Kartus J, Magnusson L, Stener S, Brandsson S, Eriksson B I, Karlsson J
Department of Orthopaedics, Norra Alvsborgs County Hospital, Trollhättan, Sweden.
Knee Surg Sports Traumatol Arthrosc. 1999;7(1):2-8. doi: 10.1007/s001670050112.
The aim of the study was to assess knee function after arthroscopic anterior cruciate ligament reconstruction and to analyse complications impeding rehabilitation, additional surgery until the final follow-up, as well as residual patellofemoral pain and donor-site problems. Between 1991 and 1994, 635 patients were operated on using patellar tendon autografts and interference screw fixation. Of these, 604 (95.1%) patients (403 male and 201 female) were re-examined by independent observers at the final follow-up 38 (range 21-68) months post-operatively. The Lysholm score was 85 (range 14-100) points and the Tegner activity level was 6 (range 1-10). Using the IKDC score, 206 patients (34.1%) were classified as normal, 244 (40.4%) as nearly normal, 122 (20.2%) as abnormal and 32 (5.3%) as severely abnormal. In patients with an uninjured contralateral knee (n = 527), the KT-1000 revealed a total side-to-side difference of 1.5 (range -7-11) mm, and 384/527 (72.9%) had a side-to-side difference of < or = 3 mm. The one-leg-hop test was 95% (range 0%-167%). One or more complications impeding rehabilitation were recorded in 184/604 patients (30.5%). The most common was an extension deficit (> 5 degrees), in 81 patients (13.4%). During the period until the final follow-up, 196 re-operations were performed in 161/604 (26.7%) patients. More than one re-operation was required in 27 patients. Shaving and anterior scar resection due to extension deficit were the most common procedures performed (on 65 occasions). Moderate to severe subjective anterior knee pain related to activity, walking up and down stairs, and sitting with the knee flexed was found in 203/604 patients (33.6%). The median loss of anterior knee sensitivity was 16 (range 0-288) cm2. Patients with a full range of motion had less anterior knee pain than patients with isolated flexion or extension deficits, or combined flexion and extension deficits (P < 0.05, P = 0.08 and P < 0.001, respectively). Patients with a full range of motion had less anterior knee pain than patients with extension deficits (with and without flexion deficits) (P < 0.001). Patients with a full range of motion and a minimal loss (< or = 4 cm2) of anterior knee sensitivity had significantly (P < 0.01) less subjective anterior knee pain than patients who did not fulfil these criteria. A considerable number of complications hindering the rehabilitation and conditions requiring additional surgery until the final follow-up were recorded. Anterior knee pain and problems with knee-walking were correlated with the loss of range of motion and anterior knee sensitivity.
本研究的目的是评估关节镜下前交叉韧带重建术后的膝关节功能，并分析阻碍康复的并发症、直至最终随访时的再次手术情况，以及残留的髌股关节疼痛和供区问题。1991年至1994年期间，635例患者接受了髌腱自体移植和界面螺钉固定手术。其中，604例（95.1%）患者（403例男性和201例女性）在术后38个月（范围21 - 68个月）的最终随访时由独立观察者进行了复查。Lysholm评分为85分（范围14 - 100分），Tegner活动水平为6分（范围1 - 10分）。根据IKDC评分，206例患者（34.1%）被分类为正常，244例（40.4%）为接近正常，122例（20.2%）为异常，32例（5.3%）为严重异常。在对侧膝关节未受伤的患者（n = 527）中，KT - 1000显示两侧总差异为1.5毫米（范围 - 7 - 11毫米），384/527（72.9%）患者的两侧差异≤3毫米。单腿跳测试为95%（范围0% - 167%）。184/604例患者（30.5%）记录有一项或多项阻碍康复的并发症。最常见的是伸直受限（>5度），81例患者（13.4%）。在直至最终随访期间，161/604例（26.7%）患者进行了196次再次手术。27例患者需要进行不止一次再次手术。因伸直受限进行的刨削和前侧瘢痕切除是最常见的手术（共65次）。203/604例患者（33.6%）存在与活动、上下楼梯以及屈膝坐位相关的中度至重度主观前膝疼痛。前膝感觉丧失的中位数为16平方厘米（范围0 - 288平方厘米）。活动范围正常的患者比单纯存在屈曲或伸直受限，或同时存在屈曲和伸直受限的患者前膝疼痛更少（分别为P < 0.05、P = 0.08和P < 0.001）。活动范围正常的患者比存在伸直受限（无论有无屈曲受限）的患者前膝疼痛更少（P < 0.001）。活动范围正常且前膝感觉丧失最小（≤4平方厘米）的患者比未满足这些标准的患者主观前膝疼痛明显更少（P < 0.01）。记录到大量阻碍康复的并发症以及直至最终随访时需要再次手术的情况。前膝疼痛和屈膝行走问题与活动范围丧失和前膝感觉相关。
