Noyes F R, Barber-Westin S D
Deaconess Hospital, Cincinnati, OH 45219, USA.
J Bone Joint Surg Am. 2001 Aug;83(8):1131-43. doi: 10.2106/00004623-200108000-00001.
A prospective study was done to determine the functional results, patient satisfaction, and graft failure rate after fifty-seven consecutive revision replacements of the anterior cruciate ligament with use of a bone-patellar tendon-bone autogenous graft.
Fifty-four patients (fifty-five operations) were followed in this study. Concurrent operative procedures were performed during the revision procedure in thirty-seven knees (67%). These procedures included repair of a meniscal tear in twenty knees (36%) and reconstruction of deficient posterolateral or medial ligament structures in seventeen knees (31%). Nine knees (16%) had a high tibial osteotomy to correct varus malalignment before the revision operation. The results were evaluated with the Cincinnati Knee Rating System.
There were significant improvements in the scores for pain (p < 0.0001), activities of daily living (p < 0.01), sports participation (p < 0.001), patient satisfaction (p < 0.0001), and overall rating of the knee (p < 0.0001). Thirty-three (60%) of the replaced ligaments were functional, nine (16%) were partially functional, and thirteen (24%) had failed.
Many knees (93%) had compounding problems, including articular cartilage damage, prior meniscectomy, loss of secondary ligament restraints, varus malalignment, and concomitant ligament replacement or meniscal repair. Therefore, the results were generally less favorable than those following primary operations. The rate of graft failure was three times higher than our previously reported failure rate after primary replacements of the anterior cruciate ligament with a bone-patellar tendon-bone autogenous graft. Even so, symptoms and functional limitations with regard to daily and sports activities were found to have decreased and patient satisfaction improved. We advocate correction of varus malalignment prior to anterior cruciate procedures. Associated posterolateral ligament deficiencies should be surgically corrected during anterior cruciate procedures to prevent excessive loading on the graft from abnormal lateral tibiofemoral joint opening. Meniscal tears, including complex tears that extend into the avascular zone, can be concurrently repaired successfully during the revision.
进行了一项前瞻性研究，以确定连续57例使用自体骨-髌腱-骨移植进行前交叉韧带翻修置换术后的功能结果、患者满意度和移植失败率。
本研究对54例患者（55次手术）进行了随访。37例膝关节（67%）在翻修手术期间同时进行了其他手术操作。这些操作包括修复20例膝关节（36%）的半月板撕裂，以及重建17例膝关节（31%）的后外侧或内侧韧带结构缺损。9例膝关节（16%）在翻修手术前进行了高位胫骨截骨术以纠正内翻畸形。结果采用辛辛那提膝关节评分系统进行评估。
疼痛评分（p < 0.0001）、日常生活活动评分（p < 0.01）、运动参与评分（p < 0.001）、患者满意度评分（p < 0.0001）以及膝关节总体评分（p < 0.0001）均有显著改善。33例（60%）置换的韧带功能良好，9例（16%）部分功能良好，13例（24%）失败。
许多膝关节（93%）存在复合问题，包括关节软骨损伤、既往半月板切除术、二级韧带约束丧失、内翻畸形以及同时进行的韧带置换或半月板修复。因此，结果总体上不如初次手术。移植失败率比我们之前报道的使用自体骨-髌腱-骨移植进行前交叉韧带初次置换后的失败率高出三倍。即便如此，发现日常和体育活动的症状及功能受限有所减轻，患者满意度提高。我们主张在前交叉韧带手术前纠正内翻畸形。在前交叉韧带手术期间应通过手术纠正相关的后外侧韧带缺损，以防止异常的胫股外侧关节开口对移植造成过度负荷。半月板撕裂，包括延伸至无血管区的复杂撕裂，在翻修期间可同时成功修复。
