关节镜下单束重建前交叉韧带前内侧束断裂

目的探讨关节镜下前交叉韧带(ACL)前内侧束断裂的重建方法及疗效。 方法 2004年5月至2010年5月采用关节镜技术重建293例ACL损伤患者，其中40例(13.7％)患者术中关节镜下诊断为ACL前内侧束断裂，男34例，女6例；年龄18～39岁，平均30.1岁。受伤至手术时间平均为4.2个月（7 d至8个月）。术中保留ACL后外侧束，使用自体4股腘绳肌腱重建前内侧束。术前及术后随访评估包括临床查体和Lysholm评分，本体感觉功能采用被动活动察觉阈值进行评估。 结果 40例患者术后获平均33个月（7～56个月）随访。膝关节Lysholm评分术前平均为(56.7±8.6)分，末次随访时平均为(92.0±5.0)分，差异有统计学意义(t=27. 750，P=0.000)。末次随访时按Lysholm评分评定疗效：优19例，良16例，可5例，优良率为87.5％。Lachman试验阴性34例，弱阳性4例，阳性2例。末次随访时患膝被动活动察觉阈值平均为2.12°±0.15°，健膝被动活动察觉阈值平均为2.09°±0. 16°，差异无统计学意义（t=0. 657,P=0.515）。术后所有患者均恢复日常工作，关节稳定性明显改善。结论关节镜下单束重建ACL前内侧束，术中保留了后外侧束，有利于隧道的精确定位和移植物固定机械强度的增加，并能加速移植肌腱的血管化和再神经支配，促进膝关节功能尽快恢复。

Arthroscopic single bundle reconstruction of the ruptured anteromedial bundle of anterior cruciate ligament

ObjectiveTo explore the surgical techniques and therapeutic effects of arthroscopic reconstruction of the ruptured anteromedial bundle of anterior cruciate ligament (ACL).MethodsFrom May 2004 to May 2010, 293 patients received arthroscopic ACL reconstruction at our department. Of them,40 cases (13.7％ ) were diagnosed as anteromedial bundle rupture of ACL during arthroscopic exploration.The ruptured anteromedial bundle was reconstructed using the autologous quadrupled hamstring graft while the posterolateral bundle was preserved during the procedure. Lysholm scoring and Lachman test were performed prior to and after the reconstruction to evaluate functional recovery of the knee. The proprioceptive function of the knee was evaluated by Threshold to Detection of Passive Motion (TDPM) system.ResultsAll the cases of ruptured anteromedial bundle were followed up for an average of 33 months (from 7 to 56 months).The average Lysholm score was 56.7 ± 8.6 before surgery and 92. 0 ± 5.0 at the last follow-up, with a significant difference ( t =27. 750, P =0. 000). By Lysholm scoring at the last follow-up, 19 patients were rated as excellent, 16 as good, 5 as fair and none as poor, with an excellent-to-good rate of 87. 5％. By the Lachman test, 34 patients were negative, 4 weakly positive and 2 positive. At the last follow-up, there was no significant difference between the average TDPM of the affected knees (2. 12° ±- 0. 15°) and that of the contralateral knees (2. 09° ±0. 16°) (t =0. 657, P =0. 515) . All the patients resumed normal activities after surgery with obviously improved stability of the knee.ConclusionArthroscopic reconstruction of the ruptured anteromedial bundle of ACL with preservation of the posterolateral bundle can help precise positioning of the bone tunnel, provide additional mechanical strength for graft fixation, and accelerate revascularization and sensory reinnervation of the reconstructed ACL.