed to determine each patient’s knee dislocation (KD) grade, final range of motion, stability on clinical examination, and the incidence of complications and reoperations. KOOS, IKDC, and Marx scores were also collected.

Results

Thirty-two knees in 32 patients (21 males and 11 females) with a mean age of 30 years (range 15–51) were followed for an average of 40 months (range 28–87 months) following MCL reconstruction with Achilles tendon bone allograft. For patients with multiligament knee injuries, there were 14 KD-I (11 ACL/MCL; 3 MCL/PCL; 1 MCL/ACL/LCL; 1 MCL/PCL/LCL), 12 KD 3-M, and 3 KD-IV. One patient underwent isolated revision MCL reconstruction. At final follow-up, clinically significant valgus laxity was observed in only 1 patient (3%). All patients were able to achieve full extension of the knee and the average flexion was 121.1?±?19.6. The average IKDC score was 67.6?±?19.9 (range 27.7–98.9), the average KOOS score 77.1?±?16.8 (range 31–100). The average Marx score was 4.9 (range 0–16, SD 5.2). Thirty-one of 32 (96%) patients reported being satisfied with results of the surgery. Knee dislocation grades were significantly correlated with post-operative outcome measures.

Conclusion

In a series utilizing a modified Marx Achilles tendon, MCL reconstruction in the setting of MLKI demonstrated satisfactory clinical and functional outcomes, as well as patient satisfaction at short- to mid-term follow-up. Furthermore, knee dislocation grades were demonstrated to correlate with post-operative IKDC, KOOS, and Marx scores.

Level of evidence

Type IV.

     

ACL reconstruction using bone-patellar tendon-bone press-fit fixation: 10-year clinical results

Multiple techniques for anterior cruciate ligament (ACL) reconstruction are currently available, most of which use hardware or resorbable material for fixation of the graft inside or outside the bony tunnels. In this study, the long-term results of 95 patients at a mean follow-up of 10.7 years were assessed. The ACL was reconstructed using a patellar tendon autograft with a press-fit fixation. Between 1987 and 1991, 159 patients were operated by the senior author (PH), 95 could be seen for follow-up. Evaluation included detailed history, physical examination, functional knee ligament testing, KT-1000 arthrometer testing, the IKDC standard evaluation form, Lysholm, Flandry, and Tegner scoring systems. Radiographs were obtained preoperatively and at follow-up to assess the grade of osteoarthritis. Subjectively, none of the patients that were seen for follow-up complained of instability. Numbness of the skin was reported by 54% of the patients and pain during knee walking was described as mild in 25% and severe in 2%. The mean Flandry score was 243 (max: 280). The mean Lysholm score was 93.2 at follow-up and the Tegner activity level was 6.8 preinjury and 6.0 postoperatively. The average KT-1000 side-to-side difference was 1.8 mm on a manual maximum pull. The IKDC knee scoring revealed 84% of the patients with normal (A) or nearly normal (B) knee joints, 15% were (C), 1% was (D). Radiographically, joint space narrowing was found in 19%, 15%, and 25% for the patello-femoral, medial, and lateral compartments, respectively. Meniscus surgery was a determining factor. This study presents long-term clinical data on a press-fit fixation for ACL reconstruction. Results were excellent and good in more then 80% of the followed patients. The advantages of the press-fit fixation are direct bone-to-bone healing of the graft, decreased donor site morbidity, cost-effectiveness and ease for revision surgery.     

关节镜下自体四股腘绳肌腱重建膝前交叉韧带

目的评估关节镜下自体四股腘绳肌腱重建膝前交叉韧带(ACL)的技术和效果方法1999年10月-2003年12月共56例患者经关节镜检查证实为ACL断裂,26例伴半月板破裂,7例伴内侧副韧带损伤,12例伴后交叉韧带断裂。均于关节镜下行自体四股腘绳肌腱ACL重建术,采用Bionx生物可吸收挤压螺钉或钛挤压螺钉解剖位固定重建韧带。结果本组术后早期均未发生严重并发症。术后随访6-48个月,平均20个月,Lysholm膝关节功能评分由术前45-80分(平均58.36分),提高至随访时70-100分(平均92.77分)(P<0.01)。国际膝关节文件编制委员会(IKDC)综合评定由术前异常(C级)14例、显著异常(D级)42例,改进为随访时正常(A级)23例、接近正常(B级)29例、异常(C级)4例(P<0.01)。56例患者中,52例恢复伤前运动水平,4例运动水平较伤前降低。结论关节镜下自体四股腘绳肌腱重建膝ACL具有手术损伤较小、术后膝关节功能恢复良好的优点,值得采用。