Buelow J U, Siebold R, Ellermann A
Arcus Sportsclinic, Pforzheim, Germany.
Knee Surg Sports Traumatol Arthrosc. 2000;8(4):218-25. doi: 10.1007/s001670000120.
We report a prospective series of 101 patients receiving a four-strand semitendinosus-gracilis autograft for anterior cruciate ligament reconstruction using a new bicortical tibial fixation technique with bioabsorbable interference screws. Patients (average age 32 years) were operated on between November 1997 and Mai 1998, and follow-up was at least 12 months postoperatively. The evaluation consisted of history, clinical examination, IKDC score, Cincinnati Knee Score, KT-1000 testing, standardized radiography and magnetic resonance imaging. One hundred patients were available for follow-up. There were two traumatic reruptures 6 and 11 months postoperatively. By IKDC score 87 patients were in groups A and B, 12 in group C, and 2 with a rerupture in group D. Mean Cincinnati Knee Score was 82 (range 46-100), KT-1000 manual maximum at follow-up showed an average difference of 1.7 mm between the sides. Full extension was rapidly achieved in all cases, and flexion averaged 135 degrees . Considering the enlargement caused by the bioabsorbable interference screws, the incidence of tunnel widening was 6.6% on the femoral side and 1.7% on the tibial side. Tunnel widening did not affect the clinical results. Three patients experienced an effusion after more than 6 months postoperatively. There was one infection, which settled without functional impairment after early arthroscopic lavage and intravenous antibiotics. Otherwise no complications occurred. The described technique for anterior cruciate ligament reconstruction combines the advantage of anatomical graft position with sufficient graft fixation. A short intra-articular graft construct with a strong tendon to bone interface was created. Clinically, 87% of patients had a normal or nearly normal IKDC score at follow-up. Magnetic resonance imaging revealed a considerable increase in tunnel area caused by the insertion of the interference screws. On the other hand, the development of a "fibrous interzone" between the graft and the bone tunnel was prevented in most cases. At short-term follow-up the bicortical tibial fixation proved to be efficient even with an aggressive rehabilitation program.
我们报告了一组前瞻性的101例患者，他们采用一种新的双皮质胫骨固定技术及生物可吸收挤压螺钉，接受了四股半腱肌-股薄肌自体移植进行前交叉韧带重建。患者（平均年龄32岁）于1997年11月至1998年5月接受手术，术后随访至少12个月。评估包括病史、临床检查、IKDC评分、辛辛那提膝关节评分、KT-1000测试、标准化放射学检查及磁共振成像。100例患者可供随访。术后6个月和11个月各有1例创伤性再断裂。根据IKDC评分，87例患者属于A组和B组，12例属于C组，2例再断裂患者属于D组。辛辛那提膝关节评分平均为82分（范围46 - 100分），随访时KT-1000手动最大测试显示两侧平均差值为1.7毫米。所有病例均迅速实现完全伸直，屈曲平均为135度。考虑到生物可吸收挤压螺钉引起的扩大，股骨侧隧道增宽发生率为6.6%，胫骨侧为1.7%。隧道增宽未影响临床结果。3例患者术后6个月以上出现积液。有1例感染，经早期关节镜灌洗及静脉使用抗生素后痊愈，未出现功能障碍。此外未发生其他并发症。所描述的前交叉韧带重建技术将移植物解剖位置的优势与充分的移植物固定相结合。创建了一个短的关节内移植物结构，具有强大的肌腱与骨界面。临床上，87%的患者在随访时IKDC评分为正常或接近正常。磁共振成像显示挤压螺钉的插入导致隧道面积显著增加。另一方面，在大多数情况下可防止移植物与骨隧道之间形成“纤维中间带”。在短期随访中，即使采用积极的康复计划，双皮质胫骨固定也证明是有效的。
